Percutaneous transhepatic biliary drainage (PTBD) with or without stenting-complications, re-stent rate and a new risk stratification score
Percutaneous transhepatic biliary drainage (PTBD) with or without stenting-complications, re-stent rate and a new risk stratification score
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DOI：
10.1007/s00330-011-2121-7
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发表时间：
2011-09-01
影响因子：
5.9
通讯作者：
Cast, J. E. I.
中科院分区：
文献类型：
--
作者：
Tapping, C. R.;Byass, O. R.;Cast, J. E. I.
回顾性分析了704例梗阻性黄疸患者行经皮经肝胆管胆道引流术（PTBD）的成功率和并发症数量，并对PTBD和胆道支架术的手术风险进行了分层。回顾性分析了7年内连续704例梗阻性黄疸患者的948例手术：345例男性; 359例女性，平均年龄70.1岁（范围48-96岁）。统计学分析采用χ 2检验和多因素Logistic回归分析，技术成功率为99%。手术相关死亡率为2%，30天死亡率为13%。研究期间插入的91枚（13%）支架闭塞。支架失效和再次支架植入术的预测因素为胆管癌诊断、远端CBD病变、高胆红素、高尿素和高白色细胞计数以及术后胆管炎。回顾性分析与并发症和30天死亡率显著相关的因素以设计风险分层评分。PTBD和支架植入术为胆道梗阻患者提供了安全有效的姑息治疗方法。在PTBD之前，可以使用风险分层评分预测可能具有高发病率和死亡率的患者，强调需要更密切的临床观察和延迟支架置入。
To review the success rate and number of complications in patients with obstructive jaundice treated with percutaneous transhepatic biliary drainage (PTBD), and to stratify the procedural risk of both PTBD and biliary stenting.948 procedures performed in 704 consecutive patients with obstructive jaundice over a 7 year period were reviewed: 345 male; 359 females, mean age 70.1 years (range 48-96 years). Statistical analysis included X (2) test and multivariate logistic regression analysis.The technical success rate was 99%. The mortality related to the procedure was 2% and the 30-day mortality 13%. 91 (13%) stents inserted occluded during the study period. Predictors for stent failure and re-stenting were a diagnosis of cholangiocarcinoma, a lesion in the distal CBD, a high bilirubin, high urea and high white cell count and post procedure cholangitis. Factors significantly related to complications and 30-day mortality were retrospectively reviewed to devise a risk stratification score.PTBD and stenting offer a safe and effective method in providing palliative treatment for patients with biliary obstruction. Patients likely to have high levels of morbidity and mortality can be predicted before PTBD, using a risk stratification score, highlighting the need for closer clinical observation and delayed stent placement.