Hernández Guerrero Angélica, Sánchez del Monte Julio, Sobrino Cossío Sergio, Alonso Lárraga Octavio, Delgado de la Cruz Lourdes, Frías Mendívil M Mauricio, Frías Mendívil C Mauricio
Servicio de Endoscopia del Instituto Nacional de Cancerología, Universidad Nacional Autónoma de México.
Rev Gastroenterol Mex. 2006 Jan-Mar;71(1):22-30.
To determine the factors prognostics of early mortality in the malignant billary estenosis after the endoscopic derivation.
The surgical, percutaneous or endoscopic derivation is the alternative of palliative treatment in the biliary obstruction unresectable. The factors prognostic the early mortality after surgical derivation are: hemoglobin < 10 g/dL, serum bilirubin > 10 mg/dL and serum albumin < 2.5 g/dL; for the percutaneous derivation they are the sanguineous urea more of 4.3 mmol/L and hemoglobin < 10.9 g/dL; whereas in the single endoscopic derivation type 3 of Bismuth and the infectious complications after the endoscopic colangiography and the absence of the clinical success were factors prognoses of early mortality.
Descriptive and retrospective analysis of 97 cases with malignant biliary obstruction. The factors were evaluated prognoses of early mortality. Univariated and bivaried analysis and of survival by the method of Kaplan-Meier was made curved.
97 cases were included that presented/displayed unresectable disease and had a biochemical control subsequent to the drainage. They were 58 women and 39 men. More frequent symptoms: ictericia, pain and prurito. 61 cases of distal obstruction and 36 with proximal obstruction. Twenty deaths (25.9%) happened within the 30 later days to the treatment. The bilirubin > 14 mg/dL and the proximal location were like predicting of early mortality.
The obstruction biliary more frequent is located in choledocho distal and is of pancreatic origin. The main factors associated to early mortality are: the bilirubin > of 14 mg/dL and the proximal location reason why is important the suitable selection of patient candidates to endoscopic derivation. The survival is better in the distal obstruction.
确定内镜引流术后恶性胆管狭窄早期死亡的预后因素。
手术、经皮或内镜引流是不可切除性胆道梗阻姑息治疗的替代方法。手术引流后早期死亡的预后因素为：血红蛋白<10 g/dL、血清胆红素>10 mg/dL和血清白蛋白<2.5 g/dL；经皮引流的预后因素为血尿素>4.3 mmol/L和血红蛋白<10.9 g/dL；而在单纯内镜引流中，Bismuth 3型、内镜胆管造影后的感染并发症以及临床未成功是早期死亡的预后因素。
对97例恶性胆道梗阻患者进行描述性和回顾性分析。评估早期死亡的预后因素。采用单因素和双因素分析，并通过Kaplan-Meier方法绘制生存曲线。
纳入97例呈现不可切除疾病且引流后有生化指标控制的患者。其中女性58例，男性39例。常见症状：黄疸、疼痛和瘙痒。61例为远端梗阻，36例为近端梗阻。20例（25.9%）在治疗后30天内死亡。胆红素>14 mg/dL和近端梗阻部位提示早期死亡。
胆道梗阻最常见于胆总管远端，起源于胰腺。与早期死亡相关的主要因素为：胆红素>14 mg/dL和近端梗阻部位，因此，合适选择内镜引流的患者很重要。远端梗阻患者的生存率更高。
