The outcomes of biliary drainage by percutaneous transhepatic cholangiography for the palliation of malignant biliary obstruction in England between 2001 and 2014: a retrospective cohort study
The outcomes of biliary drainage by percutaneous transhepatic cholangiography for the palliation of malignant biliary obstruction in England between 2001 and 2014: a retrospective cohort study
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DOI：
10.1136/bmjopen-2019-033576
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发表时间：
2020-01-01
期刊：
影响因子：
2.9
通讯作者：
Trudgill, Nigel
中科院分区：
文献类型：
--
作者：
Rees, James;Mytton, Jemma;Trudgill, Nigel
梗阻性黄疸在不能手术的胰胆癌患者中得到缓解，可提高生活质量并允许化疗。经皮经肝胆道造影伴引流和/或支架植入可减轻黄疸，但可能与显著的发病率和死亡率相关。因此，在一项国家队列研究中，对恶性胆道梗阻的经皮经肝胆道引流（PTBD）进行了检查，以确定不良预后的危险因素。方法回顾性研究2001年至2014年间英国接受PTBD治疗的胰胆道癌成年患者。使用多变量logistic回归分析来检查与死亡率和2个月内重复PTBD的必要性的关系。结果共纳入16822例患者，中位年龄72岁（19 ~ 104岁），男性50.3%。58%的胰腺癌和30%的胆道癌。住院和30天死亡率分别为15.3% （95% CI 14.7% ~ 15.9%）和23.1%（22.4% ~ 23.8%）。20.2%的患者在3个月内出现编码并发症。与30天死亡率相关的因素：年龄(>= 81岁OR 2.68 (95% CI 2.37 ~ 3.03), p
IntroductionRelieving obstructive jaundice in inoperable pancreato-biliary cancers improves quality of life and permits chemotherapy. Percutaneous transhepatic cholangiography with drainage and/or stenting relieves jaundice but can be associated with significant morbidity and mortality. Percutaneous transhepatic biliary drainage (PTBD) in malignant biliary obstruction was therefore examined in a national cohort to establish risk factors for poor outcomes.MethodsRetrospective study of adult patients undergoing PTBD for palliation of pancreato-biliary cancer in England between 2001 and 2014 identified from Hospital Episode Statistics. Multivariate logistic regression analysis was used to examine associations with mortality and the need for a repeat PTBD within 2 months.Results16 822 patients analysed (median age 72 (range 19-104) years, 50.3% men). 58% pancreatic and 30% biliary tract cancer. In-hospital and 30-day mortality were 15.3% (95% CI 14.7% to 15.9%) and 23.1% (22.4%-23.8%), respectively. 20.2% suffered a coded complication within 3 months. Factors associated with 30-day mortality: age (>= 81 years OR 2.68 (95% CI 2.37 to 3.03), p