中度黄疸患者行术前减黄的前瞻性非随机对照研究  

Clinical significance of preoperative biliary drainage for patients with moderate jaundice： a prospective non-randomized controlled study

作　　者：兰忠民[1] 汤小龙[1] 张建伟[1] 王成锋[1] 

机构地区：[1]中国国家癌症中心北京协和医学院中国医学科学院肿瘤医院胰胃外科,北京100021

出　　处：《中华医学杂志》2015年第2期93-95,共3页National Medical Journal of China

摘　　要：目的 评价术前减黄对中度梗阻性黄疸（术前血清总胆红素水平171 ～ 342 mmol/L）患者的临床价值.方法 采用前瞻性非随机对照的方法,对2012年9月至2014年9月中国医学科学院肿瘤医院胰胃外科收治的273例恶性梗阻性黄疸患者中度梗阻性黄疸105例患者,分为减黄组和未减黄组,通过对比两组患者的术中、术后各项临床指标,进行统计分析.结果 共入组患者105例,包括术前减黄组58例,未减黄组47例;减黄组术前总胆红素水平为（264±76） mmol/L,减黄后总胆红素下降为（183±44） mmol/L,减黄前后的差异有统计学意义（P＜0.001）.减黄组与未减黄组在手术时间、术中出血量、总住院时间、术后住院时间等指标上的差异无统计学意义（P＞0.05）.减黄组无围手术期死亡,未减黄组围手术期死亡2例,两组围手术期死亡率差异无统计学意义（P=0.423）.减黄组并发症共发生16例（27.59％）,与未减黄组14例（29.79％）相比略低,但差异无统计学意义（P=0.471）.分层分析显示,减黄组和未减黄组在单一并发症（伤口感染、出血、胰瘘、胆瘘、胃排空障碍、腹腔感染、肺部感染、心血管并发症等）的发生上均无显著性差异（P＞0.05）.结论 术前减黄对于中度梗阻性黄疸患者的价值有限,患者术前可不行减黄治疗,明确诊断后应尽早手术.Objective To evaluate the preoperative necessity of reducing moderate icterus index （preoperative serum total bilirubin of 171 to 342 mmol/L） in obstructive jaundice patients.Methods A prospective non-randomized control method was used to divide 105 patients into jaundice-reducing （n =58） and non-reducing （n =47） group.And the intraoperative and postoperative parameters were compared between two groups.Results In jaundice-reducing group,the level of total bilirubin decreased from （264 ± 76） mmol/L to （183 ±44） mmol/L after biliary drainage （P 〈 0.001）.There were no significant intergroup differences in operative duration,blood loss,inpatient days or postoperative inpatient days （P 〉 0.05）.There was no perioperative mortality in jaundice-reducing group while two perioperative mortalities occurred in another group.There was no significant inter-group difference in perioperative mortality rate （P =0.423）.The postoperative complication rate of jaundice-reducing group （n =16,27.59%） was slightly lower than that of non-reducing group （n =14,29.79%）.However,the difference was insignificant （P =0.471）.Stratified analysis showed that there was no significant inter-group difference in single complication （wound infection,postoperative hemorrhage,pancreatic fistula,biliary fistula,delayed gastric emptying,abdominal infection,lung infection or cardiovascular complications,etc.） （all P 〉 0.05）.Conclusions The preoperative necessity is limited for reducing moderate icterus index in obstructive jaundice patients.They should be operated as soon as possible once there is a definite diagnosis.

关 键 词：黄疸 阻塞性 胰腺肿瘤 肝胰管壶腹 术前减黄 术后并发症 

分 类 号：R657.4[医药卫生—外科学]