低位恶性梗阻性黄疸患者术前减黄临床疗效观察
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摘要
目的观察低位恶性梗阻性黄疸患者行胰十二指肠切除术(PD)术前减黄对疗效及并发症发生率的影响。方法回顾性搜集2013年1月至2018年6月南京鼓楼医院肝胆胰外科收治的112例低位恶性梗阻性黄疸患者临床资料,根据术前是否减黄分为两组,其中减黄组49例,均行内镜下逆行鼻胆管引流术(ENBD),未减黄组63例。观察减黄组ENBD并发症发生率及减黄前后血清总胆红素等指标变化,比较两组围手术期相关指标及术后并发症发生率,探讨术前减黄临床疗效。结果两组患者一般资料无统计学差异,减黄组术前血清总胆红素(P <0. 05)、血清白蛋白(P <0. 05)等指标较减黄前明显改善;减黄组ENBD并发症发生率为12. 24%,PD术后并发症发生率为48. 98%,未减黄组为41. 27%,差异无统计学意义(P>0. 05)。减黄组术前准备时间及手术时间长于未减黄组,术中出血量多于未减黄组,术后住院时间低于未减黄组,差异有统计学意义(P <0. 05)。结论术前减黄能改善低位恶性梗阻性黄疸患者术前生理状态,缩短PD术后住院时间,但并不能有效的减少手术并发症。术前减黄不推荐作为低位恶性梗阻性黄疸患者术前准备的常规措施。
Objective To observe the effect of preoperative jaundice reduction on curative and complications in patients with low malignant obstructive jaundice undergoing pancreaticoduodenectomy(PD). Methods The data of 112 patients with low malignant obstructive jaundice who were treated from January 2013 to June 2018 in Nanjing Drun Tower Hospital were collected. All the patients were treated with pancreatoduodenectomy and divided into two groups preoperatively according to whether preoperative biliary drainage was conducted or not. Among them,49 patients who were given preoperative biliary drainage were taken as reducing jaundice group;while,63 case who were not given preoperative biliary drainage were taken as unreducing jaundice group. The perioperative indicators and postoperative morbidity were compared between the two groups. Results There was no statistical difference in general data between the two groups. Preoperative TBIL(P < 0. 05) and serum albumin(P < 0. 05) in the reducing jaundice group were significantly improved. The incidence of complications after reducing jaundice in the reducing jaundice group was 12. 24%. The incidence of complications after PD was 46. 94%,and that was 41. 27% in the unreducing jaundice group(P > 0. 05). The preoperative hospitalization time and operation time of the reducing jaundice group were longer than those of the unreducing jaundice group,while the hemorrhagia amount and the post-operative hospitalization time were lower than that of the unreducing jaundice group(P < 0. 05). Conclusion Preoperative jaundice reduction can improve the preoperative physiological state of patients with low malignant obstructive jaundice and shorten the hospitalization time after PD,but it can not effectively reduce the complications of surgery. Preoperative jaundice reduction is not recommended as a routine measure for preoperative preparation of patients with low malignant obstructive jaundice.
Objective To observe the effect of preoperative jaundice reduction on curative and complications in patients with low malignant obstructive jaundice undergoing pancreaticoduodenectomy(PD). Methods The data of 112 patients with low malignant obstructive jaundice who were treated from January 2013 to June 2018 in Nanjing Drun Tower Hospital were collected. All the patients were treated with pancreatoduodenectomy and divided into two groups preoperatively according to whether preoperative biliary drainage was conducted or not. Among them,49 patients who were given preoperative biliary drainage were taken as reducing jaundice group;while,63 case who were not given preoperative biliary drainage were taken as unreducing jaundice group. The perioperative indicators and postoperative morbidity were compared between the two groups. Results There was no statistical difference in general data between the two groups. Preoperative TBIL(P < 0. 05) and serum albumin(P < 0. 05) in the reducing jaundice group were significantly improved. The incidence of complications after reducing jaundice in the reducing jaundice group was 12. 24%. The incidence of complications after PD was 46. 94%,and that was 41. 27% in the unreducing jaundice group(P > 0. 05). The preoperative hospitalization time and operation time of the reducing jaundice group were longer than those of the unreducing jaundice group,while the hemorrhagia amount and the post-operative hospitalization time were lower than that of the unreducing jaundice group(P < 0. 05). Conclusion Preoperative jaundice reduction can improve the preoperative physiological state of patients with low malignant obstructive jaundice and shorten the hospitalization time after PD,but it can not effectively reduce the complications of surgery. Preoperative jaundice reduction is not recommended as a routine measure for preoperative preparation of patients with low malignant obstructive jaundice.
引文
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6 Maki T,Sato T,Kakizaki G,Sendai.Pancreatoduodenectomy for periampullary carcinomas.Appraisal of two-stage procedure.Arch Surg,1966,92:825-833.
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8 Tsai YF,Shyu JF,Chen TH,et al.Effect of preoperative biliary drainage on surgical outcome after pancreaticoduodenectomy.Hepatogastroenterology,2006,53:823-827.
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10 Sohn TA,Yeo CJ,Cameron JL,et al.Do preoperative biliary stents increase postpancreaticoduodenectomy complications.Gastrointest Surg,2000,4:258-267.
11 Sewnath ME,Karsten TM,Prins MH,et al.A meta-analysis on the efficacy of preoperative biliary drainage for tumors causing obstructive jaundice.Ann Surg,2002,236:17-27.
12 Roebuck DJ,Stanley P.External and internal-external biliary drainage in children with malignant obstructive jaundice.Pediatr Radiol,2000,30:659-664.
13 Sewnath ME,Birjmohun RS,Rauws EA,et al.The effect of preoperative biliary drainage on postoperative complications after pancreaticoduodenectomy.Am Coll Surg,2001,192:726-734.
14 Tol JA,van Hooft JE,Timmer R,et al.Metal or plastic stents for preoperative biliary drainage in resectable pancreatic cancer.Gut,2016,65:1981-1987.
15 Song TJ,Lee JH,Lee SS,et al.Metal versus plastic stents for drainage of malignant biliary obstruction before primary surgical resection.Gastrointest Endosc,2016,84:814-821.
16 Lee PJ,Podugu A,Wu D,et al.Preoperative biliary drainage in resectable pancreatic cancer:a systematic review and network meta-analysis.HPB(Oxford),2018,20:477-486.
17 Wiggers JK,Groot Koerkamp B,Coelen RJ,et al.Preoperative biliary drainage in perihilar cholangiocarcinoma:identifying patients who require percutaneous drainage after failed endoscopic drainage.Endoscopy,2015,47:1124-1131.
2 XU C,HUANG X E,WANG S X,et al.Comparison of infection between internal external and external percutaneous trans-hepatic biliary drainage in treating patients with malignant obstructive jaundice.Asian Pac J Cancer Prev,2015,16:2543-2546.
3 Pisters PW,Hudec WA,Hess KR,et al.Effect of preoperative biliary decompression on pancreaticoduodenectomy associated morbidity in 300 consecutive patients.Ann Surg,2001,234:47-55.
4 Navaneethan U,Jayanthi V,Mohan P.Pathogenesis of cholangitis in obstructive jaundice revisited.Minerva Gastroenterol Dietol,2011,57:97-103.
5 Ljungdahl M,Osterberg J,Ransj U,et al.Inflammatory response in patients with malignant obstructive jaundice.Scand J Gastroenterol,2007,42:94-102.
6 Maki T,Sato T,Kakizaki G,Sendai.Pancreatoduodenectomy for periampullary carcinomas.Appraisal of two-stage procedure.Arch Surg,1966,92:825-833.
7 Li Z,Zhang Z,Hu W,et al.Pancreaticoduodenectomy with preoperative obstructive jaundice:drainage or not.Pancreas,2009,38:379-386.
8 Tsai YF,Shyu JF,Chen TH,et al.Effect of preoperative biliary drainage on surgical outcome after pancreaticoduodenectomy.Hepatogastroenterology,2006,53:823-827.
9 Limongelli P,Pai M,Bansi D,et al.Correlation between preoperative biliary drainage,bile duct contamination,and postoperative outcomes for pancreatic surgery.Surgery,2007,142:313-318.
10 Sohn TA,Yeo CJ,Cameron JL,et al.Do preoperative biliary stents increase postpancreaticoduodenectomy complications.Gastrointest Surg,2000,4:258-267.
11 Sewnath ME,Karsten TM,Prins MH,et al.A meta-analysis on the efficacy of preoperative biliary drainage for tumors causing obstructive jaundice.Ann Surg,2002,236:17-27.
12 Roebuck DJ,Stanley P.External and internal-external biliary drainage in children with malignant obstructive jaundice.Pediatr Radiol,2000,30:659-664.
13 Sewnath ME,Birjmohun RS,Rauws EA,et al.The effect of preoperative biliary drainage on postoperative complications after pancreaticoduodenectomy.Am Coll Surg,2001,192:726-734.
14 Tol JA,van Hooft JE,Timmer R,et al.Metal or plastic stents for preoperative biliary drainage in resectable pancreatic cancer.Gut,2016,65:1981-1987.
15 Song TJ,Lee JH,Lee SS,et al.Metal versus plastic stents for drainage of malignant biliary obstruction before primary surgical resection.Gastrointest Endosc,2016,84:814-821.
16 Lee PJ,Podugu A,Wu D,et al.Preoperative biliary drainage in resectable pancreatic cancer:a systematic review and network meta-analysis.HPB(Oxford),2018,20:477-486.
17 Wiggers JK,Groot Koerkamp B,Coelen RJ,et al.Preoperative biliary drainage in perihilar cholangiocarcinoma:identifying patients who require percutaneous drainage after failed endoscopic drainage.Endoscopy,2015,47:1124-1131.