胆管炎对经皮经肝胆道引流术治疗恶性胆道梗阻患者生存的影响。

Impact of cholangitis on survival of patients with malignant biliary obstruction treated with percutaneous transhepatic biliary drainage.

机构信息

Department of Surgery and Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.

Department of Oncology, Oulu University Hospital, Oulu, Finland.

出版信息

BMC Gastroenterol. 2023 Mar 27;23(1):91. doi: 10.1186/s12876-023-02704-8.

DOI:10.1186/s12876-023-02704-8

PMID:36973653

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10041795/

Abstract

PURPOSE

To evaluate the impact of cholangitis on survival of patients with gastrointestinal cancer and malignant biliary obstruction treated with percutaneous transhepatic biliary drainage (PTBD).

METHODS

A retrospective registry study was performed at a tertiary center from 2000 to 2016 in Northern Finland.

RESULTS

The study included 588 patients, 258 (43.9%) patients with pancreatic cancer, 222 (37.7%) with biliary tract cancer, and 108 (18.4%) with metastasis from gastrointestinal cancers. Patient mean age was 70 years, range 26 - 93 years. There were 288 [49.0%] women. The 30-day mortality rate was 30.8% for 156 patients with cholangitis before PTBD, 19.5% for 215 patients with cholangitis after PTBD and 25.8% for 217 patients without cholangitis (P = 0.039). The median survival was 1.8 months for patients with cholangitis before PTBD, 3.0 months for patients with cholangitis after PTBD, and 3.2 months for patients without cholangitis (P = 0.002). The hazard ratio (HR) for 1-year mortality for patients with cholangitis before PTBD was 1.3 (95% CI 1.06 - 1.67, P = 0.015) compared to patients with cholangitis after PTBD. After successful PTBD, 54 out of 291 patients received chemotherapy; the median survival was 5.2 months with cholangitis before PTBD, 9.4 months with cholangitis after PTBD and 15.3 months without cholangitis.

CONCLUSION

In gastrointestinal cancers with malignant biliary obstruction, survival is poorer if cholangitis occurs before PTBD compared to cholangitis after PTBD. An oncologist's consultation is essential for assessing the possibility of chemotherapy in successfully treated PTBD patients, because of the notable survival benefit.

摘要

目的

评估胆管炎对接受经皮经肝胆管引流术（PTBD）治疗的胃肠道癌和恶性胆道梗阻患者生存的影响。

方法

本研究是在芬兰北部的一家三级中心进行的一项回顾性注册研究，时间为 2000 年至 2016 年。

结果

研究纳入了 588 例患者，其中 258 例（43.9%）为胰腺癌患者，222 例（37.7%）为胆道癌患者，108 例（18.4%）为胃肠道癌转移患者。患者平均年龄为 70 岁，范围为 26-93 岁，其中 288 例（49.0%）为女性。PTBD 前胆管炎的 30 天死亡率为 156 例（30.8%），PTBD 后胆管炎为 215 例（19.5%），无胆管炎为 217 例（25.8%）（P=0.039）。PTBD 前胆管炎患者的中位生存时间为 1.8 个月，PTBD 后胆管炎患者为 3.0 个月，无胆管炎患者为 3.2 个月（P=0.002）。PTBD 前胆管炎患者的 1 年死亡率的危险比（HR）为 1.3（95%CI 1.06-1.67，P=0.015），高于 PTBD 后胆管炎患者。在成功的 PTBD 后，291 例患者中有 54 例接受了化疗；PTBD 前胆管炎患者的中位生存时间为 5.2 个月，PTBD 后胆管炎患者为 9.4 个月，无胆管炎患者为 15.3 个月。