胆汁经口回输在恶性梗阻性黄疸患者围手术期的应用

目的 探讨胆汁经口回输在中、重度低位恶性梗阻性黄疸患者围手术期的临床应用效果。方法 回顾性分析2014年1月至2021年12月哈尔滨医科大学附属第一医院普外科行胰十二指肠切除术治疗的224例中、重度低位恶性梗阻性黄疸患者的临床资料。其中150例胰十二指肠切除术前行PTCD减黄：70例行胆汁回输（PTCD+胆汁回输组）,80例胆汁不回输（PTCD组）;其余74例术前未行PTCD减黄（直接手术组）。结果 PTCD+胆汁回输组较PTCD组和直接手术组术后住院时间（17.2±5.7）d vs （21.5±8.3）d vs （22.8±9.8）d]、排气时间（47.5±11.6）h vs （54.9±17.0）h vs （56.5±15.9）h]及中心静脉拔管时间（9.9±2.8）d vs （12.0±3.6）d vs （14.3±6.4）d]短（P<0.05）,且术后胃排空延迟的发生率也显著低于PTCD组和直接手术组4.28%（3/70） vs 12.50% （10/80） vs 12.16%（9/74）,P<0.05]。胰十二指肠切除术后第10天,PTCD+胆汁回输组C反应蛋白水平下降最快,PTCD组次之,直接手术组最慢（P<0.05）;PTCD+胆汁回输组前白蛋白水平升高了107.9%,上升幅度明显高于PTCD组的73.4%和直接手术组的50.9%（P<0.05）;其总胆红素水平降低了82.9%,下降幅度明显大于PTCD组的75.7%和直接手术组的60.9%（P<0.05）,且谷丙转氨酶及谷草转氨酶的下降幅度也均明显大于其他两组（P<0.05）。结论 胆汁经口回输有助于中、重度低位恶性梗阻性黄疸患者围手术期间肝脏及胃肠道等脏器功能的恢复,缩短术后住院时间、术后排气时间及中心静脉留置时间,值得临床推广应用。

Application of oral bile reinfusion in the perioperative period of patients with malignant obstructive jaundice

Objective To explore the clinical effect of oral bile reinfusion in the perioperative period of patients with moderate-to-severe lower malignant obstructive jaundice (MOJ). Methods Clinical data of 224 patients with moderate-to-severe lower MOJ treated by pancreaticoduodenectomy (PD) in the First Affiliated Hospital of Harbin Medical University from Jan. 2014 to Dec. 2021 were retrospectively analyzed. Among them, 150 cases underwent percutaneous transhepatic cholangial drainage (PTCD) before PD, including 70 receiving PTCD plus oral bile reinfusion (PTCD + oral bile reinfusion group) and 80 being treated with only PTCD (PTCD group), and the remaining 74 cases did not undergone preoperative PTCD (direct surgery group). Results The postoperative hospitalization time, exhaust time and central venous extubation time in the PTCD + oral bile reinfusion group were shorter than those in PTCD group and the direct surgery group (17.2±5.7)d vs (21.5±8.3)d vs (22.8±9.8)d], (47.5±11.6)h vs (54.9±17.0)h vs (56.47±15.89)h] and (9.9±2.8)d vs (12.0±3.6)d vs (14.3±6.4)d], all P<0.05. Compared with PTCD group and direct surgery group, the PTCD + oral bile reinfusion group had lower incidence of delayed gastric emptying 4.28%(3/70) vs 12.50%(10/80) vs 12.16%(9/74), P<0.05]. On the 10^th day after PD, the level of C-reactive protein in the PTCD + oral bile reinfusion group had the fastest decline, followed by the PTCD group, and the direct surgery group was the slowest (P<0.05). The level of pre-albumin in the PTCD + oral bile reinfusion group increased by 107.9% on the 10^th day after PD, which was significantly higher than those of 73.4% in the PTCD group and 50.9% in the direct surgery group (P<0.05). The total bilirubin level in the PTCD + oral bile reinfusion group decreased by 82.9% on the 10^th day after PD which was significantly higher than those of 75.7% in the PTCD group and 60.9% in the direct surgery group (P<0.05). The decrease level of alanine aminotransferase and aspartate aminotransferase in the PTCD + oral bile reinfusion group was also significantly greater than those in the other two groups (P<0.05). Conclusion Oral bile reinfusion can help patients with moderate-to-severe lower MOJ to recover liver and gastrointestinal function during perioperative period, reduce postoperative hospitalization time, postoperative exhaust and central venous indwelling time. It is worthy of extensive clinical applications.