Risk factors for percutaneous transhepatic biliary drainage-related cholangitis in patients with malignant obstructive jaundice: a prospective study / 中华放射学杂志

ABSTRACT

ObjectiveTo investigate the risk factors for percutaneous transhepatic biliary drainage (PTBD) related cholangitis in patients with malignant obstructive jaundice.MethodsOne hundred and fifty-four consecutive patients with malignant obstructive jaundice and without leukocytosis,fever and other manifestations of biliary tract infection received initial PTBD drainage.They were enrolled in this study.An uncontrolled prospective study was conducted of cholangitis occurrence within 30 days after PTBD.Twenty potential preoperative risk factors were assessed by univariate and multivariate analysis.ResultsFifty-five patients (55/154,35.7％ ) developed PTBD-related cholangitis,which composed of cholangitis group.Other patients composed of non-cholangitis group (99/154).The cholangitis-related mortality rate was 2.6％ (4/154).Intraoperative bile culture were performed for 131 patients (131/154),including 45 in cholangitis group and 86 in non-cholangitis group.Positive result occurred in 26 patients (26/45) in cholangitis group and 17 patients (17/86) in non-cholangitis group.There was statistical significant difference between these two groups ( x2 =19.357,P ＜ 0.01 ).By univariate analysis,diabetes ( x2 =10.470,P ＜ 0.01 ),Child-Pugh C grade ( x2 =36.324,P ＜ 0.01 ),undrained biliary duct ( x2 =9.540,P ＜0.01 ),external-internal drainage ( x2 =9.856,P ＜ 0.01 ),history of ERCP or cholangiojejunostomy (x2 =14.196,P＜0.01),QOL (t =-3.288,P ＜0.01),KPS(t =-2.099,P＜0.05),ALT (t =-2.112,P＜0.05),PT (t =-3.648,P ＜0.01),albumin (t =-2.071,P ＜0.05),WBC (t =2.022,P ＜ 0.05 ),proximal obstruction ( x2 =6.190,P ＜ 0.05 ) and cirrhosis ( x2 =5.439,P ＜ 0.05 )were significantly different between cholangitis group and non-cholangitis group.By multivariate analysis,diabetes ( OR =5.093,P ＜0.01 ),Child-Pugh C grade ( OR =13.412,P ＜0.01 ),undrained biliary duct ( OR =3.348,P ＜ 0.05 ),external-internal drainage ( OR =3.168,P ＜ 0.05 ) and history of ERCP or cholangiojejunostomy (OR =8.330,P ＜ 0.01 ) remained significant difference.ConclusionsPTBD is an effective and safe palliative treatment for patients with malignant obstructive jaundice.Sufficient preoperative preparation and effective control of risk factors may reduce the incidence of cholangitis after PTCD.