目的 研究恶性梗阻性黄疸患者经皮肝穿胆道引流术(PTBD)后与胆道感染相关的独立危险因素.方法 因恶性梗阻性黄疸第1次行PTBD引流术,术前白细胞计数不高、无发热、不存在术前胆道感染的连续患者154例纳入研究.根据术后30 d内胆道感染发生的情况将患者分为胆道感染组和非感染组,应用单因素和多因素分析对术前20个潜在的与PTBD术后胆道感染相关的危险因素,如年龄、性别、糖尿病、肝功能分级、引流方式、是否存在未引流胆管、经内镜逆行胰胆管造影术(ERCP)或胆肠吻合手术史等进行分析.20个潜在的危险因素先行单因素分析,连续变量的比较应用Student t检验,分类变量应用x2检验；将单因素分析筛选出的可能危险因素再进行多因素Logistic分析.结果 154例患者中55例发生术后胆道感染(35.7％),即胆道感染组；99例术后未发生胆道感染,即非胆道感染组.胆道感染相关的病死率为2.6％ (4/154).154例患者中131例行术中胆汁细菌培养,胆道感染组45例,26例为阳性；非感染组86例,17例为阳性,两组差异有统计学意义(x2=19.357,P＜0.01).单因素分析显示20个潜在危险因素中,糖尿病(x2=10.470,P＜0.01)、肝功能分级(x2=36.324,P＜0.01)、存在未能引流胆管(x2=9.540,P＜0.01)、内外引流(x2=9.856,P＜0.01)、ERCP或胆肠吻合史(x2=14.196,P＜0.01)、肿瘤患者的生活质量评分(t=-3.288,P＜0.01)、Karnofsky功能状态评分(t=-2.099,P＜0.05)、丙氨酸转氨酶(t=-2.112,P＜0.05)、凝血时间(t=-3.648,P＜0.01)、血白蛋白含量(t=-2.071,P＜0.05)、白细胞计数(t=2.022,P＜0.05)、高位胆道梗阻(x2 =6.190,P＜0.05)、肝硬化病史(x2=5.439,P＜0.05)13个因素为具有统计学意义的危险因素；对这13个因素继续行多因素分析显示糖尿病(OR=5.093,P＜0.01)、肝功能分级(OR=13.412,P＜0.01)、存在未能引流胆管(OR=3.348,P＜0.05)、内外引流(OR=3.168,P＜0.05)、ERCP或胆肠吻合病史(OR=8.330,P＜0.01)为具有统计学意义的危险因素.其中糖尿病、肝功能分级、ERCP或胆肠吻合手术史为3个相关的患者因素,内外引流和存在未能引流胆管为2个与手术相关的因素.结论 PTBD是一种有效且安全的恶性梗阻性黄疸患者的姑息治疗方法.术前采取更积极的措施,如控制血糖、改善肝功能、改变引流方式、充分引流等,能够降低PTBD术后胆道感染的发生率.
目的 研究噁性梗阻性黃疸患者經皮肝穿膽道引流術(PTBD)後與膽道感染相關的獨立危險因素.方法 因噁性梗阻性黃疸第1次行PTBD引流術,術前白細胞計數不高、無髮熱、不存在術前膽道感染的連續患者154例納入研究.根據術後30 d內膽道感染髮生的情況將患者分為膽道感染組和非感染組,應用單因素和多因素分析對術前20箇潛在的與PTBD術後膽道感染相關的危險因素,如年齡、性彆、糖尿病、肝功能分級、引流方式、是否存在未引流膽管、經內鏡逆行胰膽管造影術(ERCP)或膽腸吻閤手術史等進行分析.20箇潛在的危險因素先行單因素分析,連續變量的比較應用Student t檢驗,分類變量應用x2檢驗；將單因素分析篩選齣的可能危險因素再進行多因素Logistic分析.結果 154例患者中55例髮生術後膽道感染(35.7％),即膽道感染組；99例術後未髮生膽道感染,即非膽道感染組.膽道感染相關的病死率為2.6％ (4/154).154例患者中131例行術中膽汁細菌培養,膽道感染組45例,26例為暘性；非感染組86例,17例為暘性,兩組差異有統計學意義(x2=19.357,P＜0.01).單因素分析顯示20箇潛在危險因素中,糖尿病(x2=10.470,P＜0.01)、肝功能分級(x2=36.324,P＜0.01)、存在未能引流膽管(x2=9.540,P＜0.01)、內外引流(x2=9.856,P＜0.01)、ERCP或膽腸吻閤史(x2=14.196,P＜0.01)、腫瘤患者的生活質量評分(t=-3.288,P＜0.01)、Karnofsky功能狀態評分(t=-2.099,P＜0.05)、丙氨痠轉氨酶(t=-2.112,P＜0.05)、凝血時間(t=-3.648,P＜0.01)、血白蛋白含量(t=-2.071,P＜0.05)、白細胞計數(t=2.022,P＜0.05)、高位膽道梗阻(x2 =6.190,P＜0.05)、肝硬化病史(x2=5.439,P＜0.05)13箇因素為具有統計學意義的危險因素；對這13箇因素繼續行多因素分析顯示糖尿病(OR=5.093,P＜0.01)、肝功能分級(OR=13.412,P＜0.01)、存在未能引流膽管(OR=3.348,P＜0.05)、內外引流(OR=3.168,P＜0.05)、ERCP或膽腸吻閤病史(OR=8.330,P＜0.01)為具有統計學意義的危險因素.其中糖尿病、肝功能分級、ERCP或膽腸吻閤手術史為3箇相關的患者因素,內外引流和存在未能引流膽管為2箇與手術相關的因素.結論 PTBD是一種有效且安全的噁性梗阻性黃疸患者的姑息治療方法.術前採取更積極的措施,如控製血糖、改善肝功能、改變引流方式、充分引流等,能夠降低PTBD術後膽道感染的髮生率.
목적 연구악성경조성황달환자경피간천담도인류술(PTBD)후여담도감염상관적독립위험인소.방법 인악성경조성황달제1차행PTBD인류술,술전백세포계수불고、무발열、불존재술전담도감염적련속환자154례납입연구.근거술후30 d내담도감염발생적정황장환자분위담도감염조화비감염조,응용단인소화다인소분석대술전20개잠재적여PTBD술후담도감염상관적위험인소,여년령、성별、당뇨병、간공능분급、인류방식、시부존재미인류담관、경내경역행이담관조영술(ERCP)혹담장문합수술사등진행분석.20개잠재적위험인소선행단인소분석,련속변량적비교응용Student t검험,분류변량응용x2검험；장단인소분석사선출적가능위험인소재진행다인소Logistic분석.결과 154례환자중55례발생술후담도감염(35.7％),즉담도감염조；99례술후미발생담도감염,즉비담도감염조.담도감염상관적병사솔위2.6％ (4/154).154례환자중131례행술중담즙세균배양,담도감염조45례,26례위양성；비감염조86례,17례위양성,량조차이유통계학의의(x2=19.357,P＜0.01).단인소분석현시20개잠재위험인소중,당뇨병(x2=10.470,P＜0.01)、간공능분급(x2=36.324,P＜0.01)、존재미능인류담관(x2=9.540,P＜0.01)、내외인류(x2=9.856,P＜0.01)、ERCP혹담장문합사(x2=14.196,P＜0.01)、종류환자적생활질량평분(t=-3.288,P＜0.01)、Karnofsky공능상태평분(t=-2.099,P＜0.05)、병안산전안매(t=-2.112,P＜0.05)、응혈시간(t=-3.648,P＜0.01)、혈백단백함량(t=-2.071,P＜0.05)、백세포계수(t=2.022,P＜0.05)、고위담도경조(x2 =6.190,P＜0.05)、간경화병사(x2=5.439,P＜0.05)13개인소위구유통계학의의적위험인소；대저13개인소계속행다인소분석현시당뇨병(OR=5.093,P＜0.01)、간공능분급(OR=13.412,P＜0.01)、존재미능인류담관(OR=3.348,P＜0.05)、내외인류(OR=3.168,P＜0.05)、ERCP혹담장문합병사(OR=8.330,P＜0.01)위구유통계학의의적위험인소.기중당뇨병、간공능분급、ERCP혹담장문합수술사위3개상관적환자인소,내외인류화존재미능인류담관위2개여수술상관적인소.결론 PTBD시일충유효차안전적악성경조성황달환자적고식치료방법.술전채취경적겁적조시,여공제혈당、개선간공능、개변인류방식、충분인류등,능구강저PTBD술후담도감염적발생솔.
Objective To investigate the risk factors for percutaneous transhepatic biliary drainage (PTBD) related cholangitis in patients with malignant obstructive jaundice.Methods One hundred and fifty-four consecutive patients with malignant obstructive jaundice and without leukocytosis,fever and other manifestations of biliary tract infection received initial PTBD drainage.They were enrolled in this study.An uncontrolled prospective study was conducted of cholangitis occurrence within 30 days after PTBD.Twenty potential preoperative risk factors were assessed by univariate and multivariate analysis.Results Fifty-five patients (55/154,35.7％ ) developed PTBD-related cholangitis,which composed of cholangitis group.Other patients composed of non-cholangitis group (99/154).The cholangitis-related mortality rate was 2.6％ (4/154).Intraoperative bile culture were performed for 131 patients (131/154),including 45 in cholangitis group and 86 in non-cholangitis group.Positive result occurred in 26 patients (26/45) in cholangitis group and 17 patients (17/86) in non-cholangitis group.There was statistical significant difference between these two groups ( x2 =19.357,P ＜ 0.01 ).By univariate analysis,diabetes ( x2 =10.470,P ＜ 0.01 ),Child-Pugh C grade ( x2 =36.324,P ＜ 0.01 ),undrained biliary duct ( x2 =9.540,P ＜0.01 ),external-internal drainage ( x2 =9.856,P ＜ 0.01 ),history of ERCP or cholangiojejunostomy (x2 =14.196,P＜0.01),QOL (t =-3.288,P ＜0.01),KPS(t =-2.099,P＜0.05),ALT (t =-2.112,P＜0.05),PT (t =-3.648,P ＜0.01),albumin (t =-2.071,P ＜0.05),WBC (t =2.022,P ＜ 0.05 ),proximal obstruction ( x2 =6.190,P ＜ 0.05 ) and cirrhosis ( x2 =5.439,P ＜ 0.05 )were significantly different between cholangitis group and non-cholangitis group.By multivariate analysis,diabetes ( OR =5.093,P ＜0.01 ),Child-Pugh C grade ( OR =13.412,P ＜0.01 ),undrained biliary duct ( OR =3.348,P ＜ 0.05 ),external-internal drainage ( OR =3.168,P ＜ 0.05 ) and history of ERCP or cholangiojejunostomy (OR =8.330,P ＜ 0.01 ) remained significant difference.Conclusions PTBD is an effective and safe palliative treatment for patients with malignant obstructive jaundice.Sufficient preoperative preparation and effective control of risk factors may reduce the incidence of cholangitis after PTCD.
