To investigate the critical complications in patients with malignant biliary obstruction after biliary stent implantation and analyze the risk factors.

A total of 77 patients with malignant biliary obstruction undergoing percutaneous transhepatic biliary stent implantation at Sir Run Run Shaw Hospital of Zhejiang University School of Medicine from January 2015 to August 2019 and 69 patients with malignant biliary obstruction undergoing endoscopic biliary stent implantation in the Second Affiliated Hospital of Zhejiang University School of Medicine from August 2016 to September 2021 were retrospectively analyzed.They were divided into critical complications groups and non-critical complications groups according to whether critical complications occurred within 1 month after surgery.Patient factors and surgical factors were included in the analysis(t test for continuous variables, χ² test for categorical variables and independent risk factors from binary Logistic multivariate analysis).

A total of 146 patients(18 patients in the critical complication group, 128 patients in the non-critical complication group)were enrolled.Univariate analysis showed that implanted stent type(P=0.013), number of implanted ¹²⁵I particles(P=0.007), operation time(P=0.000), intraoperative biliary hemorrhage(P=0.000), postoperative biliary hemorrhage(P=0.000), postoperative stent patency time(P=0.000), coexisting biliary stones(P=0.003), preoperative jaundice time(P=0.000), and preoperative biliary obstruction length(P=0.000)were related to critical complications after biliary stent implantation.Operation time of ¹²⁵I seed simple stent group(P=0.011)and the length of preoperative biliary obstruction(P=0.002)were positively correlated with postoperative critical complications.The binary Logistic multivariate analysis concluded that preoperative jaundice time(OR=1.059, P=0.033)and preoperative biliary obstruction length(OR=3.595, P=0.007)were independent risk factors for postoperative critical complications.

There is no significant difference in the incidence of critical complications between percutaneous transhepatic biliary stent implantation and endoscopic biliary stent implantation.Preoperative jaundice time and length of biliary obstruction are independent risk factors for critical complications after biliary stenting.The incidence of critical complications after biliary ¹²⁵I seed stent is higher than that after bare stenting, and there was no significant correlation between the number of implanted ¹²⁵I particles and the incidence of critical complications.