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作 者:颜鹏 倪牧含 沈永华[1] 孟睿 王雷[1] Peng Yan;Muhan Ni;Yonghua Shen;Rui Meng;Lei Wang(Department of Gastroenterology,Nanjing Drum Tower Hospital,The Affiliated Hospital of Nanjing University Medical School,Nanjing 210008,China)
机构地区:[1]南京大学医学院附属鼓楼医院消化科,南京210008
出 处:《中华消化内镜杂志》2023年第5期379-384,共6页Chinese Journal of Digestive Endoscopy
基 金:江苏省卫生健康委员会医学科研面上项目(M20200034)。
摘 要:目的比较超声内镜引导下肝胃吻合术(endoscopic ultrasound-guided hepaticogastrostomy,EUS-HGS)治疗梗阻性黄疸患者不同部位胆道梗阻的安全性与有效性。方法回顾性分析2016年1月—2021年6月在南京鼓楼医院收治的82例胆道梗阻患者的临床资料。患者均接受EUS-HGS治疗,根据胆道梗阻位置分为肝门部胆道梗阻组(30例)和远端胆道梗阻组(52例)。使用Logistic回归进行单因素分析与多因素分析调整协变量,比较两组技术成功率、临床成功率、不良反应发生率、住院时间和费用。结果肝门部胆道梗阻组和远端胆道梗阻组的技术成功率分别为93.3%(28/30)和94.2%(49/52),两组技术成功率差异无统计学意义(P=0.870,OR=1.17,95%CI:0.18~7.41)。肝门部胆道梗阻组和远端胆道梗阻组的临床成功率分别为83.3%(25/30)和88.5%(46/52),两组临床成功率差异无统计学意义(P=0.514,OR=1.53,95%CI:0.43~5.53)。肝门部胆道梗阻术后不良反应发生率为10.0%(3/30),其中胆管炎3.3%(1/30),胆漏6.7%(2/30),胆汁性腹膜炎6.7%(2/30);而远端胆道梗阻患者不良反应发生率为17.3%(9/52),其中胆管炎9.6%(5/52),胆漏7.7%(4/52),胆汁性腹膜炎5.8%(3/52)。两组在不良事件发生率上差异均无统计学意义(P>0.05)。结论EUS-HGS治疗肝门部胆道梗阻与远端胆道梗阻的安全性和有效性均无显著差异。Objective To compare the safety and efficacy of endoscopic ultrasound-guided hepaticogastrostomy(EUS-HGS)for the treatment of biliary obstruction at different locations.Methods From January 2016 to June 2021 data of 82 patients with obstructive jaundice treated with EUS-HGS in Nanjing Drum Tower Hospital were reviewed in this retrospective cohort study.According to the location of biliary obstruction,patients were divided into hilar biliary obstruction group(n=30)and distal biliary obstruction group(n=52).Univariate and multivariate logistic regression analyses were conducted adjusting covariates to compare the technical success rate,the clinical success rate,the adverse reaction incidence,hospital stay and cost of the two groups.Results The technical success rates were 93.3%(28/30)and 94.2%(49/52)in the hilar biliary obstruction group and the distal biliary obstruction group with no significant difference between the two groups(P=0.870,OR=1.17,95%CI:0.18-7.41).The clinical success rates were 83.3%(25/30)and 88.5%(46/52)in the hilar biliary obstruction group and the distal biliary obstruction group with no significant difference between the two groups(P=0.514,OR=1.53,95%CI:0.43-5.53).The incidence of adverse events in hilar biliary obstruction group was 10.0%(3/30),including cholangitis 3.3%(1/30),biliary fistula 6.7%(2/30),biliary peritonitis 6.7%(2/30).The incidence of adverse events in patients with distal biliary obstruction was 17.3%(9/52),including cholangitis 9.6%(5/52),biliary fistula 7.7%(4/52)and biliary peritonitis 5.8%(3/52).There was no significant difference in the incidence of adverse events between the two groups(P>0.05).Conclusion There is no significant difference in safety or efficacy of EUS-HGS for hilar biliary obstruction and distal biliary obstruction.
关 键 词:胆道 超声内镜引导下肝胃吻合术 梗阻 安全性 有效性
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