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目的:探讨胆道支架置放后动脉化疗栓塞治疗恶性梗阻性黄疸(MOJ)的并发症和疗效,研究影响黄疸复发时间和患者生存期的预后因素。方法:51例MOJ患者放置胆道支架后接受动脉化疗栓塞术(TACE),观察手术并发症,血清胆红素下降程度,随访黄疸复发时间和患者生存期。分析性别,年龄,肿瘤类型,术前血清胆红素浓度、碱性磷酸酶、谷丙转氨酶、白蛋白、血红蛋白浓度,梗阻时间,梗阻水平10个因素对黄疸复发时间和患者生存期的影响。结果:51例共计放置支架64枚,行TA-CE术86次,技术成功率为100％。1例于术后1个月死亡,在治疗过程中,4例出现肝脓肿。4例失访,51例生存期为1-34个月,平均9.0个月,中位值8.0个月。22例黄疸复发,复发率43.2％,黄疸复发时间2-14个月,平均11.0个月,中位值9.0个月。单因素(P=0.010)和多因素(P=0.010)分析均显示术前血清总胆红素浓度是影响患者生存期的重要因素。单因素分析显示对黄疸复发有显著影响的因素为肿瘤类型(P=0.035)。结论:MOJ患者放置胆道支架后进行TACE术,可以延缓黄疸复发,延长患者生存期。术前血清总胆红素浓度高的患者生存期较短;肝细胞肝癌患者的黄疸复发时间较非肝细胞肿瘤患者明显延长,黄疸复发率亦低于后者。
Objective: To investigate the complication and curative effect of transcatheter arterial chemoembolization after malignant obstructive jaundice (MOJ) after biliary stent implantation and to study the prognostic factors influencing the relapse time of jaundice and the survival time of patients. Methods: Fifty - one patients with MOJ underwent transcatheter arterial chemoembolization (TACE) after placement of biliary stents. The surgical complications, serum bilirubin level, follow - up duration of jaundice and patient survival were observed. The influence of sex, age, tumor type, preoperative serum bilirubin concentration, alkaline phosphatase, alanine aminotransferase, albumin, hemoglobin concentration, obstruction time and obstruction level on the time of jaundice recurrence and patient survival were analyzed. Results: Totally 64 stents were placed in 51 cases, and 86 cases underwent TA-CE. The technical success rate was 100%. One patient died at 1 month after operation. In the course of treatment, 4 patients had liver abscess. Four patients were lost to follow-up, and 51 patients were alive for 1-34 months with an average of 9.0 months with a median of 8.0 months. 22 cases of jaundice relapse, the recurrence rate was 43.2%, jaundice recurrence time 2-14 months, an average of 11.0 months, a median of 9.0 months. Univariate (P = 0.010) and multivariate (P = 0.010) analysis showed that preoperative serum total bilirubin concentration is an important factor affecting the survival of patients. Univariate analysis showed that the factors that significantly influenced the relapse of jaundice were tumor type (P = 0.035). Conclusion: TACE can be performed after placement of biliary stents in patients with MOJ, which can delay the recurrence of jaundice and prolong the survival of patients. Patients with high preoperative serum total bilirubin had a shorter survival; patients with hepatocellular carcinoma had longer jaundice relapse time than those without hepatocellular carcinoma, and the recurrence rate of jaundice was lower than the latter.