经皮穿肝胆管支架置入术治疗恶性梗阻黄疸发生早期胆道感染的风险及对策

Percutaneous transhepatic biliary stent for malignant obstructive jaundice: risk factors for early biliary tract infection and appropriate strategy

摘要:

目的  研究恶性梗阻黄疸患者接受经皮穿肝胆管支架置入后发生早期胆道感染的危险因素，探讨可行治疗方案。方法  观察128例恶性梗阻黄疸患者行支架置入术后1个月内发生胆道感染情况。应用单因素及多因素分析法针对相关危险因素进行统计学分析。结果  128例患者引流成功率71.1%（91/128），早期胆道感染发生率30.4%（39/128）。年龄、致胆管狭窄类型、梗阻部位、黄疸持续时间、支架位置及术后胆红素下降比为差异具有统计学意义的危险因素，后3者为独立危险因素。支架跨过十二指肠大乳头患者引流成功率高82.5%（47/57），早期胆道感染发生率19.2%（11/57）低于未跨过组38.0%（28/71），差异有统计学意义（χ2=6.053，P =0.014）。结论  经皮穿肝胆管支架置入术针对恶性梗阻黄疸患者减黄效果稳定、操作安全。支架跨过十二指肠大乳头能够迅速减黄从而降低早期胆道感染发生率。

Abstract:

 Objective To investigate the risk factors for biliary tract infection related to percutaneous transhepatic biliary stenting (PTBS) in patients with malignant obstructive jaundice and determine the feasible therapeutic strategy. Methods One hundred and twenty-eight consecutive patients with malignant obstructive jaundice received initial PTBS for bile drainage. A prospective study was conducted on the occurrence of biliary tract infection within 30 days after PTBS. Potential preoperative risk factors, like age, sex, stricture type of biliary tract, obstructive location, duration of jaundice, stent across Oddi, decreased ratio of serum bilirubin, were assessed by univariate and multivariate analyses. Results Successful drainage was achieved in 91 patients (71.1%). Early biliary tract infections were observed in 39 cases (30.4%). By univariate analysis, age, stricture type of biliary tract, obstructive location, duration of jaundice, stent across Oddi and decreased ratio of serum bilirubin were significantly different between biliary tract infection group and non-infection group. Long duration of jaundice, stent across the duodenal papilla and a 30% decrease in serum bilirubin level were independent predictors of early biliary tract infections. Patient with stent across papilla had a successful drainage rate of 82.5% (47/57) and a lower rate of biliary tract infection compared with patients who had a stent above papilla (19.2% vs 38.0% respectively, P = 0.014). Conclusions PTBS is a safe and effective therapeutic intervention for malignant biliary jaundice. Stent across the duodenal papilla makes a fast decline of serum bilirubin level, which is associated with a lower rate of early biliary tract infection.