梗阻性黄疸PTCD出血并发症的危险因素
Risk factors of bleeding complications in patients with obstructive jaundice after percutaneous transhepatic cholangial drainage
叶子鸣 1许敏 1王黎洲 1周石 1李兴1
作者信息
- 1. 550004 贵州贵阳 贵州医科大附属医院
- 折叠
摘要
目的 探讨梗阻性黄疸患者经皮肝穿刺胆道置管引流术(percutaneous transhepatic cholangial drainage,PTCD)出血并发症相关的影响因素.方法 收集贵州医科大学附属医院、中南大学湘雅二医院、贵州医科大学附属肿瘤医院2015年1月至2021年1月,接受PTCD资料完整的1 042例梗阻性黄疸患者的临床资料,并对PTCD出血并发症相关的危险因素进行回顾性分析.结果 引流管成襻位置对PTCD出血并发症有影响,差异有统计学意义(P＜0.01),与总胆管成襻位置相比,左右肝管成襻术后出血风险增加155.6％(OR=2.556,95％CI:1.251～5.225),左右肝管下一级分支成襻术后出血增加414.4％(OR=5.144,95％CI:2.618～10.106).穿刺成功后引流方式选择差异有统计学意义(P＜0.05),与外引流方式相比,内外共同引流方式增加术后出血风险159.1％(OR=2.591,95％CI:1.102～6.091).术前血小板计数与术前总胆红素水平为PTCD出血并发症的独立危险因素(P＜0.05);术前血小板计数每增加1个单位,术后出血并发症的发生的概率减少0.2％(OR=0.998,95％CI:0.995～1.000),且术前血小板计数＜228×109/L时,对术后出血产生影响;术前总胆红素每增加1个单位,术后出血并发症的发生概率增加0.3％(OR=1.003,95％CI:1.001～1.004),且术前总胆红素＞264.4 μmol/L时,对术后出血产生影响.结论 PTCD引流管成襻位置及引流方式是PTCD出血并发症的独立危险因素,成襻位置越靠近三级分支,出血风险越大;内外引流方式的出血风险高于外引流方式.术前总胆红素、术前血小板计数是PTCD出血并发症的独立危险因素;术前总胆红素水平与出血风险呈正相关;术前血小板计数水平与出血风险呈负相关.
Abstract
Objective To investigate the influencing factors associated with bleeding complications in patients with obstructive jaundice treated with percutaneous transhepatic cholangial drainage(PTCD).Methods Clinical data of 1 042 patients with obstructive jaundice,who received PTCD at the Affiliated Hospital of Guizhou Medical University,the Xiangya Second Hospital of Central South University,and the Affiliated Cancer Hospital of Guizhou Medical University of China between January 2015 and January 2021,were collected.The risk factors related to PTCD bleeding complications were retrospective analyzed.Results The location where the drainage tube forming loop had a statistically significant effect on PTCD bleeding complications(P＜0.01).Compared with the loop-forming within the common bile duct,the loop-forming within the left and right hepatic duct would increase the risk of postoperative bleeding by 155.6％(OR=2.556,95％CI:1.251-5.225),the loop-forming within the lower order branch of the left and right hepatic duct would increase the risk of postoperative bleeding by 414.4％(OR=5.144,95％CI:2.618-10.106).The difference in the risk degree of postoperative bleeding between different drainage ways after successful puncturing was statistically significant(P＜0.05).Compared with the external drainage method,internal-external joint drainage method would increase the risk degree of postoperative bleeding by 159.1％(OR=2.591,95％CI:1.102-6.091).Preoperative platelet count and preoperative total bilirubin level were the independent risk factors for bleeding complications of PTCD(P＜0.05).For each unit increase in preoperative platelet count,the probability of developing postoperative bleeding complications would decrease by 0.2％(OR=0.998,95％CI:0.995-1.000),and a preoperative platelet count level＜228 ×109/L would have an impact on the postoperative bleeding.For each unit increase in preoperative total bilirubin,the probability of developing postoperative bleeding complications would increase by 0.3％(OR=1.003,95％CI:1.001-1.004),and a preoperative total bilirubin＞264.4 μmol/L would have an impact on the postoperative bleeding.Conclusion The loop-forming location of draining tube and the drainage method are the independent risk factors for PTCD bleeding complications.The closer the loop-forming location to the tertiary branches is,the greater the risk of bleeding would be.The bleeding risk of internal-external joint drainage method is higher than that of external drainage method.The preoperative total bilirubin and preoperative platelet count are the independent risk factors for bleeding complications of PTCD.The preoperative total bilirubin level is positively correlated with bleeding risk,while the preoperative platelet count level is negatively correlated with the bleeding risk.(J Intervent Radiol,2024,33:500-506)
关键词
经皮肝穿刺胆道置管引流术/梗阻性黄疸/胆道出血/并发症/危险因素Key words
percutaneous transhepatic cholangial drainage/obstructive jaundice/biliary tract hemorrhage/complication/risk factor引用本文复制引用
出版年
2024
NETL
NSTL
万方数据