Clinical effect of percutaneous transhepatic cholangial drainage combined with biliary stent implantation in treatment of high malignant obstructive jaundice and the influencing factors for prognosis

Objective To investigate the clinical effect of percutaneous transhepatic cholangial drainage ( PTCD) combined with biliarystent implantation in the treatment of high malignant obstructive jaundice ( MOJ) and the risk factors for survival time. Methods A retro-spective analysis was performed for the clinical data of 92 patients with high MOJ who were admitted to Department of Hepatobiliary Surgeryin Air Force General Hospital, PLA, from June 2015 to June 2017. The t-test was used for comparison of normally distributed continuousdata between two groups; an analysis of variance was used for comparison between multiple groups, and the SNK-q test was used for furthercomparison between two groups. The Mann-Whitney U test was used for comparison of non-normally distributed continuous data betweentwo groups. The chi-square test was used for comparison of categorical data between groups. The receiver operating characteristic ( ROC) curve was used to determine the optimal cut-off values of influencing factors for survival time; the patients were divided into groups accord-ing to the optimal cut-off values, and the Kaplan-Meier method was used for survival analysis. The multivariate Cox proportional hazardsmodel was used to identify the independent influencing factors for survival time. Results All patients were followed up for a median time of6 months ( range 1-10 months) . A total of 56 patients died and 36 survived during follow-up, with a median survival time of 6 months, asurvival rate of 39. 1% at the end of follow-up, and a half-year survival rate of 44. 6%. Of all 92 patients, 14 experienced postoperativecomplications, resulting in an incidence rate of complications of 15. 2%. At 3 days and 1 week after surgery, there were significant reduc-tions in total bilirubin ( TBil) , direct bilirubin, alanine aminotransferase ( ALT) , and aspartate aminotransferase ( F = 206. 264, 106. 161, 86. 332, and 166. 857, all P < 0. 05) . The ROC Curve was used to analyze the data, TBil had a sensitivity of 95. 12% and a specificity of46. 15% at the optimal cut-off value of 112. 9 μmol/L; ALT had a sensitivity of 92. 68% and a specificity of 31. 58% at the optimal cut-off value of 210 U/L; albumin had a sensitivity of 68. 29% and a specificity of 58. 33% at the optimal cut-off value of 35. 7 g/L; red blood cell count had a sensitivity of 60. 98% and a specificity of 69. 23% at the optimal cut-off value of 3. 56 × 1012/L. Child-Pugh class, TBil, and ALT showed a significant difference in predicting overall survival ( all P < 0. 05) . The multivariate Cox proportional hazards model showed that Child-Pugh class C was an independent influencing factor for survival time after PTCD combined with biliary stent implantation. Conclusion PTCD combined with biliary stent implantation has a good clinical effect in the treatment of patients with MOJ, but preoperative liver function has a great impact on survival time. Therefore, liver function should be observed dynamically to guide clinical treatment, in order to prolong the survival time of such patients.