恶性梗阻性黄疸手术死亡、术后并发症及相关因素分析  

POSTOPERATIVE MORTALITY, MORBIDITY IN MALIGNANT OBSTRUCTIVE JAUNDICE AND RELEVANT FACTORS

作　　者：任智[1] 徐计秀[1] 李正中[1] 赵秉化[1] 李士骏[1] 

机构地区：[1]山西医科大学第一临床医学院普外科

出　　处：《中国癌症杂志》1997年第3期180-182,共3页China Oncology

摘　　要：目的探讨引起恶性梗阻性黄疸手术死亡与术后并发症的相关因素。方法回顾性地复习连续手术治疗的恶性梗阻性黄疸９７例，重点分析手术死亡、术后并发症及相关因素之间的关系。结果胰头或壶腹周围癌行Ｗｈｉｐｐｌｅ手术治疗３０例。胆囊癌或胆管癌行切除术１６例，内、外引流术各为１５例和１６例，单纯剖腹探查２０例。死亡８例（８．２％），血尿素氮（ＢＵＮ）增高者６２．５％，胆红素总量＞２００μｍｏｌ／Ｌ者６２．５％。与死亡有关的术后并发症有：急性肾功能衰竭、消化道出血、肝昏迷、高血糖症、感染性休克、切口哆开。术后并发症组死亡率明显高于无并发症组（Ｐ＜０．０００１）。死亡组术前胆红素总量和ＢＵＮ明显高于无并发症组和有并发症存活组（Ｐ＜０．００２，Ｐ＜０．０００１）。结论恶性梗阻性黄疸时发生的内毒素血症与急性肾功能衰竭、消化道出血、感染等并发症密切相关。术后并发症组死亡率明显高于无并发症组。胆红素总量和ＢＵＮ增高是手术死亡的高危因素。PURPOSE To study the relationship of factors affecting postoperative mortality and morbidity in malignant obstructive jaundice. METHODS 97 patients with malignant obstructive jaundice were reviewed.Mortality,morbidity and their relationship to relevant factors were studied. RESULTS 30 patients with cancer in the head of pancreas and periampulla underwent Whipple procedure. Patients with cancer in the gallbladder and common bile duct underwent tumor resection in 16,internal and external biliary drainage in 15 and 16 respectively,and exploratory laparotomy in the other 20 cases. In the 8 patients who died (8.2%),bilirubin level was elevated over 200 μmol/L in five(62.5%); BUN level elevated in five patients (62.5%). Postoperative complications associated with surgical mortality included acute renal failure, gastrointestinal hemorrhage,hepatic coma,hyperglycemia, septic shock, and wound dehiscence. Mortality was much higher in malignant jaundice patients with postoperative complications than those without postoperative complications ( P <0 0001) The preoperative levels of serum bilirubin and BUN were significantly higher in malignant jaundiced dead patients with postoperative complications than those without postoperative complications and those with complications but not dead(BIL P <0 002;BUN P <0 0001) CONCLUSIONS Because of absence of intraluminal bile salts and depressed Küpffer cell clearance capacity in the liver, endotoxemia occurs. Endotoxemia was responsible for morbidity such as renal failure, gastrointestinal hemorrhage and sepsis. Mortality was much higher in malignant jaundice patients with postoperative complications than those without. Increase in serum bilirubin and BUN are high risk factors for operative mortality.

关 键 词：胆管梗阻 肿瘤 术后并发症 外科手术 胆道肿瘤 

分 类 号：R735.805[医药卫生—肿瘤]