肝门部胆管癌术前减黄临床价值  

Effect of preoperative biliary drainage on hilar cholangiocarcinoma in patients underwent resection operation

作　　者：陈东[1] 彭宝岗[1] 李绍强[1] 梁力建[1] 殷晓煜[1] 汤地[1] 吕明德[1] 黄洁夫[1] 

机构地区：[1]中山大学附属第一医院肝胆外科,广东广州510080

出　　处：《中国实用外科杂志》2007年第10期805-808,共4页Chinese Journal of Practical Surgery

摘　　要：目的探讨术前减黄对肝门部胆管癌手术切除病人的影响。方法回顾中山大学附属第一医院1999年1月至2005年12月58例血清总胆红素(TB)>85μmol/L的肝门部胆管癌手术切除病人临床资料,分析并发症的发生情况以及减黄和其他因素对术后并发症、病死率的影响。结果术前减黄31例(53.4%,31/58),平均减黄9d,减黄组术前的TB下降为(214±125)μmol/L,与减黄前的(292±103)μmol/L及未减黄组术前的(382±174)μmol/L相比差异有显著性意义。术前减黄可降低天冬氨酸转氨酶(AST)、γ-谷氨酰转肽酶(GGT)、丙氨酸转氨酶(ALP)、直接胆红素(DB)水平。术后并发症总发生率为55.2%(32/58);减黄组为58.1%(18/31),未减黄组为51.9%(14/27),两组之间差异无显著性意义。单个并发症总发生率两组之间差异亦无显著性意义。影响术后病死率的危险因素为肝切除,影响术后肾功能不全的危险因素为TB>340μmol/L。结论术前减黄可以有效降低胆红素水平及改善肝门部胆管癌手术切除病人术前的肝功能;肝门部胆管癌切除手术的风险性较高;术前胆红素过高易引发术后肾功能不全;术前是否减黄与术后并发症发生率不相关。Objective To investigate the effect of preoperative biliary drainage （PTBD） on hilar cholangiocarcinoma in patients underwent resection operation. Methods Data of 58 cases of patients with hilar cholangiocareinoma underwent resection operation whose total bilirubin （TB） over 85μmoL/L was collected from Jan, 1999 to Dec, 2005, the postoperative morbidity and the potential effect of PTBD on morbidity were analyzed, Results Thirty-one （53, 4%, 31/58 ） cases received PTBD procedure and the mean drainage duration was 9 days. The total bilirubin was significantly reduced from （292 ± 103 ） μmoL/L to（214 ± 125 ） μmoL/L and was significantly lower than 382 ± 174μmoL/L of non-PTBD group, the PTBD procedure can reduce the level of AST, GGT, ALP, DB. The overall postoperative morbidity was 55.2% （32/58）. The morbidity in PTBD group was 58% （ 18/31 ） and 52% （ 14/27 ） in non-PTBD group and there was no significance between the two groups, and so did in the single complication, The hospital stay duration was significantly longer in the PT- BD group than in the non-PTBD group, whether hepatectomy or not was important risk factor for postoperative death and TB over 340μmol/L was important risk factor for postoperative renal dysfuntioin. Conclusion PTBD procedure can reduce the total bilirubin level and improve the hepatic function of the patients. The resection operation of hilar cholangio- carcinoma was still a procedure with high risk. The high TB level can increase the possibility of postoperative renal dysfunction. However, there was no relationship between PTBD procedure and postoperative complication and death.

关 键 词：梗阻性黄疸 术前胆道引流 肝门部胆管癌 肝切除 

分 类 号：R6[医药卫生—外科学]