CAJ | 학술논문

目的评价经皮肝穿刺胆道置管引流(percutaneous transhepatic biliary drainage,PTBD)作为胰十二指肠切除术前减黄手段对于手术后结果的影响.方法收集本院2001至2009年115例因胰头癌、胆管远端癌、壶腹癌、十二指肠乳头癌而行胰十二指肠切除患者的临床资料.患者术前采用PTBD作为减黄手段或未进行任何减黄处理,术前或引流前血清胆红素至少＞100 μmol/L且术前无胆管炎表现.115例患者分为PTBD组(42例),早期手术组(73例).对两组间胆瘘、胰瘘、腹腔感染、切口并发症、胃瘫、总并发症、围手术期死亡率、住院时间、住院费用等指标应用PEMS 3.1医学统计软件包进行统计检验.结果围手术期死亡率PTBD组为2.38％(1例),早期手术组为2.74％(2例),差异无统计学意义.总并发症率PTBD组为54.76％(23例),早期手术组为50.68％(37例),差异无统计学意义.胆瘘、胰瘘、腹腔感染、切口并发症、胃瘫等观察指标也未显示统计学差异.在住院时间和住院费用方面,早期手术组明显优于PTBD组(P＜0.05),差异有统计学意义.结论 PTBD术前减黄对于降低因壶腹周围癌行胰十二指肠切除术术后并发症的作用有限.如果不存在胆管炎或手术需要推迟的原因,术前不需要常规PTBD减黄治疗.
목적 평개경피간천자담도치관인류(percutaneous transhepatic biliary drainage,PTBD)작위이십이지장절제술전감황수단대우수술후결과적영향.방법 수집본원2001지2009년115례인이두암、담관원단암、호복암、십이지장유두암이행이십이지장절제환자적림상자료.환자술전채용PTBD작위감황수단혹미진행임하감황처리,술전혹인류전혈청담홍소지소＞100 μmol/L차술전무담관염표현.115례환자분위PTBD조(42례),조기수술조(73례).대량조간담루、이루、복강감염、절구병발증、위탄、총병발증、위수술기사망솔、주원시간、주원비용등지표응용PEMS 3.1의학통계연건포진행통계검험.결과 위수술기사망솔PTBD조위2.38％(1례),조기수술조위2.74％(2례),차이무통계학의의.총병발증솔PTBD조위54.76％(23례),조기수술조위50.68％(37례),차이무통계학의의.담루、이루、복강감염、절구병발증、위탄등관찰지표야미현시통계학차이.재주원시간화주원비용방면,조기수술조명현우우PTBD조(P＜0.05),차이유통계학의의.결론 PTBD술전감황대우강저인호복주위암행이십이지장절제술술후병발증적작용유한.여과불존재담관염혹수술수요추지적원인,술전불수요상규PTBD감황치료.
Objective To evaluate the effect of preoperative percutaneous transhepatic biliary drainage (PTBD) on postoperative outcomes after pancreaticoduodenectomy.Methods The clinical data of 115 patients undergoing pancreatoduodenectomy between 2001 and 2009 were retrospectively analyzed.The diagnosis of periampullary cancer or cancer of the pancreatic head was confirmed histologically.The preoperative total bilirubin level was more than 100 μmol/L and there was no concomitant cholangitis.Forty-two patients underwent PTBD (PTBD group),and 73 were not drained (early operation group).The following parameters were analyzed:wound infection,intra-abdominal abscess,intra-abdominal or gastrointestinal bleeding,biliary or pancreatic leakage,gastroparesis,morbidity and mortality.The length of hospital stay and cost were also assessed.Results The perioperative mortality and morbidity were 2.38％/54.76％ in the PTBD group and 2.74％/50.68％ in the early operative group,respectively.There were no significantly differences between these two groups.Similar results were obtained in biliary leak,pancreatic leak,intra-abdominal infection,wound infection and gastroparesis.The length of hospital stay and cost were significantly less in the early operation group than the PTBD group.Conclusions PTBD had no beneficial effects on postoperative outcomes following pancreaticoduodenectomy.For distal biliary obstruction,PTBD should not be carried out routinely.