| 程 进,戴静华,万智勇,安 潇,赵儒义.恶性胆道梗阻患者所行经皮穿刺肝内胆管引流术中成功置入金属支架的术前影响因素分析[J].,2018,(21):4035-4040 |
| 恶性胆道梗阻患者所行经皮穿刺肝内胆管引流术中成功置入金属支架的术前影响因素分析 |
| Metal Stent Implantation during Percutaneous Transhepatic Biliary Drainage for Palliative Treatment of Proximal Malignant Biliary Tract Obstruction: a Retrospective Analysis of Pre-procedure Factors |
| 投稿时间：2018-06-25 修订日期：2018-07-20 |
| DOI：10.13241/j.cnki.pmb.2018.21.007 |
| 中文关键词: 近端恶性胆道梗阻 金属支架置入 胆道感染 胰腺癌 胃癌 |
| 英文关键词: Proximal malignant biliary tract obstruction Metal stent implantation Biliary infection Pancreatic cancer Gastric cancer |
| 基金项目:国家自然科学基金青年基金项目(81502648) |
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| 中文摘要: |
| 摘要 目的：探讨恶性胆道梗阻患者行PTBD（Percutaneous Transhepatic Biliary Drainage）术中金属支架置入成功率的影响因素。方法：回顾性搜集2010年10月-2017年1月上海市第一人民医院收治的因患有近端恶性胆道梗阻行PTBD术患者的相关临床资料。比较不同原发病因患者支架置入情况。根据患者支架置入是否成功将其分为支架组和非支架组，比较患者的一般临床特征。结果：胰腺癌、胃癌和胆囊癌为本研究中数量上前3位的肿瘤，将以上3组分别按照支架置入数行x2检验，其中胰腺癌(n=18，支架=6)和胃癌(n=14，支架=11)有统计学意义。将50例患者分为支架组(n=28)和非支架组(n=22)，组间比较差异有统计学意义的因素包括：白细胞计数(支架组=6.40±3.40×109/L，非支架组=10.74±6.41×109/L)，中性粒细胞计数(支架组=4.90±3.06×109/L，非支架组=8.92±6.25×109/L)，胆道感染(支架组=9，非支架组=15)。进一步将该50例患者分为6组：胰腺癌-胆道感染组、胃癌-胆道感染组、其他肿瘤-胆道感染组、胰腺癌+胆道感染组、胃癌+胆道感染组、其他肿瘤+胆道感染组。将以上6组分别按照支架置入数行x2检验，胰腺癌+胆道感染组(n=11，支架=1，P=0.001)有统计学意义。结论：PTBD术对于恶性胆道梗阻是一种有效的姑息治疗手段。胆道感染是PTBD术中支架置入成功的不利因素，胰腺癌合并胆道感染会显著降低PTBD术中支架置入成功率。 |
| 英文摘要: |
| ABSTRACT Objective: To investigate the preprocedure factors of successful stent implantation during percutaneous transhepatic biliary drainage for palliative treatment of proximal malignant biliary tract obstruction. Methods: We retrospectively analyzed preproce- dure factors of 50 patients with proximal malignant biliary tract obstruction receiving percutaneous transhepatic biliary drainage from Oc- tober 2010 to January 2017. We separated the 50 patients by histological diagnosis and successful stent implantation to analyze the signif- icance. Results: Firstly, we separated the 50 patients by histological diagnosis. Pancreatic cancer (n=18), gastric cancer (n=14) and gall- bladder carcinoma (n=7) were the top three quantitatively. We analyzed the three groups each for successful stent implantation by x2 test, and the statistically significant comparisons were pancreatic cancer (stent=6) and gastric cancer (stent=11). Then the 50 patients with low malignant biliary tract obstruction were separated into two groups: stent group (n=28) and non-stent group (n=22). the statistically signifi- cant comparisons of preprocedure factors included leukocyte count, neutrophil count, biliary infection. Based on these results above, fi- nally we separated patients into 6 groups according to the results above: pancreatic cancer- biliary infection (n=7, stent=5), gastric cancer- biliary infection (n=10, stent=7), other malignancy- biliary infection (n=9, stent=7), pancreatic cancer+ biliary infection (n=11, stent=1), gastric cancer+ biliary infection (n=4, stent=4), other malignancy+ biliary infection (n=9, stent=4). We analyzed the 6 groups each for successful stent implantation by x2 test, and the statistically significant comparison was pancreatic cancer+ biliary infection group (P=0.001). Conclusion: Percutaneous transhepatic biliary drainage is an effective treatment for palliation of proximal malignant biliary tract obstruction. During percutaneous transhepatic biliary drainage procedure, biliary infection is bad for stent implantation. Pancreatic cancer combined with biliary infection will deeply reduce the stent implantation rate. |
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