金属支架不同放置位置在肝门胆管恶性梗阻内镜引流术中应用价值的多中心研究  

Application value of different metal stents placement position in endoscopic drainage of malig-nant hilar bile duct obstruction:a multicenter study

作　　者：夏明星 潘阳林 蔡晓波[3] 胡贤荣 叶馨 吴军 高道键 周东勋 王田田 陈萃 陆蕊 张婷 胡冰 Xia Mingxing;Pan Yanglin;Cai Xiaobo;Hu Xianrong;Ye Xin;Wu Jun;Gao Daojian;Zhou Dongxun;Wang Tiantian;Chen Cui;Lu Rui;Zhang Ting;Hu Bing(Department of Endoscopy,the Third Affiliated Hospital of Naval Medical University,Shanghai 200438,China;Department of Gastroenterology,Xijing Hospital of Air Force Medical University,Xi'an 710032,China;Department of Gastroenterology,the First People's Hospital Affiliated to Shanghai Jiaotong University School of Medicine,Shanghai 200080,China)

机构地区：[1]海军军医大学第三附属医院内镜科,上海200438 [2]空军军医大学西京医院消化内科,西安710032 [3]上海交通大学附属第一人民医院消化内科,上海200080

出　　处：《中华消化外科杂志》2022年第7期901-909,共9页Chinese Journal of Digestive Surgery

基　　金：上海市医学领军人才项目(2015‑83)。

摘　　要：目的探讨金属支架不同放置位置在肝门胆管恶性梗阻内镜引流术中的应用价值。方法采用回顾性队列研究方法。收集2012年1月至2019年1月3家医学中心收治的300例(海军军医大学第三附属医院216例、空军军医大学西京医院48例、上海交通大学附属第一人民医院36例)肝门胆管恶性梗阻患者的临床病理资料;男164例,女136例;年龄为(67±12)岁。所有患者经多学科联合会诊确定为无法手术切除,行内镜逆行胰胆管造影。观察指标:(1)患者临床病理特征。(2)随访情况。(3)影响患者胆管金属支架通畅时间和总生存时间的相关因素分析。采用门诊、电话等方式进行随访,了解患者胆管金属支架通畅情况和生存情况。随访时间截至2019年7月或患者死亡。正态分布的计量资料以x±s表示,组间比较采用独立样本t检验;偏态分布的计量资料以M(Q 1,Q 3)表示,组间比较采用Mann‑Whitney U检验。计数资料以绝对数或百分比表示,组间比较采用χ²检验或Fisher确切概率法。等级资料比较采用秩和检验。采用Kaplan‑Meier法绘制生存曲线并计算生存率,采用Log‑Rank检验进行生存情况分析。单因素和多因素分析采用COX回归模型,将单因素分析中P<0.1的因素纳入多因素分析。结果(1)患者临床病理特征。300例患者中,163例行内镜引流术中≥1根胆管金属支架的远端跨越十二指肠主乳头(以下简称跨越乳头);137例行内镜引流术中没有胆管金属支架的远端跨越十二指肠主乳头(以下简称未跨越乳头)。跨越乳头患者的年龄,疾病类型(肝门部胆管癌、肝细胞癌、肝内胆管细胞癌、胆囊癌、转移性胆管肿瘤),胆管金属支架类型(单侧金属支架、双侧金属支架)分别为(68±13)岁,95、8、11、31、18例,63、100例;未跨越乳头患者上述指标分别为(64±12)岁,63、22、20、23、9例,126、11例;两者上述指标比较,差异均有统计学意义(t=2.7Objective To investigate the application value of different metal stents place-ment position in endoscopic drainage of magnant hilar bile duct obstruction.Methods The retro-spective cohort study was conducted.The clinicopathological data of 300 patients with malignant hilar bile duct obstruction who were admitted to 3 medical centers,including 216 patients in the Third Affiliated Hospital of Naval Medical University,48 patients in the Xijing Hospital of Air Force Medical University,36 patients in the First People's Hospital Affiliated to Shanghai Jiaotong University School of Medicine,from January 2012 to January 2019 were collected.There were 164 males and 136 females,aged(67±12)years.All patients were determined to be unresectable by multidisciplinary consultation and underwent endoscopic retrograde cholangiopancreatography.Observation indicators:(1)clinicopathological features of patients;(2)follow-up;(3)analysis of influencing factors for patency time of metal biliary stents and overall survival time of patients.Follow-up was conducted using outpatient examination and telephone interview to detect patency of metal biliary stents and survival of patients up to July 2019 or death of patients.Measurement data with normal distribution were represented as Mean±SD,and comparison between groups was conducted using the independent sample t test.Measurement data with skewed distribution were represented as M(Q 1,Q 3),and comparison between groupwas conducted using the Mann-Whitney U test.Count data were expressed as absolute numbers or percentages,and comparison between groups was conducted using the chi-square test or Fisher exact probability.Comparison of ordinal data was conducted using the rank sum test.Kaplan-Meier method was used to calculate survival rates and draw survival curves,and Log-Rank test was used to conduct survival analysis.COX regression model was used for univariate and multivariate analyses.Factors with P<0.1 in univariate analysis were included in multivariate analysis.Results(1)Clinicopatholo

关 键 词：肝肿瘤 内镜逆行胰胆管造影 肝门胆管恶性梗阻 金属支架 临床成功率 支架通畅期 总生存时间 并发症 

分 类 号：R657.4[医药卫生—外科学]