手术减黄对高龄患者安全性及有效性分析  

Effects of surgical bypass in obstructive jaundice for elderly patients

作　　者：马浩越 李锦粱 冯玉杰[2] 马凯[2] 张炳远[2] MA Hao-yue;LI Jin-liang;FENG Yu-jie;MA Kai;ZHANG Bing-yuan(Department of Medicine,Qingdao University,Qingdao 266071,China;Department of Hepatobiliary and Pancreatic Surgery,the Affiliated Hospital of Qingdao University,Qingdao 266003,China)

机构地区：[1]青岛大学医学部,山东青岛266071 [2]青岛大学附属医院肝胆胰外科,山东青岛266003

出　　处：《中国现代普通外科进展》2020年第2期118-121,共4页Chinese Journal of Current Advances in General Surgery

摘　　要：目的:探究胆总管-空肠Roux-en-Y吻合术对高龄恶性胆道梗阻(MBO)患者进行姑息性减黄的安全性与有效性。方法:2012年10月—2017年6月,178例MBO患者行胆囊切除术加胆总管-空肠Roux-en-Y吻合术,分为高龄组(≥70岁,61例)及低龄组(<70岁,117例)。分析两组患者术前情况(术前相关风险因素、临床表现、检验结果、影像学资料)、术中情况(手术时间、出血量)、术后相关指标(胆红素下降程度、总花费、住院时间、相关并发症、出院后在入院等)。结果:高龄组术前相关风险因素,如高血压、心脏病、肺部疾病、脑血管疾病、腹部手术史患病率明显高于低龄组(P<0.05)。两组术前相关临床表现、检验结果、影像学结果差异无统计学意义(P>0.05)。手术时间、术中出血量、术后胆红素下降、术后相关并发症发生率、住院日、总花费、胃肠道功能恢复时间、出院后再次入院两组差异无统计学意义(P>0.05)。结论:高龄患者手术风险明显较高,但术后减黄疗效佳,并发症发生率低,且与低龄组无明显差异。胆总管-空肠Roux-en-Y吻合术对高龄恶性胆道梗阻患者进行姑息性减黄是安全有效。Objective:To explore the safety and efficacy of Roux-en-Y choledochojejunostomy for palliation of jaundice in elderly patients with malignant biliary obstruction.Methods:178 patients with malignant biliary obstruction in our hospital from October 2012 to June 2017 were included in the study.All patients met the diagnostic criteria and indications of palliative treatment for malignant biliary obstruction.Cholecystectomy and choledochojejunostomy were performed for pallia tive jaundice reduction. According to the age of the patients, they were divided into the elderly group(n=61) and the younger group(n=117). The age of patients in the elderly group was over 70 years old, and the age of patients in the younger group was less than 70 years old. The preoperative conditions(preoperative risk factors, clinical manifestations, blood work, imaging data), intraoperative conditions(duration of surgery, bleeding loss), postoperative related indicators(bilirubin level decline, hospital expenses, total hospital stay, related complications, admission after discharge, etc.) were compared and analyzed between the two groups. Results: Preoperative risk factors such as hypertension, heart disease, pulmonary disease, cerebrovascular disease, abdominal surgery history in the elderly group were significantly higher than those in the younger group(P<0.05), and so the elderly group has higher surgical risks. There were no significant differences in preoperative clinical manifestations, blood work and imaging results between the two groups(P>0.05). There were no significant differences in operation time and bleeding volume(P>0.05). There were no significant differences between the two groups. The incidence of postoperative complications was lower in both groups and there were no significant differences between the two groups(P>0.05). There were no significant differences in total hospital stay, hospital expenses, recovery time of gastrointestinal function and readmission after discharge between the two groups(P>0.05). Conclusin: The ope

关 键 词：恶性胆道梗阻 胆总管-空肠Roux-en-Y吻合术 高龄患者 

分 类 号：R735.8[医药卫生—肿瘤]