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经皮肝穿刺胆道支架置放术治疗恶性梗阻性黄疸的疗效及影响因素
胡颖,陈君辉,任毅
0
(成都市第二人民医院介入科)
摘要:
目的 探讨经皮肝穿刺胆道支架置放术治疗恶性梗阻性黄疸的疗效及影响因素。方法 选取2015年5月~2017年5月我院收治的426例恶性梗阻性黄疸患者为研究对象,回顾性分析所有患者的临床及随访资料,并比较治疗前后相关临床指标的变化及不同临床治疗效果患者的相关资料差异。结果 426例恶性梗阻性黄疸患者经皮肝穿刺胆道支架置放术治疗后,临床治疗有效率为76.06%;所有患者治疗后其直接、间接以及总胆红素水平均较治疗前显著下降(均P<0.05);经非条件单因素Logistic回归模型分析,术前KPS评分<50分、术后出现并发症、术前肝功能分级为ChildPugh C级以及术前总胆红素水平超过300umol/L的患者治疗后,其有效率均显著较低(P<0.05);经非条件多因素Logistic回归进一步分析,术前KPS评分<50分、术后出现并发症、术前肝功能分级为Child=Pugh C级以及术前总胆红素水平超过300umol/L均为患者治疗后临床治疗欠佳的独立危险因素(P<0.05)。结论 经皮肝穿刺胆道支架置入术治疗恶性梗阻性黄疸具有较好的临床效果,但术前KPS评分<50分、术后出现并发症、术前肝功能分级为Child-Pugh C级以及术前总胆红素水平超过300umol/L均为导致其临床疗效欠佳的独立危险因素,因此,临床上可根据上述指标水平对其治疗效果进行评估并及时采取干预措施。
关键词:  经皮肝穿刺胆道支架置放术  恶性梗阻性黄疸  临床疗效  影响因素
DOI:
基金项目:四川省卫生和计划生育委员会科研课题(150010)
Therapeutic effect and influencing factors of percutaneous transhepatic biliary stent placement for malignant obstructive jaundice
HU Ying,CHEN Junhui,REN Yi
(Department of Intervention Therapy, The Second People's Hospital of Chengdu)
Abstract:
Objective To explore the therapeutic effect and influencing factors of percutaneous transhepatic biliary stent placement for malignant obstructive jaundice. Methods 426 patients with malignant obstructive jaundice admitted to our hospital from May 2015 to May 2017 were enrolled. The clinical and followup data of all patients were analyzed by retrospective analysis. All patients were treated with percutaneous transhepatic biliary stent placement after complete examination and preparation. The general clinical data such as gender and age and diseaserelated conditions of all patients were recorded. Changes in clinical indicators before and after treatment in all patients and the differences in the above data among patients with different clinical treatment effects were compared. The factors affecting the efficacy of percutaneous transhepatic biliary stent placement in the treatment of patients with malignant obstructive jaundice were analyzed. Results According to the clinical data, 426 cases of malignant obstructive jaundice were treated with percutaneous transhepatic biliary stent placement. The clinical effect was significant in 324 cases, poor in 102 cases, and the clinical effective rate was 76.06%. The direct, indirect and total bilirubin levels of all patients with malignant obstructive jaundice after treatment with percutaneous transhepatic biliary stent placement were significantly lower than those before treatment (P<0.05). Analysis by unconditional single factor logistic regression model, the clinical effective rates of patients with malignant obstructive jaundice with preoperative KPS score less than 50, postoperative complications, preoperative liver function grade was Child-Pugh C grade and preoperative total bilirubin level over 300umol were significantly lower (P<0.05). Further analysis by unconditional multivariate logistic regression showed that, the preoperative KPS score less than 50, postoperative complications, preoperative liver function grade was Child-Pugh C grade, and preoperative total bilirubin level over 300umol/ L were independent risk factors for poor clinical treatment after percutaneous transhepatic biliary stent placement in patients with malignant obstructive jaundice (P<0.05). Conclusion Percutaneous transhepatic biliary stenting for the treatment of malignant obstructive jaundice can significantly reduce the bilirubin level and has a good clinical effect. The preoperative KPS score less than 50 points, postoperative complications, preoperative liver function grade, and preoperative total bilirubin level over 300umol/ L are independent risk factors for poor clinical outcomes.
Key words:  Percutaneous transhepatic biliary stent placement  Malignant obstructive jaundice  Clinical efficacy  Influencing factors

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