| Objective:To discuss the complications associated with high malignant biliary obstruction caused by the primary diseases and interventional operation,and the influence of p rognostic factors will be analyzed, the study is designed to reduce the occurrenceof complications, as well as comprehensive assess prognosis and guide clinical decisi on-making basis.Methods:Collect the patients’ data in the Interventional Department of Second Hospital o f Shanxi Medical University during August 2009- December 2014, which with hig hmalignant biliary obstruction by pathology and(or) imaging diagnosis, consummat e relevant preoperative examinations.Eligible patients without contraindications will have anoperation: percutaneous biliary drainage and(or) stenting guided by DSA or B-mode ultrasonography. If the general state of the patients permit, we can cons ider the lesion artery catheterization chemotherapy. After the interventional operation,we collect general data and preoperative / postoperative clinical examination data, a nd 1. We count the types and incidence of complications, and analyze the reasons for major complications according to the level of incidence of the sort, 2. The pati ents will be divided into two groups by prognosis(the prognosis poor and the pro gnosis good). Then we collect relevant prognostic factors( gender, age, ALT, AST,ALB, TBIL, ALP, GGT, etc.) and apply the unconditional logistic regression analys is.The first we conduct single factor analysis, and find effective prognostic factors,then the multivariate analysis, and make the logistic equation. The analysis of stat istical standards is α = 0.05. That is, P <0.05 is considered statistically significant.Results:1. The study enrolled patients a total of 76 cases. male was 41 cases, female was 35 cases. Preoperative diagnosis of hilar cholangiocarcinoma was 31 cases,15 c ases of gallbladder cancer,10 cases of hilar liver cancer, malignant hilar lymphnode metastasis was 8 cases,12 cases of ampullary cancer. Due to induced gall-bladder cardiac reflex, 3 cases’ surgery was forced to stop,the rest were all success-fully performed PTCD and(or) stenting. Bilateral drainage + bilateral stent was 5cases,26 cases of stent + drainage on the right, the left stent + drainage was 10 cases,20 cases of isolated right drainage,drainage alone on the left side was 10 cases, 3cases’ surgery was not successful, 2 cases were treated again in ourdepartment be cause stent stenosis after performed drainage + stent in other hospital.2. 18 cases of anemia, hypoalbuminemia was 24 cases, 10 cases of biliary tract i nfection, electrolyte imbalance was 30 cases, acute renal failure occurred in 9 cases,2 cases of biliary tract bleeding, liver abscess occurred in 2 cases, 5 cases of perp erative death, 7 cases of acute pancreatitis, stress ulcer was 1 case,1 case of meta stasis along the needle, gallbladder heart reflex was 3 cases,3 cases of stent reste nosis, each complication rate: 13.16% of biliary tract infection; electrolyte imbalanc e was 39.47%;11.84% of acute renal failure; hemobilia was 2.63%; 2.63% of live r abscesses;perioperative mortality was 6.58%; hypoproteinemia was 31.58%;23.68% of anemia; 9.21% of acute pancreatitis;stress ulcer was 1.39%;1.39% needle metastasis; gallbladder cardiac reflex was 3.95%; 3.95% stent restenosis.3.Prognostic factors were age(P = 0.006), A / G(P = 0.018), ALB(P = 0.025), the site of obstruction I(P = 0.006),factors that with no effection on progno stic were ALT(P = 0.265), TBIL(P = 0.258), gender(P = 0.421), GGT(P = 0.856), AST(P = 0.497), ALP(P = 0.514), and we obtained the logistic equation :Lo gistic(p) = 1.332 + 0.681 * Age-0.215 * A / G-0.335 * ALB + 1.587 * obstructi on I.Conclusions:1. The common complication rates in descending order are electrolyte imbalan ce hypoalbuminemia, anemia, biliary tract infection; acute renal failure, acute pancr eatitis have occurred sometime; stress ulcer, needle metastasis, gallbladder heart refl ex, stent restenosis and others have lower incidence. We should focus on common complications, accordingly observation, promptly make the appropriate treatment fo r the patients to avoid complications.2. Age, A / G, ALB, obstruction are prognosis related; ALT, TBIL, gender, G GT,AST,ALP have no significant relationship with the prognosis. Age is a risk fact or, the older, the worse of prognosis, while A / G and ALB ratio decreased are th e risk factors for poor prognosis. We should make a comprehensive evaluation of t he patients, strict selection of patients is needed for interventional treatment, espec ially patients with more risk factors such as older, poor general conditions, we sho uld propose scientific and reasonable treatment options in order to achieve the best clinical benefit. |
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