胆道恶性梗阻患者内镜射频消融治疗术后发生并发症的影响因素分析  

Influencing factors of endoscopic radiofrequency ablation complications for malignant biliary obstruction

作　　者：胡雨飞 顾伟刚 金杭斌 楼奇峰 张筱凤 杨建锋 Hu Yufei;Gu Weigang;Jin Hangbin;Lou Qifeng;Zhang Xiaofeng;Yang Jianfeng(The Fourth School of Clinical Medicine,Zhejiang Chinese Medical University,Hangzhou 310006,China;Department of Gastroenterology,Affiliated Hangzhou First People’s Hospital,Zhejiang University School of Medicine,Key Laboratory of Integrated Traditional Chinese and Western Medicine for Biliary and Pancreatic Diseases of Zhejiang Province,Hangzhou 310006,China)

机构地区：[1]浙江中医药大学第四临床医学院,杭州310006 [2]浙江大学医学院附属杭州市第一人民医院消化内科浙江省中西医结合胆胰疾病重点实验室,杭州310006

出　　处：《中华肝胆外科杂志》2022年第11期838-842,共5页Chinese Journal of Hepatobiliary Surgery

基　　金：浙江省医药卫生科技计划项目(2021ZH003、2021441076);杭州市科技发展计划项目(202004A14);杭州市医学重点学科(OO20190001)。

摘　　要：目的:分析内镜射频消融治疗胆道恶性梗阻患者术后发生并发症的影响因素。方法:回顾分析2010年1月至2021年6月在浙江大学医学院附属杭州市第一人民医院消化内科接受内镜射频消融治疗的110例胆道恶性梗阻患者资料,其中男性62例,女性48例,年龄(74.1±11.1)岁。依据术后是否发生并发症分为并发症组(n=18)和对照组(n=92)。单因素和多因素logistic回归分析并发症影响因素。结果:110例胆道恶性梗阻患者均顺利完成射频消融,技术成功率为100.0%(110/110)。术后发生并发症18例(16.4%),其中胆道感染12例(急性胆管炎8例,急性胆囊炎4例),急性胰腺炎6例,均经治疗后治愈。并发症组合并糖尿病、胆管狭窄长度>2.5 cm、分段射频消融狭窄胆管、置入单根支架比例均高于对照组,差异均有统计学意义(均P<0.05)。多因素logistic回归分析,合并糖尿病(OR=6.967,95%CI:1.256~38.658)、分段射频消融狭窄胆管(OR=8.297,95%CI:1.526~45.122)的胆道恶性梗阻患者内镜射频消融术后发生并发症的风险增加,置入多根支架(OR=0.037,95%CI:0.008~0.169)术后并发症风险降低(均P<0.05)。结论:合并糖尿病、分段射频消融狭窄胆管是胆道恶性梗阻射频消融术后发生并发症的危险因素,置入多根支架是保护因素,临床上应对存在危险因素的患者予以重视。Objective To study the influencing factors of postoperative complications in patients with malignant biliary obstruction treated by endoscopic radiofrequency ablation(RFA).Methods Data of patients with malignant biliary obstruction who underwent endoscopic RFA at the Department of Gastroenterology,Affiliated Hangzhou First People's Hospital,Zhejiang University School of Medicine from January 2010 to June 2021 were retrospectively analyzed.There were 62 males and 48 females,with age(74.1±11.1)years.Based on occurrence of postoperative complications,these patients were divided into the complication group(n=18)and the control group(n=92).Univariate and multivariate logistic regression analysis were used to analysis the influencing factors of complications.Results RFA was successfully performed in 110 patients with malignant biliary obstruction,and the technical success rate was 100.0%(110/110).Postoperative complications occurred in 18 patients(16.4%),including 12 patients with of biliary tract infection(8 patients with acute cholangitis,4 patients with acute cholecystitis)and 6 patients with acute pancreatitis.All these patients responded well to treatment.The proportion of patients who developed complications having associated diabetes,bile duct stenosis length>2.5 cm,fractional RFA for bile duct stenosis,and single stent drainage were significantly higher than those in the control group(all P<0.05).Multivariate logistic regression analysis showed that the risk of complications after endoscopic RFA was significantly increased in patients with diabetes(OR=6.967,95%CI:1.256-38.658)and fractional RFA of bile duct stenosis(OR=8.297,95%CI:1.526-45.122),while the risk of complications after multiple stents drainage(OR=0.037,95%CI:0.008-0.169)was significantly decreased(all P<0.05).Conclusion Diabetes and fractional RFA of bile duct stenosis were risk factors for complications after endoscopic RFA of malignant biliary obstruction.Multiple stents drainage was a protective factor.Better clinical attention should be paid t

关 键 词：胆道疾病 消融技术 危险因素 手术后并发症 

分 类 号：R657.4[医药卫生—外科学]