选择性胆道引流在肝门部胆管癌联合肝切除术中的临床价值  

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

作　　者：赵传宗[1] 贺兆斌[1] 洪建国[1] 彭程[1] 刘恩宇[1] 牛军[1] 

机构地区：[1]山东大学齐鲁医院肝胆外科,山东济南250012

出　　处：《中国现代普通外科进展》2013年第3期206-209,共4页Chinese Journal of Current Advances in General Surgery

摘　　要：目的:探讨选择性胆道引流是否能够降低行联合肝切除的肝门部胆管癌患者术后的并发症以及病死率。方法:回顾山东大学齐鲁医院2007年1月—2012年1月116例血清总胆红素(TB)在85μmol/L以上行联合肝切除的肝门部胆管癌病人的临床资料,分析选择性胆道引流对肝功能以及术后并发症、病死率的影响。结果:直接手术组54例,引流组62例,平均引流9 d,引流组术前的TB下降为(214±115)μmol/L,与引流前的(290±100)μmol/L相比差异有统计学意义。选择性胆道引流可降低天冬氨酸转氨酶(AST)、谷氨酰转肽酶(GGT)、丙氨酸转氨酶(ALP)、总胆红素(TB)、直接胆红素(DB)水平。术后并发症总发生率为55.2%(64/116),引流组为58.1%(36/62),手术组为51.9%(28/54),2组之间差异无统计学意义,单个并发症总发生率2组之间差异亦无统计学意义。引流组死亡6例(9.7%),手术组死亡6例(11.1%),2组病死率比较差异无统计学意义(P=0.859)。结论:选择性胆道引流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,但不能降低术后并发症以及病死率。Objective： To investigate the effect of preoperative selective biliary drainage on hilar cholangiocarcinoma in patients who underwent liver resection operation. Methods： Data of 116 cases of patients with hilar cholangiocarcinoma underwent liver resection operation whose total bilirubin（TB） over 85 μ mol/L was collected from Jan, 2007 to Jan, 2012, the postoperative morbidity and mortality were analyzed. Results： 62 （53.4%） cases received SBD procedure and the mean drainage duration was 9 days. The total bilirubin was significantly reduced from （290 ± 100）umol/L to （214 ± 115）umol/L, the SBD procedure can reduce the level of AST, GGT, ALP, DB. The overall postoperative morbidity was 55.2% （64/116）. The morbidity in SBD group was 58.1% （36/62） and 51.9% （28/54） in direct-operation group and there was no significant difference between the two groups. Conclusion,： SBD procedure can reduce the total bilirubin level and improve the hepatic function of the patients. However, it can not reduce the postoperative complication and death.

关 键 词：梗阻性黄疸 选择性胆道引流 肝门部胆管癌 肝切除 

分 类 号：R735.7[医药卫生—肿瘤]