中华消化外科杂志
中華消化外科雜誌
중화소화외과잡지
CHINESE JOURNAL OF DIGESTIVE SURGERY
2013年
3期
210-212
,共3页
朱峰%王敏%彭丰%温松奇%俞亚红
硃峰%王敏%彭豐%溫鬆奇%俞亞紅
주봉%왕민%팽봉%온송기%유아홍
胆管肿瘤,肝门%黄疸%肝切除术%并发症
膽管腫瘤,肝門%黃疸%肝切除術%併髮癥
담관종류,간문%황달%간절제술%병발증
Cholangiocarcinoma,hilar%Jaundice%Hepatectomy%Complications
目的 探讨术前彻底减轻黄疸对肝门部胆管癌半肝切除治疗的影响.方法 回顾性分析2007年1月至2012年1月华中科技大学同济医学院附属同济医院收治的18例行半肝切除术前彻底减轻黄疸的肝门部胆管癌患者(减轻黄疸组)的临床资料,与同期24例半肝切除术前未行减轻黄疸治疗的肝门部胆管癌患者(未减轻黄疸组)的临床资料进行比较.分析两组患者术前、术中情况(手术时间、出血量、输血量)和术后并发症等的差异.计量资料组间比较采用t检验,计数资料采用x2检验.结果减轻黄疸治疗后,患者的平均TBil、DBil、ALT分别为(27±5)μmol/L、(22±6)μmol/L、(52±42) U/L,分别与治疗前的(287±120)μmol/L、(212 ± 86) μmol/L、(267±180) U/L比较,差异有统计学意义(=4.33,6.61,4.19,P＜0.05).减轻黄疸组患者行左半肝切除术14例、右半肝切除术4例,R0切除率为16/18.未减轻黄疸组患者行左半肝切除术11例、右半肝切除术13例,R0切除率为83.3％ (20/24).两组患者R0切除率比较,差异无统计学意义(x2=1.09,P＞0.05).减轻黄疸组和未减轻黄疸组患者手术时间分别为(5.0±0.8)h和(6.3±1.5)h,术中出血量分别为(562±207) ml和(815±463) ml,术中输血量分别为(430±317) ml和(750±146) ml.两组比较,差异均有统计学意义(t=4.77,7.80,4.65,P＜0.05).减轻黄疸组和未减轻黄疸组患者术后并发症发生率分别为3/18和75.0％ (18/24),其中术后出血发生率分别为1/18和33.3％ (8/24),术后肝功能衰竭发生率分别为1/18和33.3％ (8/24),两组比较,差异均有统计学意义(x2=5.14,7.58,7.58,P ＜0.05).结论 肝门部胆管癌患者行半肝切除术前有效减轻黄疸能缩短手术时间,减少术中出血量和术后并发症的发生.
目的 探討術前徹底減輕黃疸對肝門部膽管癌半肝切除治療的影響.方法 迴顧性分析2007年1月至2012年1月華中科技大學同濟醫學院附屬同濟醫院收治的18例行半肝切除術前徹底減輕黃疸的肝門部膽管癌患者(減輕黃疸組)的臨床資料,與同期24例半肝切除術前未行減輕黃疸治療的肝門部膽管癌患者(未減輕黃疸組)的臨床資料進行比較.分析兩組患者術前、術中情況(手術時間、齣血量、輸血量)和術後併髮癥等的差異.計量資料組間比較採用t檢驗,計數資料採用x2檢驗.結果減輕黃疸治療後,患者的平均TBil、DBil、ALT分彆為(27±5)μmol/L、(22±6)μmol/L、(52±42) U/L,分彆與治療前的(287±120)μmol/L、(212 ± 86) μmol/L、(267±180) U/L比較,差異有統計學意義(=4.33,6.61,4.19,P＜0.05).減輕黃疸組患者行左半肝切除術14例、右半肝切除術4例,R0切除率為16/18.未減輕黃疸組患者行左半肝切除術11例、右半肝切除術13例,R0切除率為83.3％ (20/24).兩組患者R0切除率比較,差異無統計學意義(x2=1.09,P＞0.05).減輕黃疸組和未減輕黃疸組患者手術時間分彆為(5.0±0.8)h和(6.3±1.5)h,術中齣血量分彆為(562±207) ml和(815±463) ml,術中輸血量分彆為(430±317) ml和(750±146) ml.兩組比較,差異均有統計學意義(t=4.77,7.80,4.65,P＜0.05).減輕黃疸組和未減輕黃疸組患者術後併髮癥髮生率分彆為3/18和75.0％ (18/24),其中術後齣血髮生率分彆為1/18和33.3％ (8/24),術後肝功能衰竭髮生率分彆為1/18和33.3％ (8/24),兩組比較,差異均有統計學意義(x2=5.14,7.58,7.58,P ＜0.05).結論 肝門部膽管癌患者行半肝切除術前有效減輕黃疸能縮短手術時間,減少術中齣血量和術後併髮癥的髮生.
목적 탐토술전철저감경황달대간문부담관암반간절제치료적영향.방법 회고성분석2007년1월지2012년1월화중과기대학동제의학원부속동제의원수치적18례행반간절제술전철저감경황달적간문부담관암환자(감경황달조)적림상자료,여동기24례반간절제술전미행감경황달치료적간문부담관암환자(미감경황달조)적림상자료진행비교.분석량조환자술전、술중정황(수술시간、출혈량、수혈량)화술후병발증등적차이.계량자료조간비교채용t검험,계수자료채용x2검험.결과감경황달치료후,환자적평균TBil、DBil、ALT분별위(27±5)μmol/L、(22±6)μmol/L、(52±42) U/L,분별여치료전적(287±120)μmol/L、(212 ± 86) μmol/L、(267±180) U/L비교,차이유통계학의의(=4.33,6.61,4.19,P＜0.05).감경황달조환자행좌반간절제술14례、우반간절제술4례,R0절제솔위16/18.미감경황달조환자행좌반간절제술11례、우반간절제술13례,R0절제솔위83.3％ (20/24).량조환자R0절제솔비교,차이무통계학의의(x2=1.09,P＞0.05).감경황달조화미감경황달조환자수술시간분별위(5.0±0.8)h화(6.3±1.5)h,술중출혈량분별위(562±207) ml화(815±463) ml,술중수혈량분별위(430±317) ml화(750±146) ml.량조비교,차이균유통계학의의(t=4.77,7.80,4.65,P＜0.05).감경황달조화미감경황달조환자술후병발증발생솔분별위3/18화75.0％ (18/24),기중술후출혈발생솔분별위1/18화33.3％ (8/24),술후간공능쇠갈발생솔분별위1/18화33.3％ (8/24),량조비교,차이균유통계학의의(x2=5.14,7.58,7.58,P ＜0.05).결론 간문부담관암환자행반간절제술전유효감경황달능축단수술시간,감소술중출혈량화술후병발증적발생.
Objective To investigate the effects of preoperative jaundice relieving on hemihepatectomy of hilar cholangiocarcinoma.Methods The clinical data of 18 patients who received preoperative percutaneous transhepatic cholangiography and drainage (PTCD) or endoscopic nasobiliary drainage (ENBD) before hemihepatectomy at the Tongji Hospital of Huazhong University of Science and Technology from January 2007 to January 2012 were retrospectively analyzed.The condition of the 18 patients (jaundice relieving group) was compared with that of 24 patients (non-jaundice relieving group) who did not receive PTCD or ENBD before hemihepatectomy.The differences in the pre-and postoperative blood loss,blood transfusion,operation time and postoperative incidence of complications between the 2 groups were analyzed.All data were analyzed using the t test or chi-square test.Results After PTCD or ENBD,the levels of total bilirubin (TBil),direct bilirubin (DBil),alanine aminotransferase (ALT) were (27 ± 5) μmol/L,(22 ± 6) μmol/L and (52 ± 42) U/L,which were significantly lower than (287 ± 120)μmol/L,(212 ± 86)μmol/L,and (267 ± 180)U/L before PTCD or ENBD in the jaundice relieving group (t =4.33,6.61,4.19,P ＜0.05).In the jaundice relieving group,left hemihepatectomy was performed on 14 patients,and right hemihepatectomy on 4 patients,and the radical resection rate was 16/18.In the nonjaundice relieving group,left hemihepatectomy was performed on 11 patients,and right hemihepatectomy on 13 patients,and the radical resection rate was 83.3％ (20/24).There was no significant difference in the radical resection rate between the 2 groups (x2 =1.09,P ＞ 0.05).The operation time,volume of intraoperative blood loss,volume of blood transfusion were (5.0 ± 0.8) hours,(562 ± 207) ml and (430 ± 317) ml in the jaundice relieving group,and (6.3 ± 1.5)hours,(815 ± 463)ml and (750 ± 146)ml in the non-jaundice relieving group,with significant differences between the 2 groups (t =4.77,7.80,4.65,P ＜ 0.05).The incidences of postoperative complications,bleeding and postoperative hepatic failure were 3/18,1/18 and 1/18 in the jaundice relieving group,and 75.0％ (18/24),33.3％ (8/24) and 33.3％ (8/24) in the non-jaundice relieving group,with significant differences between the 2 groups (x2=5.14,7.58,7.58,P ＜ 0.05).Conclusion Preoperative jaundice relieving could shorten the operation time and reduce the volume of intraoperative blood loss and the incidence of postoperative complications.
