姜磊, 都晓英, 孙医学, 张大坤, 周凯, 徐建中, 陈芳芳. PTBS术治疗恶性梗阻性黄疸的临床价值及预后因素分析[J]. 蚌埠医学院学报, 2019, 44(9): 1202-1205, 1209. DOI: 10.13898/j.cnki.issn.1000-2200.2019.09.016
    引用本文: 姜磊, 都晓英, 孙医学, 张大坤, 周凯, 徐建中, 陈芳芳. PTBS术治疗恶性梗阻性黄疸的临床价值及预后因素分析[J]. 蚌埠医学院学报, 2019, 44(9): 1202-1205, 1209. DOI: 10.13898/j.cnki.issn.1000-2200.2019.09.016
    JIANG Lei, DU Xiao-ying, SUN Yi-xue, ZHANG Da-kun, ZHOU Kai, XU Jian-zhong, CHEN Fang-fang. Clinical value and prognostic factors of PTBS in the treatment of malignant obstructive jaundice[J]. Journal of Bengbu Medical College, 2019, 44(9): 1202-1205, 1209. DOI: 10.13898/j.cnki.issn.1000-2200.2019.09.016
    Citation: JIANG Lei, DU Xiao-ying, SUN Yi-xue, ZHANG Da-kun, ZHOU Kai, XU Jian-zhong, CHEN Fang-fang. Clinical value and prognostic factors of PTBS in the treatment of malignant obstructive jaundice[J]. Journal of Bengbu Medical College, 2019, 44(9): 1202-1205, 1209. DOI: 10.13898/j.cnki.issn.1000-2200.2019.09.016

    PTBS术治疗恶性梗阻性黄疸的临床价值及预后因素分析

    Clinical value and prognostic factors of PTBS in the treatment of malignant obstructive jaundice

    • 摘要:
      目的探讨超声引导下经皮肝胆管置管引流联合胆道支架植入(PTBS)术治疗恶性梗阻性黄疸(MOJ)病人的临床价值及预后因素分析。
      方法回顾性分析2014年5月至2018年3月蚌埠医学院第一附属医院普外科接受姑息治疗的MOJ病人,按其治疗方式不同分为经皮肝胆管置管引流(PTCD)组和PTBS组,分析病人肝功能的改善情况、中性粒细胞-淋巴细胞比值(NLR)、血小板-淋巴细胞比值(PLR)、单核细胞-淋巴细胞比值(MLR)变化情况、并发症发生情况及术后生存情况等。Kaplan-Meier曲线及Cox比例风险回归模型分析影响病人术后总体生存时间的相关因素。
      结果共纳入病人69例,其中PTCD组30例,PTBS组39例。2组病人术后1个月ALT、AST、TBil、DBil均较术前显著降低(P < 0.01);与PTCD组相比,PTBS组术后1月NLR、MLR、PLR均较术前显著升高(P < 0.01),PTBS组病人可获得更佳的术后生存(P < 0.05)。2组病人术后并发症发生方面比较差异无统计学意义(P>0.05),Cox多因素回归模型结果表明:术前较高的TBiL、MLR、CA19-9是影响病人预后的独立危险因素,接受PTBS治疗是独立的保护性因素(P < 0.05~P < 0.01)。
      结论与单纯PTCD相比,PTBS法可改善MOJ病人的预后,延长其生存期。术前较高的TBiL、MLR、CA19-9是影响病人预后的独立危险因素。

       

      Abstract:
      ObjectiveTo compare the clinical value and prognostic factors between ultrasound-guided percutaneous transhepatic cholangial drainage(PTCD) and percutaneous transhepatic biliary stent(PTBS) in the treatment of malignant obstructive jaundice(MOJ).
      MethodsThe clinical data of the MOJ patients treated with palliative care in The First Affiliated Hospital of Bengbu Medical College from May 2014 to March 2018 were retrospectively analyzed, and divided into PTCD group and PTBS group according to the different treatment methods.The improvement of liver function, changes of neutrophil-lymphocyteratio(NLR), platelet-lymphocyte ratio(PLR) and monocyte-lymphocyte ratio(MLR), complications and postoperative survival situation were analyzed in two groups.The influencing factors of postoperative overall survival(OS) in two groups were analyzed using Kaplan-Meier curves and Cox proportional hazard model.
      ResultsA total of 69 patients were investigated, which included 30 cases in PTCD group and 39 cases in PTBS group, 36 males and 33 females, and aged(70.7±5.6) years.The levels of ALT, AST, TBil and DBil in two groups after 1 month of operation significantly decreased compared before operation(P < 0.05).Compared with the PTCD group, the levels of DBIL, NLR, MLR and PLR in PTBS group after 1 month of operation significantly decreased(P < 0.01), and the better postoperative survival in the PTBS group was found(P < 0.05).There was no statistical significance in the postoperative complications between two groups(P>0.05).The results of Cox multivariate proportional hazard model showed that the higher preoperative TBiL, MLR and CA19-9 were the independent risk factors of influencing the prognosis of patients, and the PTBS treatment was an independent protective factor.
      ConclusionsCompared with PTCD alone, PTBS can improve the prognosis and prolong the survival time of MOJ patients.Preoperative higher TBiL, MLR, and CA19-9 are the independent risk factors of influencing the prognosis of patients.

       

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