Zhang Guang Yuan, Li Wen Tao, Peng Wei Jun, Li Guo Dong, He Xin Hong, Xu Li Chao
Department of Radiology, Shanghai Cancer Center, Fudan University, Shanghai 200032, P.R. China.
Oncol Lett. 2014 Apr;7(4):1185-1190. doi: 10.3892/ol.2014.1860. Epub 2014 Feb 7.
The present study aimed to investigate the clinical outcomes of percutaneous transhepatic biliary drainage in patients with obstructive jaundice and identify potential predictors of patient survival. Clinical data from 102 patients (66 males and 36 females; median age, 63.50 years; range, 29-84 years) with a mean (± standard deviation) pre-drainage serum bilirubin level of 285.4 (±136.7 μmol/l), were retrospectively studied. Technical and clinical success, complications and survival time were recorded and their relationship with clinical factors, including age, obstruction level, liver metastases, serum bilirubin level and subsequent treatments following drainage, were analyzed by Fisher's exact test. Patient survival rate and other predictors were analyzed by Kaplan-Meier survival curves and Cox's proportional hazard model. The technical and clinical success rates were 100 and 76.5%, respectively. The presence of liver metastases was associated with reduced successful drainage. The overall complication rate was 7.8% and the overall median survival time was 185 days [95% confidence interval (CI), 159-211 days]. A log-rank test showed that age (χ, 4.003; P=0.04), bilirubin levels following procedure (χ, 5.139; P=0.02) and subsequent therapy (χ, 15.459; P=0.00) affected survival time. However, Cox's regression analysis revealed no administration of additional treatments to be a risk factor of survival (odds ratio, 2.323; 95% CI, 1.465-3.685; P=0.000). Percutaneous transhepatic biliary drainage for malignant biliary obstruction was found to be a safe and effective method to relieve jaundice caused by progressive neoplasms. Subsequent radical therapy following drainage, including surgery, chemotherapy and other local treatment types, are likely to increase patient survival.
本研究旨在探讨经皮经肝胆道引流术在梗阻性黄疸患者中的临床疗效，并确定患者生存的潜在预测因素。对102例患者（66例男性和36例女性；中位年龄63.50岁；范围29 - 84岁）的临床资料进行回顾性研究，这些患者引流前血清胆红素水平平均（±标准差）为285.4（±136.7μmol/l）。记录技术成功率、临床成功率、并发症及生存时间，并通过Fisher精确检验分析它们与年龄、梗阻部位、肝转移、血清胆红素水平及引流后后续治疗等临床因素的关系。采用Kaplan-Meier生存曲线和Cox比例风险模型分析患者生存率及其他预测因素。技术成功率和临床成功率分别为100%和76.5%。肝转移的存在与引流成功率降低相关。总并发症发生率为7.8%，总中位生存时间为185天[95%置信区间（CI），159 - 211天]。对数秩检验显示年龄（χ²，4.003；P = 0.04）、术后胆红素水平（χ²，5.139；P = 0.02）和后续治疗（χ²，15.459；P = 0.00）影响生存时间。然而，Cox回归分析显示未进行额外治疗是生存的危险因素（比值比，2.323；95% CI，1.465 - 3.685；P = 0.000）。经皮经肝胆道引流术治疗恶性胆道梗阻是一种安全有效的方法，可缓解进展性肿瘤引起的黄疸。引流后进行包括手术、化疗和其他局部治疗类型在内的后续根治性治疗可能会提高患者生存率。
