恶性梗阻性黄疸181例术前减黄临床分析

目的:观察恶性梗阻性黄疸病人术前减黄的临床疗效。方法:对181例恶性梗阻性黄疸病人术前行超声引导下经皮经肝胆道穿刺引流,并对肿瘤切除率、并发症发生率等指标进行了分析。结果:97例胰头癌中行胰十二指肠切除35例(36.1%),单纯内引流62例;84例胆管癌中行胰十二指肠切除14例,肝门部胆管癌切除19例,胆管中段癌切除7例,共计40例(47.6%);行单纯内引流者44例。术后发生并发症15例次,死亡3例。减黄速度平均每周递减30%以上者在肿瘤切除率、并发症发生率以及住院时间上均优于30%以下者;而减黄速度平均每周递减30%以上者,无论引流2周或3周,其肿瘤切除率及并发症发生率无显著差别。结论:恶性梗阻性黄疸病人行术前减黄后黄疸是否顺利下降,可作为预测手术风险、手术效果以及病人预后的指标,血清胆红素连续2周下降30%可作为选择手术时机的标准。

Preoperative ultrasonic guided percutaneous transhepatic biliary drainage for malignant obstructive jaundice

Objective To evaluate the therapeutic effect of preoperative jaundice relief for patients with malignant obstructive jaundice. Methods Ultrasonic guided percutaneous transhepatic biliary drainage was performed to 181 patients with malignant obstructive jaundice. The clinical data of these patients were analyzed. Results In 97 patients with pancreatic head carcinoma, pancreatoduodenectomy was successfully performed in 35 (36.1%) cases, and simple bypass procedure was performed in the other 62 patients. Of 84 patients with biliary carcinoma, pancreatoduodenectomy was performed in 14 patients, tumor resection in 19 patients with hilus biliary carcinoma and in 7 cases of middle segment biliary carcinoma; and simple bypass procedure in the other 44 patients. Postoperative complications occurred in 15 patients, and death in 3 of them. The clinical parameters denoting the effect of preoperative drainage included resection rate of carcinoma, incidence of complications and duration of hospitalization; in patients with satisfactory jaundice relief (decrease of total bilirubin over 30% weekly), they were better than those with unsatisfactory relief. Of the patients with satisfactory jaundice relief, there were no significant difference of resection rate of carcinoma and incidence of complications between those who had 2 or 3 weeks of preoperative biliary drainage. Conclusions As an important parameter, the decrease of total bilirubin can be applied to predict operative risk, operative effect and prognosis. The continuous decrease of total bilirubin over 30% for 2 weeks can be regarded as an optimal indicator for the proper selection of the time of operation.