肝门部恶性胆道梗阻患者行内镜逆行胰胆管造影术塑料支架置入术后短期再梗阻的危险因素分析

Risk factors for short-term re-obstruction following ERCP plastic stent placement in patients with hilar malignant biliary obstruction

摘要:

目的 分析肝门部恶性胆道梗阻患者行内镜逆行胰胆管造影术（ERCP）塑料支架置入术后短期再梗阻的危险因素。方法 回顾性分析2015年1月－2024年1月该院因肝门部恶性胆道梗阻行ERCP塑料支架引流的93例患者的临床资料，了解患者一般资料、临床特征、手术相关因素和实验室相关指标对术后短期再梗阻的影响。以术后短期是否再发胆道支架梗阻为因变量，采用单因素分析和多因素Logistic回归分析影响肝门部恶性胆道梗阻患者行ERCP塑料支架置入术后短期再梗阻的独立危险因素。结果 49例术后短期再发胆道梗阻，复发率为52.7%。单因素分析结果显示，性别、胆道恶性狭窄的类型、术前发生胆管炎、术前未引流、术中行内镜十二指肠乳头括约肌切开术（EST）、支架放置的位置、术后24 h内发热、术后2周总胆红素（TBiL）下降 < 50%、γ-谷氨酰转移酶（GGT）下降 < 50%、GGT和碱性磷酸酶（ALP）下降 < 50%是影响肝门部恶性胆道梗阻患者行ERCP塑料支架置入术后短期再梗阻的潜在危险因素（P < 0.05）。多因素Logistic回归分析结果显示，术前未引流（OR＾ = 5.738，P = 0.013）、术前发生胆管炎（OR＾ = 5.347，P = 0.025）和左、右单侧放置支架（OR＾ = 6.739，P = 0.014；OR＾ = 9.719，P = 0.005）是肝门部恶性胆道梗阻患者行ERCP塑料支架置入术后短期再梗阻的独立危险因素。结论 术前未引流、术前发生胆管炎和左、右单侧放置支架是导致肝门部恶性胆道梗阻患者行ERCP塑料支架置入术后短期再梗阻的独立危险因素。在临床中，早期识别危险人群，并对危险因素及时干预，对预防此类患者行ERCP塑料支架置入术后短期再梗阻有重要意义。

Abstract:

Objective To analyze the risk factors of short-term re-obstruction after plastic stent placement by endoscopic retrograde cholangiopancreatography (ERCP) in patients with hilar malignant biliary obstruction.Methods A retrospective study was performed on clinical data of 93 patients with hilar malignant biliary obstruction who underwent ERCP biliary plastic stent placement from January 2015 to January 2024. Understanding the effects of general information, clinical characteristics, operative-related factors, and laboratory-related indicators on postoperative short-term re-obstruction. The dependent variable was whether biliary stent re-obstruction in short-term after operation, univariate and multivariate Logistic regression analysis were used to analyze the risk factors for the patients with hilar malignant biliary obstruction occurred re-obstruction in short-term after ERCP plastic stent placement.Results Among the 93 patients, 49 patients had short-term recurrent biliary stent obstruction after plastic stent placement by ERCP and the recurrence rate was 52.7%. Univariate analysis showed that gender, types of malignant biliary strictures, preoperative cholangitis, no drainage before operation and endoscopic sphincterotomy (EST) during ERCP plastic stent placement, location of stent placement, fever within 24 h after ERCP plastic stent placement, the decrease less than 50% of total bilirubin (TBiL) at 2 weeks after operation, the decrease less than < 50% of γ-glutamyl transpeptidase (GGT) at 2 weeks after operation, GGT and alkaline phosphatase (ALP) by less than 50% at 2 weeks after operation were potential risk factors affecting for short-term re-obstruction after ERCP plastic stent placement in patients with hilar malignant biliary obstruction. Multivariate analysis showed that, no drainage before operation (OR＾ = 5.738, P = 0.013), preoperative cholangitis (OR＾ = 5.347, P = 0.025) and place stents on the left or on the right （OR＾ = 6.739，P = 0.014；OR＾ = 9.719，P = 0.005）were independent risk factors for short-term re-obstruction after ERCP plastic stent placement.Conclusion No drainage before operation, preoperative cholangitis, place stents on the left or on the right are independent risk factors for short-term re-obstruction after ERCP plastic stent placement in patients with hilar malignant biliary obstruction.Early identification of risk groups and timely intervention of risk factors in clinical practice are of great significance for the prevention of short-term re-obstruction after ERCP plastic stent placement in such patients.