中国实用外科杂志

中国实用外科杂志

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经内镜逆行胆管引流治疗梗阻性黄疸影响因素分析

杨泽煌，邵子力，宋笑冬，明思远，苏泽隆，陈俊勇   

  1. 广州医科大学附属第二医院肝胆外科，广东广州510260
  • 发布日期:2020-07-23

  • Published:2020-07-23

摘要： 目的    探讨经内镜逆行胰胆管造影（ERCP）+鼻胆管引流术（ENBD）和（或）胆道内支架植入术（ERBD）治疗梗阻性黄疸的影响因素。方法    回顾性分析2016年1月至2018年12月广州医科大学附属第二医院收治的成功施行ERCP+ENBD和（或）ERBD治疗的379例梗阻性黄疸病例资料。共实施ERCP 435例次，其中术后退黄不理想为74例次（17.0%）。结果    单因素分析结果显示，恶性肿瘤（χ2=24.502，P=0.000）、重度黄疸（χ2=6.738，P=0.009），合并乙肝肝硬化（χ2=18.010，P=0.000）、自身免疫性肝病（χ2=5.484，P=0.019）、合并肝吸虫病（χ2=4.788，P=0.029）、引流方式（χ2=9.685，P=0.021）、黄疸病程时间较长≥2周（χ2=26.103， P=0.000）、术后胆道感染（χ2=10.463，P=0.001）是影响ERCP术后退黄效果的因素。多因素分析结果显示，恶性肿瘤（OR=3.675，P=0.000）、乙肝肝硬化（OR=3.685，P=0.001）、自身免疫性肝病（OR=12.308，P=0.004）、肝吸虫病（OR=6.591，P=0.000）、黄疸持续时间≥2周（OR=2.620，P=0.001）及术后胆道感染（OR=5.865，P=0.016） 是ERCP术后黄疸下降不理想的独立影响因素。 随访2个月，大部分病例经过针对性治疗后黄疸症状改善明显。 结论    恶性肿瘤、乙肝肝硬化、自身免疫性肝病、合并有肝吸虫病、黄疸病程时间较长（≥2周）和术后胆道感染是ERCP治疗梗阻性黄疸病人术后退黄不理想的独立影响因素。

关键词: 梗阻性黄疸, 内镜逆行胰胆管造影, 多因素分析

Abstract: Analysis of influence factors for obstructive jaundice after ERCP        YANG Ze-huang，SHAO Zi-li，SONG Xiao-dong，et al. Department of Hepatobiliary Surgery, Affiliated No.2 Hospital of Guangzhou Medical University，Guangzhou 510260，China
Corresponding author：SONG Xiao-dong，E-mail：ky_drsong@163.com
Abstract    Objective    To investigate the influence factors of obstructive jaundice after endoscopic retrograde cholangiopancreatography (ERCP) combined with endoscopic nasobiliary drainage (ENBD) and (or) endoscopic retrogradebiliary drainage (ERBD). Methods    The clinical data of 379 patients who were diagnosed with obstructive jaundice，and underwent ERCP combined with ENBD and (or) ERBD in Affiliated NO.2 Hospital of Guangzhou Medical University  from January 2016 to December 2018 were analyzed retrospectively. A total of 435 cases ERCP were performed，and there were 74 cases (17%) presented unsatisfactory relief condition of obstructive jaundice after ERCP. Results    Univariate analysis showed that malignant obstruction（χ2=24.502, P=0.000），severe jaundice （χ2=6.738，P=0.009），hepatitis B induced cirrhosis（χ2=18.010，P=0.000），autoimmune liver disease （χ2=5.484，P=0.019），infections with liver fluke（χ2=4.788，P=0.029），biliary drainage way（χ2=9.685，P=0.021），long course of jaundice disease（χ2=26.103，P=0.000）and postoperative biliary infection（χ2=10.463，P=0.001）may be the influence factors for unsatisfactory relief condition of jaundice after ERCP. Multivariate analysis showed that malignant obstruction (OR=3.675，P=0.000)，hepatitis B induced cirrhosis (OR=3.685，P=0.001)，autoimmune liver disease (OR=12.308，P=0.004)，infections with liver fluke (OR=6.591，P=0.000)，long course of jaundice disease (OR=2.620，P=0.001) and postoperative biliary infection (OR=5.865，P=0.016) were independent risk factors for unsatisfactory relief condiction of jaundice after ERCP. Most of obstructive jaundice cases showed notable relieving effect through the appropriate therapy during followed up for 2 months. Conclusion    Malignant relevant obstructive jaundice，hepatitis B induced cirrhosis，autoimmune liver disease，infections with liver fluke，long course of jaundice disease，postoperative biliary infection are the independent risk factors for unsatisfactory relief condition of obstructive jaundice after ERCP.

Key words: obstructive jaundice, ERCP, multivariate analysis