超声内镜引导胆管引流术治疗胆道梗阻的有效性及安全性分析

Efficacy and safety of endoscopic ultrasound‑guided biliary drainage for biliary obstruction

摘要:

目的 探讨超声内镜引导胆管引流术（endoscopic ultrasound‑guided biliary drainage， EUS‑BD）治疗胆道梗阻的有效性及安全性。方法 回顾性分析2013年1月1日至2023年12月31日期间在杭州市第一人民医院接受EUS‑BD治疗的良性及恶性胆道梗阻患者资料。分析EUS‑BD治疗的成功率、术后并发症发生率、支架失效情况以及随访结果。结果 研究纳入97例患者，EUS‑BD治疗的技术成功率为96.9%（94/97），临床成功率为86.2%（81/94），术后总胆红素中位水平由术前的167.4 μmol/L显著下降至75.9 μmol/L，差异有统计学意义（Z=-6.734，P<0.001）。术后并发症发生率为19.6% （19/97）。患者均完成了术后3个月的随访或直至死亡，无患者失访，术后3个月内的死亡率为9.3%（9/97）。支架失效发生率为9.3%（9/97），远端胆总管梗阻（P=0.016，OR=5.236，95%CI：1.350~20.038）是恶性胆道梗阻患者行EUS‑BD术后发生并发症的独立危险因素。结论 EUS‑BD治疗胆道梗阻安全有效。

Abstract:

Objective To investigate the clinical efficacy and safety of endoscopic ultrasound-guided biliary drainage (EUS-BD) for biliary obstruction. Methods Data of patients with biliary obstruction who underwent EUS-BD in Hangzhou First People''s Hospital from January 1, 2013 to December 31, 2023 were retrospectively analyzed. The success rate of EUS-BD treatment, the incidence of postoperative complications, stent dysfunction and follow-up results were collected and analyzed. Results A total of 97 patients with biliary obstruction were included in the analysis. The technical success rate of EUS-BD treatment was 96.9% (94/97), and the clinical success rate was 86.2% (81/94). Postoperative total bilirubin levels decreased significantly from a preoperative median of 167.4 μmol/L to 75.9 μmol/L (Z=-6.734, P<0.001). The postoperative complication incidence was 19.6% (19/97). All patients completed either the 3-month postoperative follow-up or were followed until death, with no loss to follow-up during this period. The three-month postoperative mortality was 9.3% (9/97). Distal common bile duct obstruction (P=0.016, OR=5.236, 95%CI: 1.350-20.038) was an independent risk factor for complications after EUS-BD in patients with malignant biliary obstruction. Conclusion EUS-BD is safe and effective for the treatment of biliary obstruction.