恶性胆道梗阻行胆道支架植入术后危重并发症及其危险因素研究 [中文引用][英文引用]

 【摘要】  目的  探讨恶性胆道梗阻患者行胆道支架置入术后出现危重并发症的情况，分析其危险因素。方法 回顾性分析2015年1月至2019年8月浙江大学医学院附属邵逸夫医院行经皮经肝胆道支架置入术的恶性胆道梗阻患者77例，2016年8月至2021年9月浙江大学医学院附属第二医院行内镜胆道支架置入术的恶性胆道梗阻患者69例。依据术后1个月之内是否出现危重并发症分成危重并发症组和非危重并发症组。将患者因素和手术因素纳入分析（连续变量采用t检验，分类变量采用χ2检验，二元Logistic多因素分析得出独立危险因素）。结果  146例（危重并发症组18例，非危重并发症组128例）患者入组，单因素分析显示：置入支架类型(P=0.013)、置入125I粒子数量(P=0.007)、手术操作时间(P=0.000)、术中并发胆道出血(P=0.000)、术后并发胆道出血(P=0.000)、术后支架通畅时间(P=0.000)、并存胆道结石(P=0.003)、术前黄疸时间(P=0.000)、术前胆道梗阻长度(P=0.000)与胆道支架置入术后危重并发症相关。单纯125I粒子支架组手术操作时间(P=0.011)、术前胆道梗阻长度(P=0.002)与术后危重并发症呈正相关。二元Logistic多因素分析得出术前黄疸时间(OR=1.059，P=0.033)、术前胆道梗阻长度(OR=3.595，P=0.007)是术后出现危重并发症的独立危险因素。结论 经皮经肝胆道支架置入术和内镜胆道支架置入术的术后危重并发症发生率无显著差异；术前黄疸时间、胆道梗阻长度是胆道支架置入术后危重并发症的独立危险因素。胆道125I粒子支架较裸支架术后危重并发症发生率增高，置入125I粒子数量与危重并发症发生率无显著差异。

 【Abstract】  Objective  To investigate the critical complications in patients with malignant biliary obstruction after biliary stent implantation and analyze the risk factors. Methods  A total of 77 patients with malignant biliary obstruction undergoing percutaneous transhepatic biliary stent implantation at Sir Run Run Shaw Hospital of Zhejiang University School of Medicine from January 2015 to August 2019 and 69 patients with malignant biliary obstruction undergoing endoscopic biliary stent implantation in the Second Affiliated Hospital of Zhejiang University School of Medicine from August 2016 to September 2021 were retrospectively analyzed. They were divided into critical complications groups and non-critical complications groups according to whether critical complications occurred within 1 month after surgery. Patient factors and surgical factors were included in the analysis (t test for continuous variables, χ2 test for categorical variables and independent risk factors from binary Logistic multivariate analysis). Results  A total of 146 patients (18 patients in the critical complication group, 128 patients in the non-critical complication group) were enrolled. Univariate analysis showed that implanted stent type (P=0.013), number of implanted 125I particles (P=0.007), operation time (P=0.000), intraoperative biliary hemorrhage (P=0.000), postoperative biliary hemorrhage (P=0.000), postoperative stent patency time (P=0.000), coexisting biliary stones (P=0.003), preoperative jaundice time (P=0.000), and preoperative biliary obstruction length (P=0.000) were related to critical complications after biliary stent implantation. Operation time of 125I seed simple stent group (P=0.011) and the length of preoperative biliary obstruction (P=0.002) were positively correlated with postoperative critical complications. The binary Logistic multivariate analysis concluded that preoperative jaundice time (OR=1.059, P=0.033) and preoperative biliary obstruction length (OR=3.595, P=0.007) were independent risk factors for postoperative critical complications. Conclusion  There is no significant difference in the incidence of critical complications between percutaneous transhepatic biliary stent implantation and endoscopic biliary stent implantation. Preoperative jaundice time and length of biliary obstruction are independent risk factors for critical complications after biliary stenting. The incidence of critical complications after biliary 125I seed stent is higher than that after bare stenting, and there was no significant correlation between the number of implanted 125I particles and the incidence of critical complications.