梗阻性黄疸及术前内镜下胆道引流对胰十二指肠切除术疗效的影响

目的:探讨梗阻性黄疸和术前减黄对胰十二指肠切除术(PD)疗效的影响.方法:对2000～2006年166侧PD病例资料进行回顾性分析,根据有无黄疸及是否行胆道引流(PBD)分为PBD组、非PBD组和非黄疸组,统计分析3组胆红素水平、手术时间、术中出血量、并发症发生率、围术期病死率.结果:PBD组与非PBD组术前平均胆红素水平比较差异无统计学意义(P＞0.05),3组平均手术时间、术中平均失血量、单一并发症发生率、围术期死亡率比较差异无统计学意义(P＞0.05);PBD组减黄前、后胆红素水平差异有统计学意义(P＜0.05);并发症总发生率组间比较,非PBD组明显高于非黄疸组(P＜0.05),PBD组与非PBD组、非黄疸组之间比较差异无统计学意义(P＞0.05).结论:梗阻性黄疸是进行PD的危险因素之一,术前减黄治疗虽然减黄效果确切,但是并不能明显降低术后并发症发生率和病死率,故早期手术对改善患者预后更有意义.

Influence of Obstructive Jaundice and Preoperative Biliary Drainage on Pancreaticoduodenectomy

Objective:To investigate the influence of obstructive jaundice and preoperative biliary drainage(PBD) on Pancreaticoduodenectomy(PD).Methods:The clinical data of 166 patients from 2000 to 2006 were collected.The patients were divided into 3 groups: PBD group,non-PBD group and non-jaundice group.The bilirubin level,operating time,blood loss,post-operative complications and the peri-operative period mortality rate were also collected and analyzed.Results:There was no significant difference in the mean bilirubin level,operating time,blood loss,post-operative complications and the peri-operative period mortality rate between the 3 groups(P>0.05);In PBD group the mean bilirubin level was significantly reduced after PBD(P<0.05),The total post-operative complications was significantly rate higher in non-PBD group than that of non-jaundice group(P<0.05),but there was no significant difference between PBD,non-PBD and non-jaundice groups(P>0.05).Conclusion:Obstructive jaundice is one of the risk factors of PD,although the curative effect of PBD is definite,but PBD does not help to reduce postoperative complications and mortality.So earlier operations seem to be of more significance in prognosis.