转化医学杂志2025，Vol.14Issue(9)：16-21,6.DOI:10.3639/j.issn.2095-3097.2025.09.004
PTCD联合胆汁回输治疗恶性梗阻性黄疸效果及术后胆道感染发生的影响因素分析
Efficacy of PTCD Combined with Bile Reinfusion in Treating Malignant Obstructive Jaundice and Risk Factors for Postoperative Biliary Tract Infection
摘要
Abstract
Objective To observe the efficacy of percutaneous transhepatic cholangiodrainage(PTCD)combined with bile reinfusion in treating patients with malignant obstructive jaundice(MOJ),and to analyze the influencing factors of postoperative biliary tract infection.Methods A total of 116 MOJ patients who underwent PTCD at the Second Affiliated Hospital of Hebei North University from July 2021 to July 2023 were retrospectively included.According to bile management methods,they were divided into an observation group(87 cases)and a control group(29 cases).The observation group received bile reinfusion combined with enteral nutrition support after PTCD,while the control group had bile discarded and received total parenteral nutrition support.The observation group was further divided into three subgroups based on reinfusion methods:in vitro docking subgroup,autologous intermittent reinfusion subgroup,and allogeneic intermittent reinfusion subgroup,with 29 cases in each subgroup.Liver function indicators[serum total bilirubin(TBil),alanine aminotransferase(ALT)],nutritional status[Mini Nutritional Assessment(MNA)score],incidence of electrolyte disorders,and incidence of biliary tract infection within 30 days after surgery were compared between the observation group and the control group before surgery and on the 14th day after surgery.Based on the occurrence of biliary tract infection within 30 days after surgery,the observation group was further divided into an infection group(28 cases)and a non-infection group(59 cases).Multivariate logistic regression analysis was used to analyze the influencing factors of biliary tract infection in the observation group.Results On the 14th day after surgery,the observation group had lower TBil and ALT levels,as well as a lower incidence of electrolyte disorders,and a higher MNA score than the control group(P<0.05).In the subgroup analysis,the in vitro docking subgroup had lower TBil and ALT levels than the autologous and allogeneic intermittent reinfusion subgroups,and a higher MNA score than the other two subgroups(P<0.05).The in vitro docking subgroup and the autologous intermittent reinfusion subgroup had a lower incidence of electrolyte disorders and biliary tract infection than the allogeneic intermittent reinfusion subgroup(P<0.05).Multivariate logistic regression analysis showed that age≥70 years,indwelling nutrition tube time>14 days,complete biliary obstruction,and bile reinfusion method(allogeneic intermittent reinfusion)were independent risk factors for biliary tract infection(P<0.05).Conclusion Bile reinfusion combined with enteral nutrition can significantly improve liver function and nutritional status in MOJ patients after PTCD.Among the reinfusion methods,in vitro short-path docking reinfusion has the lowest risk of infection.Age,indwelling time of nutrition tube,degree of biliary obstruction,and bile reinfusion method are influencing factors for biliary tract infection.关键词
黄疸,阻塞性/经皮经肝胆管造影引流术/胆汁回输器/营养支持/疗效比较研究Key words
obstructive jaundice/percutaneous transhepatic cholangiodrainage/bile reinfusion device/nutritional support/comparative efficacy study引用本文复制引用
席江伟,王艳,张文双,赵雅楠,刘斌,王新波..PTCD联合胆汁回输治疗恶性梗阻性黄疸效果及术后胆道感染发生的影响因素分析[J].转化医学杂志,2025,14(9):16-21,6.基金项目
张家口市重点研发计划项目(2121093D) （2121093D）
