Clinical effect of percutaneous transhepatic cholangial drainage combined with biliary stent implantation in treatment of high malignant obstructive jaundice and the influencing factors for prognosis

• Main Author: CHEN Weiwei
• Format: Article
• Language: zho
• Published: Editorial Department of Journal of Clinical Hepatology 2019-03-01
• Series: Linchuang Gandanbing Zazhi
• Online Access: http://www.lcgdbzz.org/qk_content.asp?id=9782

ObjectiveTo investigate the clinical effect of percutaneous transhepatic cholangial drainage (PTCD) combined with biliary stent implantation in the treatment of high malignant obstructive jaundice (MOJ) and the risk factors for survival time. MethodsA retrospective analysis was performed for the clinical data of 92 patients with high MOJ who were admitted to Department of Hepatobiliary Surgery in Air Force General Hospital, PLA, from June 2015 to June 2017. The t-test was used for comparison of normally distributed continuous data between two groups; an analysis of variance was used for comparison between multiple groups, and the SNK-q test was used for further comparison between two groups. The Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups. The chi-square test was used for comparison of categorical data between groups. The receiver operating characteristic (ROC) curve was used to determine the optimal cut-off values of influencing factors for survival time; the patients were divided into groups according to the optimal cut-off values, and the Kaplan-Meier method was used for survival analysis. The multivariate Cox proportional hazards model was used to identify the independent influencing factors for survival time. ResultsAll patients were followed up for a median time of 6 months (range 1-10 months). A total of 56 patients died and 36 survived during follow-up, with a median survival time of 6 months, a survival rate of 39.1% at the end of follow-up, and a half-year survival rate of 44.6%. Of all 92 patients, 14 experienced postoperative complications, resulting in an incidence rate of complications of 15.2%. At 3 days and 1 week after surgery, there were significant reductions in total bilirubin (TBil), direct bilirubin, alanine aminotransferase (ALT), and aspartate aminotransferase (F=206.264, 106.161, 86.332, and 166.857, all P＜0.05). The ROC Curve was used to analyze the data, TBil had a sensitivity of 95.12% and a specificity of 46.15% at the optimal cut-off value of 112.9 μmol/L; ALT had a sensitivity of 92.68% and a specificity of 31.58% at the optimal cut-off value of 210 U/L; albumin had a sensitivity of 68.29% and a specificity of 58.33% at the optimal cut-off value of 35.7 g/L; red blood cell count had a sensitivity of 60.98% and a specificity of 69.23% at the optimal cut-off value of 3.56×1012/L. Child-Pugh class, TBil, and ALT showed a significant difference in predicting overall survival (all P＜0.05). The multivariate Cox proportional hazards model showed that Child-Pugh class C was an independent influencing factor for survival time after PTCD combined with biliary stent implantation. ConclusionPTCD combined with biliary stent implantation has a good clinical effect in the treatment of patients with MOJ, but preoperative liver function has a great impact on survival time. Therefore, liver function should be observed dynamically to guide clinical treatment, in order to prolong the survival time of such patients.