经皮经肝胆管引流术治疗恶性梗阻性黄疸疗效的影响因素分析  

Analysis of influencing factors on the efficacy of percutaneous transhepatic cholangial drainage for malignant obstructive jaundice

作　　者：夏振威 万旭英 孙保木 Xia Zhenwei;Wan Xuying;Sun Baomu(Department of Integrated Traditional Chinese and Western Medicine,Third Affiliated Hospital,Naval Medical University,Shanghai 201805,China)

机构地区：[1]海军军医大学第三附属医院中西医结合科,上海201805

出　　处：《海军医学杂志》2021年第6期732-735,共4页Journal of Navy Medicine

基　　金：上海市卫生局课题(20114179);上海市卫生和计划生育委员会中医药科研课题(2018JQ002);上海市嘉定区卫生健康委员会中医药科研课题(2020⁃KY⁃ZYY⁃01)。

摘　　要：目的研究经皮经肝胆管引流(percutaneous transhepatic cholangial drainage,PTCD)术治疗恶性梗阻性黄疸疗效的相关影响因素。方法回顾性分析2018年8月至2020年8月经PTCD治疗的126例恶性梗阻性黄疸住院患者临床资料,选择性别、年龄、梗阻时间、梗阻部位、术前总胆红素水平、是否合并胆道感染、术后是否有并发症、中医辨证分型作为研究参数,参照胆红素水平下降程度将疗效分为显著(70例)和欠佳(56例),应用χ^(2)进行单因素分析,并进行多因素非条件Logistic分析。结果单因素分析显示,梗阻时间、梗阻部位、术前总胆红素水平、Child⁃Pugh评分、胆道感染及中医辨证分型差异有统计学意义(P<0.05);多因素分析显示,影响术后效果的因素分别为中医辨证分型(P=0.001)、术前总胆红素水平(P=0.021)、胆道感染(P=0.032)及Child⁃Pugh评分(P=0.048)。结论PTCD术治疗恶性梗阻性黄疸安全有效。其中中医辨证分型、术前总胆红素水平、胆道感染及Child⁃Pugh评分与恶性梗阻性黄疸PTCD术后效果关系密切,应积极进行相应的术前评估和干预。Objective To study influencing factors on the efficacy of percutaneous transhepatic cholangial drainage(PTCD)for malignant obstructive jaundice.Methods 126 patients with malignant obstructive jaundice treated with PTCD in the hospital from August 2018 to August 2020 were retrospectively analyzed.Gender,age,obstruction location,obstruction time,total bilirubin level be⁃fore surgery,rates of biliary tract infection and complication after surgery,and TCM syndrome differentiation were chosen as research parameters.According to the degree of serum bilirubin decline,the patients were divided into the significant type(70 cases)and the poor type(56 cases).Single factor analysis was made by usingχ^(2) test and multi⁃factor non⁃conditional logistic regression analysis was also made in the study.Results Single variate analysis showed that obstruction time,obstruction location,preoperative total bilirubin level,Child⁃Pugh score,biliary tract infection and TCM syndrome analysis were statistically significant(P<0.05).Multivariate analy⁃sis indicated that the factors affecting postoperative therapeutic effects were:the TCM syndrome differentiation(P=0.001),the preop⁃erative total bilirubin level(P=0.021),biliary tract infection(P=0.032)and Child⁃Pugh score(P=0.048).Conclusion PTCD is safe and effective in treatment of malignant obstructive jaundice.TCM syndrome differentiation,preoperative total bilirubin level,bil⁃iary tract infection and Child⁃Pugh score are closely related to therapeutic efficacy of malignant obstructive jaundice after PTCD.Corresponding preoperative evaluation and intervention measures should be taken to achieve better treatment results.

关 键 词：恶性梗阻性黄疸 经皮经肝胆管引流术 影响因素 

分 类 号：R735[医药卫生—肿瘤]