恶性肝门部胆管梗阻术前内镜下胆道引流功能障碍的危险因素。

Risk factors for dysfunction of preoperative endoscopic biliary drainage for malignant hilar biliary obstruction.

作者信息

Sugiura Ryo, Kuwatani Masaki, Kato Shin, Kawakubo Kazumichi, Kamachi Hirofumi, Taketomi Akinobu, Noji Takehiro, Okamura Keisuke, Hirano Satoshi, Sakamoto Naoya

机构信息

Department of Gastroenterology and Hepatology, Faculty of Medicine, Graduate School of Medicine, Hokkaido University, Sapporo, Japan.

Division of Endoscopy, Hokkaido University Hospital, Sapporo, Japan.

出版信息

J Hepatobiliary Pancreat Sci. 2020 Nov;27(11):851-859. doi: 10.1002/jhbp.778. Epub 2020 Jul 6.

DOI:10.1002/jhbp.778

PMID:32506844

Abstract

BACKGROUND

Few studies have focused on the risk factors for dysfunction of endoscopic biliary drainage (EBD) in preoperative patients with malignant hilar biliary obstruction (MHBO).

METHODS

We searched the database between February 2011 and December 2018 and identified patients with MHBO who underwent radical operation. The rate of dysfunction of the initial EBD, risk factors for dysfunction of the initial EBD and survival after surgery were retrospectively evaluated.

RESULTS

We analyzed a total of 131 patients [95 males (72.5%); mean age, 69.5 (±7.3) years; Bismuth-Corlette classification (BC) I/II/IIIa/IIIb/IV, 50/26/22/17/16; hilar cholangiocarcinoma/gall bladder cancer, 115/16]. Dysfunction of the initial EBD occurred in 28 patients (21.4%). The cumulative incidences of dysfunction of the initial EBD in all patients were 18.4%, 38.2% and 47.0% at 30, 60 and 90 days, respectively (Kaplan-Meier method). The rate of dysfunction of the initial EBD increased in patients with BC-IV (P = .03). Multivariate analysis showed that BC-IV and pre-EBD cholangitis were significantly associated with the occurrence of dysfunction of the initial EBD. Survival rates were not significantly different according to the initial biliary drainage methods and presence/absence of the initial EBD dysfunction.

CONCLUSIONS

Dysfunction of the initial EBD frequently occurs in patients with the BC-IV and those with pre-EBD cholangitis.

摘要

背景

很少有研究关注术前恶性肝门部胆管梗阻（MHBO）患者内镜下胆管引流（EBD）功能障碍的危险因素。

方法

我们检索了2011年2月至2018年12月期间的数据库，确定了接受根治性手术的MHBO患者。对初始EBD功能障碍的发生率、初始EBD功能障碍的危险因素及术后生存率进行回顾性评估。

结果

我们共分析了131例患者[95例男性（72.5%）；平均年龄69.5（±7.3）岁；Bismuth-Corlette分类（BC）I/II/IIIa/IIIb/IV，分别为50/26/22/17/16例；肝门部胆管癌/胆囊癌，分别为115/16例]。28例患者（21.4%）出现初始EBD功能障碍。所有患者初始EBD功能障碍的累积发生率在30、60和90天时分别为18.4%、38.2%和47.0%（Kaplan-Meier法）。BC-IV期患者初始EBD功能障碍发生率增加（P = 0.03）。多因素分析显示，BC-IV期和EBD术前胆管炎与初始EBD功能障碍的发生显著相关。根据初始胆管引流方法及初始EBD功能障碍的有无，生存率无显著差异。