胰腺癌梗阻性黄疸患者经皮穿刺胆管引流术后胰腺炎危险因素分析  

Risk factors of pancreatitis after percutaneous transhepatic biliary drainage in patients with pancreatic cancer and obstructive jaundice

作　　者：李梅 王海松 王成丽 张磊 杨雪玲 徐彦 高炜 郭志 于海鹏 Li Mei;Wang Haisong;Wang Chengli;Zhang Lei;Yang Xueling;Xu Yan;Gao Wei;Guo Zhi;Yu Haipeng(Tianjin Medical University Cancer Institute and Hospital,National Clinical Reserch Center for Cancer,Key Laboratory of Cancer Prevention and Therapy,Tianjin,Tianjin′s Clinical Research Center for Cancer,Tianjin 300000,China;The Affiliated Hospital of Hebei University,Experimental Center of Hebei University Hospital,Baoding 071000,China)

机构地区：[1]天津医科大学肿瘤医院介入治疗肿瘤科,国家肿瘤临床医学研究中心,天津市“肿瘤防治”重点实验室,天津市恶性肿瘤临床医学研究中心,天津300000 [2]河北大学附属医院,河北大学附属医院实验中心,保定市071000

出　　处：《中华内科杂志》2022年第1期82-85,共4页Chinese Journal of Internal Medicine

基　　金：中国健康促进基金会肿瘤介入科研基金(XM-2018-011-0006-01);北京癌症防治学会癌症预防与诊治科研基金(IZ学研字2021-1001);中国医药卫生事业发展基金;天津医科大学肿瘤医院(药理自发2021-02)。

摘　　要：目的探讨胰腺癌梗阻性黄疸患者经皮穿刺胆管引流术(PTBD)后发生胰腺炎的危险因素及预防策略。方法回顾性收集2001年5月至2014年10月天津医科大学肿瘤医院胰腺癌梗阻性黄疸行PTBD治疗患者。共241例纳入研究,其中男性192例、女性49例,年龄30~89岁,中位年龄61岁。分析患者性别、年龄、血红蛋白、总胆红素水平、胰管扩张程度、胰腺萎缩程度、术中器械通过梗阻段难易程度、胰管是否显影及引流方式等9项因素与PTBD术后并发胰腺炎的相关性。结果单因素分析结果显示胰管扩张、胰腺萎缩、胰管显影、引流方式与PTBD术后胰腺炎发生率有关(P<0.05)。logistic回归分析结果显示胰管显影(OR=6.33)为发生胰腺炎的危险因素,胰管扩张(OR=0.14)、胰腺萎缩(OR=0.12)、外引流(OR=0.11)为发生胰腺炎的保护因素。结论胰腺癌梗阻性黄疸行PTBD治疗,术前影像提示胰管扩张、胰腺萎缩术后并发胰腺炎的概率相对较低,而术中胰管显影、选择内外引流可能在一定程度上增加术后胰腺炎的发生率。Objective To explore the risk factors and preventive strategies of pancreatitis after percutaneous transhepatic biliary drainage(PTBD)in patients with pancreatic cancer and obstructive jaundice.Methods A total of 241 patients were retrospectively analyzed from May 2001 to October 2014 in Tianjin Medical University Cancer Institute and Hospital.The possibly correlated 9 factors were analyzed,including gender,age,hemoglobin level,total bilirubin level,degree of pancreatic duct dilatation,degree of pancreatic atrophy,degree of biliary stenosis,the pancreatic duct visualization,and drainage mode.Results Univariate analysis suggested that pancreatic duct dilatation,pancreatic atrophy,visualized pancreatic duct and drainage mode were associated with the incidence of pancreatitis after PTBD(P<0.05).Logistic regression analysis showed that visualization of pancreatic duct(OR=6.33)was a risk factor for pancreatitis,while pancreatic duct dilatation(OR=0.14),pancreatic atrophy(OR=0.12)and external drainage(OR=0.11)were protective factors for pancreatitis.Conclusion In pateints with pancreatic cancer and obstructive jaundice,pancreatic duct dilatation and pancreatic atrophy predict low risk of pancreatitis after PTBD,while intraoperative pancreatic duct visualization and internal or external drainage may increase the incidence of postoperative pancreatitis.

关 键 词：胰腺肿瘤 黄疸 阻塞性 胰腺炎 引流术 

分 类 号：R735.9[医药卫生—肿瘤] R576[医药卫生—临床医学]