恶性肿瘤所致梗阻性黄疸PTCD术后短期影响胆红素下降速率相关因素分析  

Analysis of factors associated with short-term effects on rate of bilirubin reduction after percutaneous transhepatic cholangial drainage for malignant obstructive jaundice

作　　者：王健岗 崔云甫[1] 史武江 王浩[1] 高坚钧 盛嘉麟 董青福 邹欣蕾 钟翔宇[1] Wang Jiangang;Cui Yunfu;Shi Wujiang;Wang Hao;Gao Jianjun;Sheng Jialin;Dong Qingfu;Zou Xinlei;Zhong Xiangyu(Department of Hepatobiliary&Pancreatic Surgery,Second Affiliated Hospital,Harbin Medical University,Heilongjiang Harbin 150086,China)

机构地区：[1]哈尔滨医科大学附属第二医院胆胰外科,黑龙江哈尔滨150086

出　　处：《腹部外科》2022年第5期358-362,共5页Journal of Abdominal Surgery

基　　金：湖北陈孝平科技发展基金会项目(CXPJJH1900002-058)。

摘　　要：目的探讨恶性肿瘤所致梗阻性黄疸病人经皮经肝穿刺胆道引流术(percutaneous transhepatic cholangial drainage,PTCD)后影响胆红素下降速率的相关因素。方法回顾性分析哈尔滨医科大学附属第二医院2015年1月至2021年3月收治的117例因恶性肿瘤所致梗阻性黄疸行PTCD病人的术前血常规、生化、病史等临床资料,根据临床观察和实验设想选择相关自变量,分析各自变量与总胆红素下降速率的相关性并建立多重线性回归预测模型。结果117例病人PTCD术后总胆红素均有下降,每日平均下降幅度为(41.8±29.0)μmol/L。单变量分析显示与总胆红素下降速率有关的变量分别为:术前总胆红素(P<0.001)、丙氨酸转氨酶(ALT,P=0.049)、天冬氨酸转氨酶(AST,P=0.003)、Na^(+)(P<0.001)、白蛋白(P=0.033)、Cl^(-)(P=0.002)、中性粒细胞(P=0.024)。多重线性回归结果显示与胆红素下降速率有关的变量为:术前总胆红素[P<0.001,95%CI(0.06,0.13)],ALT[P=0.003,95%CI(0.02,0.09)]。结论恶性肿瘤所致梗阻性黄疸病人胆红素下降速率受多种因素影响,对其机制的研究有助于降低病人围手术期等待时间,降低住院时间及住院费用。Objective To explore the factors associated with rate of bilirubin reduction after percutaneous transhepatic cholangial drainage(PTCD)in patients with malignant obstructive jaundice.Methods Preoperative blood routine,biochemical tests,medical history and clinical data were retrospectively reviewed for 117 patients undergoing PTCD for malignant obstructive jaundice.The relevant independent variables were selected through clinical observations and assays for examining the correlation between each variable and rate of total bilirubin reduction and establishing a multiple linear regression prediction model.Results Total bilirubin declined with a mean daily reduction of(41.8±29.0)μmol/L.Univariate analysis showed that the variables associated with declining rate of total bilirubin were preoperative total bilirubin(P<0.001),alanine aminotransferase(ALT,P=0.049),aspartate amino transaminase(AST,P=0.003),Na^(+)(P<0.001),albumin(P=0.033),Cl^(-)(P=0.002)and neutrophils(P=0.024).Multiple linear regression indicated that the variables associated with declining rate of bilirubin were preoperative total bilirubin(P<0.001,95%CI:0.06-0.13)and ALT(P=0.003,95%CI:0.02-0.09).Conclusion Rate of bilirubin reduction in patients with malignant obstructive jaundice has several influencing factors.Elucidating its mechanism may help reduce perioperative waiting time,shorten length of hospitalization and lower hospital costs.

关 键 词：阻塞性黄疸 经皮经肝穿刺胆道引流术 胆道引流术 

分 类 号：R445.4[医药卫生—影像医学与核医学]