对恶性梗阻性黄疸术前减黄指标的再认识（附28例临床分析）

目的：对恶性梗阻性黄疸的术前减黄标准以及减黄后手术时机进行探讨。方法：在既往研究的基础上,将原有的减黄公式年龄（岁）×3＋TB（μmol/L）〉380修改为年龄（岁）×3＋TB（μmol/L）〉450,并将满足〉450的28例患者进行术前减黄。将患者肿瘤切除率、并发症发生率等临床资料和前期研究的17例减黄患者（〉380）的临床资料进行对比分析。结果：年龄（岁）×3＋TB（μmol/L）〉450的28例中完成肿瘤切除10例（35.7%）,行单纯内引流18例（64.3%）,术中失血量（438.7±276.6）mL,术后并发症发生率10.7%（3/28）,1例死亡。年龄（岁）×3＋TB（μmol/L）〉450的17例中完成肿瘤切除6例（35.3%）,行单纯内引流11例（64.7%）,术中失血量（445.3±254.5）mL,术后并发症发生率11.8%（2/17）,1例死亡。结论：以年龄（岁）×3＋TB（μmol/L）〉450作为恶性梗阻性黄疸患者术前减黄的标准,并根据TB下降情况决定手术时机,能够获得良好的治疗效果。

Recognition about preoperative jaundice-reducing in the patients with malignant obstructive jaundice

Objective： To explore the indication of preoperative jaundice-reducing and the operation opportunity. Methods： Based on early clinical search, the primary indication of preoperative jaundice-reducing （Age ×3＋TB380）has been adjusted with a new indication： Age ×3＋TB450. According to the new indication, PTBD were performed on twenty-eight patients before operation. The clinical data of these patients were analyzed. As the comparative group, the data of seventeen patients （Age ×3＋TB380）who accepted PTBD before operation in the early clinical search were analyzed simultaneously. Results： Of the patients （Age×3＋TB450）, tumor resection were performed in ten cases, simple internal drainage were performed in eighteen cases. Operative blood loss were 438.7±276.6 milliliter, the complication rate were 10.7 percent. Of the patients （Age × 3＋TB380）, tumor resection were performed in six cases, simple internal drainage were performed in eleven cases. Operative blood loss were 445.3±254.5 milliliter, the complication rate were 11.8 percent. Conclusion： The new standard, Age ×3＋TB450, can be chosen as the indication of preoperative jaundice-reducing. The jaundice index descending rate can be chosen as the standard of the operation opportunity.