术前梗阻性黄疸对胰十二指肠切除术后手术并发症及病死率的影响  

Influence of obstructive jaundice on postoperative complications and mortality after pancreaticoduodenectomy, analysis of the 25-year single-center data

作　　者：冯健[1] 黄志强[1] 陈永亮[1] 董家鸿[1] 陈明易[1] 王燕生[1] 刘志伟[1] 肖敏[1] 李鸾[1] 辛宪磊[1] 

机构地区：[1]解放军总医院肝胆外科医院,北京100853

出　　处：《中华外科杂志》2012年第4期294-298,共5页Chinese Journal of Surgery

摘　　要：目的探讨术前黄疸严重程度、持续时间及术前胆管引流对胰十二指肠切除术后并发症及病死率的影响。方法回顾性分析1986年6月至2010年12月1025例胰十二指肠切除术患者的临床资料。其中男性659例，女性366例；年龄4-81岁，平均（54±12）岁。1025例患者中恶性病变869例，良性或交界性病变156例。行经典Whipple手术746例，保留幽fJ胰十二指肠切除术279例。根据黄疸严重程度、持续时间、术前减黄与否进行分组，对比各组术后并发症发生情况。统计学方法采用单因素方差分析及X^2。检验。结果术前不同黄疸严重程度的患者，胰十二指肠切除术后出血并发症的发生率存在差异（X^2=11．06，P=0．03）；而术后临床胰漏、腹腔感染、胆漏、胃排窄延迟、切口感染的风险及病死率并无差异。术前黄疸持续时间对术后并发症及病死率无明显影响。术前胆管引流不能减少胰十二指肠切除术后患者并发症及病死率，反而导致术后切口感染发生率增加（X^2=9．84，P=0．00）。胆管引流时间对术后并发症及病死率无明显影响。结论术前黄疸对胰十二指肠切除术后除出血并发症以外的其余并发症及病死率门：无影响。术前胆管引流并不能使患者存胰十二指肠切除术后获益，不应作为常规操作，但对于一般状况差兀法立即实施手术治疗的重度黄疸患者，术前胆管引流仍足必要的。Objective To study the influence of the depth of jaundice, the duration of jaundice and preoperative biliary drainage （ PBD ） on postoperative complications and mortality after pancreaticoduodenectomy （PD）. Methods A retrospective review was performed of the medical reeords of 1025 patients who underwent PD between June 1986 and December 2010. The patients comprised 659 men and 366 women, ranging from 4 to 81 years old with a mean age of （54±12）years. The indications for PD were malignant disease in 869 patients （84. 78% ） and benign or borderline tumors in 156 patients （15.22%）. The operative procedures performed were pylorus-preserving modification in 279 patients and conventional PD, i.e. Whipple＇s operation in 746 patients. Complications after PD were compared among the different groups which was classified according to the depth of obstructive jaundice, the duration of obstructive jaundice and whether undergoing preoperative biliary drain or not, and the analysis was made by variance analysis and X^2 test respectively. Results The depth of jaundice did not significantly affect the incidence of complications after PD except for the hemorrhage complication （ X^2 = 11.06, P = 0. 03 ）. The duration of jaundice had no much influence on the postoperative complications and mortality. PBD could not reduce the postoperative complications and mortality, however, it would increase the incidence of postoperative incision infection （X^2 = 9.84 ,P = 0. 01 ）. No significant relationship was observed between the duration of PBD and the postoperative complications and mortality. Conclusions Either the depth or duration of obstructive jaundice has no relationship with the postoperative complications and mortality afterPD but the postoperative hemorrhage. Patients undergoing PD can not be benefited from PBD. Consequently, PBD should not be performed routinely, but it can be used in some serious patients with severe depth of jaundice who can not received surgery at once.

关 键 词：胰十二指肠切除术 黄疸 阻塞性 引流术 手术后并发症 死f_率 

分 类 号：R656.6[医药卫生—外科学]