The effect of biliary stent position on short?term and long?term outcomes of patients with low malignant obstructive jaundice after surgical treatment / 中国综合临床

ABSTRACT

Objective To explore the effect of the position of the biliary stents on the short?term and long?term effects of the patients with low malignant obstructive jaundice after treatment.Methods Seventy?eight patients with low?grade malignant obstructive jaundice diagnosed in Jiangyin Hospital Affiliated to Medical College of Southeast University who underwent biliary stenting were enrolled as the study object.According to the placement of the biliary stents,the stents were divided into the spanning group and the non?crossing group.The baseline data and related serological indexes were recorded,and the changes of jaundice between the two groups were compared by repeated measurements.All patients were followed up for 48 weeks.Multivariate Cox regression analysis was applied on the risk factors that might affect the prognosis of patients, and the degree of influence of various factors on the prognosis of patients was further evaluated.Results Repeated measures analysis showed that the biochemical indicators of the spanning group and the non?crossing group showed a significant downward trend and the difference was statistically significant (TBil Fintra?group＝9.392,Pintra?group＝0.000; DBil Fintra?group＝7.581,Pintra?group＝0.001).Among them,the total bilirubin (TBil) (Preoperative (318.69±101.13) μmol／L,1 week after surgery (135.98 ±63.61) μmol／L,2 weeks after surgery (60.21±24.81) μmol／L) was lower than the non?crossing group preoperative (309.07±109.97) μmol／L,1 week after surgery (158.87±66.92) μmol／L,2 weeks after surgery (75.91 ± 20.46) μmol／L), and the difference was statistically significant ( Finter?group ＝3.362, Pinter?group＝0.041).The direct bilirubin ( DBil) ( Preoperative (171.93 ± 73.01) μmol／L,1 week after surgery (90.38± 57.33) μmol／L,2 weeks after surgery(36.64± 18.95) μmol／L) was lower than the non?crossing group ( Preoperative ( 174.53 ± 82.74) μmol／L,1 week after surgery ( 107.85 ± 49.07) μmol／L,2 weeks after surgery ( 37.87 ± 14.55 ) μmol／L.The difference was statistically significant (Finter?group＝6.284,Pinter?group＝0.003).There was an interaction between the treatment regimen and treatment time (1 week after surgery and 2 weeks after surgery) (TBil Finteraction＝12.262,Pinteraction＝0.000; DBilFinteraction＝10.254,Pinteraction＝0.000).The results of the multi factor Cox proportional hazard model of the spanning group and the non?crossing group showed that the ALP, DBil, TBil and lymphatic metastasis of malignant tumor were the two independent risk factors that affect the prognosis.However, the pancreatic cancer,ALT and age in the spanning group across the ampulla also have a certain effect on the prognosis of the patients.Conclusion The effect of the placement of biliary stents across the Vater ampullary was more obvious in the short term on the decline of bilirubin.But in the long term,there was no significant difference in the prognosis of patients with biliary stenting position.ALP,TBil,DBil,and disease classification were all important risk factors affecting the prognosis of two groups of patients