术前胆道引流对低位恶性胆道梗阻患者行胰十二指肠切除术后的影响

目的 评价术前胆道引流(PBD)对低位恶性胆道梗阻性黄接受胰十二指肠切除术(PD)后的并发症、死亡率及住院时间的影响.方法 回顾性总结分析2001年1月至2010年12月期间接受PD术的71例低位恶性胆道梗阻患者的临床资料.术前胆道引流方法包括经皮肝穿刺胆道引流(PTCD)、逆行胰胆管造影术(ERCP)及胆囊造瘘术,71例中行PBD患者19例(26.8%),未行PBD患者52例(73.2%).结果 PBD组总胆红素(TBIL)在引流前为(424.9±129.9)μmol/L,引流后下降为(77.7±48.6)μmol/L,差异具有统计学意义(t=11.1,P＜0.001).PBD组直接胆红素(DBIL)在引流前为(300.7±98.1)μmol/L,引流后下降为(60.0±34.5)μmol/L,差异具有统计学意义(t=10.7,P＜0.001).PBD组谷丙转氨酶(ALT)在引流前为(227.9±275.8)U/L,引流后下降为(90.3±66.5)U/L,差异具有统计学意义(t=2.5,P=0.023).PBD组术中输血量为(589±93)ml,非PBD组为(603±71)ml,差异无统计学意义(t=-110,P=0.913).PBD组术后并发症发生率为52.6%(10/19),非PBD组为55.8%(29/52),差异无统计学意义(P＞0.05).PBD组术后住院时间为(33±3)d,非PBD组为(25±2)d,差异无统计学意义(P＞0.05).结论 对黄疸较重、肝功能严重受损的患者,行PBD可有效改善患者的一般状况,但并未降低PD术后并发症发生率及死亡率,也未减少术后的住院时间.

Effect of preoperative biliary drainage on patients undergoing pancreaticoduodenectomy for distal bile duct malignant obstructive jaundice

Objective To evaluate the influence of preoperative biliary drainage(PBD) on complications,mortality and hospital stay,after pancreaticoduodenectomy(PD) for obstructive jaundice resulting from distal bile duct malignant tumors.Methods We analyzed data from 71 patients who underwent PD for distal bile duct malignant tumors from January 2001 to December 2010.19 patients underwent PBD(26.8%),including percutaneous transhepatic cholangiodrainage(PTCD),endoscopic retrograde cholangiopancreatography(ERCP),cholecystostomy.52 patients were not drained(73.2%).Results In PBD group,TBIL was reduced from(424.9±129.9)μmol/L to(77.7±48.6)μmol/L after the biliary drainage procedure,which showed a significant statistical difference(t=11.1,P<0.001).DBIL was reduced to(60.0±34.5)μmol/L from(300.7±98.1)μmol/L after the biliary drainage procedure,which showed a significant statistical difference(t=10.7,P<0.001).ALT was reduced to(90.3±66.5)U/L from(227.9±275.8)U/L after the biliary drainage procedure,which showed a significant statistical difference(t=2.5,P=0.023).Intraoperative blood transfusion of PBD group and non-PBD group was(589±93)ml,and(603±71)ml,which showed no significant difference(P>0.05).Incidence of postoperative complications of PBD group and non-PBD group was 52.6%(10/19) and 55.8%(29/52),which showed no significant difference(P>0.05).Postoperative hospital stay of PBD group and non-PBD group was(33±3)d and(25±2)d,which showed no significant difference(P>0.05).Conclusion For the distal bile duct malignant tumors,with severe jaundice and obvious liver function damage,PBD is able to relieve the clinical symptoms remarkably,but is not able to significantly decrease the postoperative mortality,complications and postoperative hospital stay.