Analysis Of High Risk Factors For Post-PTCD Drainage Catheter Obstruction

Objective: To study the high risk factors of obstruction of drainage catheter in patients with obstructive jaundice after treatment of percutaneous transhepatic cholangial drainage(PTCD),which provides guidance for prevention and treatment of post-PTCD drainage catheter obstruction.Methods: 112 patients who received PTCD treatment,in the department of Interventional Radiology of the Affiliated Hospital of Zunyi Medical College from September 2015 to May 2017 was seen for follow-up 6 months,collect complete clinical data,and the data were analyzed retrospectively.During the follow-up period,the patients after PTCD were divided into two groups: bile drainage patency group and bile drainage obstruction group.The age,sex,cause of obstruction,site of obstruction,history of biliary surgery,preoperative jaundice time,liver function index(AST、ALT、ALP、GGT),liver function score,whether or not PTCD combined with biliary stent implantation,puncture catheter drainage path(left or right hepatic duct),whether or not biliary tract infection,the decrease degree of total bilirubin(TBIL)one week post-PTCD and the daily average flow rate of bile were observed in the two groups.The software SPSS 17.0 was used for Single factor analysis,and the results with statistical significance were selected into multivariate Logistic regression analysis.Results: Among 112 cases underwent PTCD,52 cases obstruction of drainage catheter occurred during the follow-up period,the incidence rate was 46.42%(52/112).Their drainage catheter patency time was 8~177d,average of 148.82 d.Analysis of single factor: cause of obstruction(χ~2=16.180,P < 0.001),site of obstruction(χ~2=4.951,P=0.026),whether or not PTCD combined with biliary stent implantation(χ~2=4.891,P=0.027),puncture catheter drainage path(χ~2=12.391,P<0.001),whether or not biliary tract infection(χ~2=5.635,P=0.018),the decrease degree of TBIL one week post-PTCD(t=3.033,P=0.003)and the daily average flow rate of bile(Z=-2.095,P=0.036),the difference between the two groups was statistically significant(P<0.05).But age,sex,history of biliary surgery,preoperative jaundice time,liver function index(AST、ALT、ALP、GGT),liver function score and so on factor,there were no statistical difference between the two groups(P>0.05).Putting the related factors into the multiple logistic regression analysis,which showed that biliary calculi(OR=8.744,P<0.001),high biliary tract obstruction(OR=4.579,P=0.020),right hepatic duct puncture catheter drainage path(OR=3.183,P=0.035),biliary tract infection(OR=7.101,P=0.005)were the independent high risk factors for post-PTCD drainage catheter obstruction.PTCD combined with biliary stent implantation(B=-1.444,OR=0.236,P=0.020),the decrease degree of TBIL one week post-PTCD(B=-0.011,OR=0.989,P=0.017)were protective factor for maintaining the patency of drainage catheter.Conclusion: The post-PTCD drainage catheter obstruction was easily caused by biliary calculi,high biliary tract obstruction,right hepatic duct puncture catheter drainage path,biliary tract infection.PTCD combined with biliary stent implantation is beneficial to prolonging the patency time of the drainage catheter.The decrease degree of TBIL one week post-PTCD can be used as a prognostic index for the drainage effect of PTCD.