术前胆道引流方式对合并梗阻性黄疸病人胰十二指肠切除术的影响  

Effect of biliary drainage methods on patients with obstructive jaundice undergoing pancreaticoduodenectomy

作　　者：赵诗葳 沈子贇 王建承[1,2] 彭承宏 张俊[1,2] 吴卫泽[1,2] ZHAO Shiwei;SHEN Ziyun;WANG Jiancheng;PENG Chenghong;ZHANG Jun;WU Weize(Department of Surgery,Pancreatic Disease Center,Ruijin Hospital,Shanghai Jiao Tong University School of Medicine;Research Institute of Pancreatic Diseases,Shanghai Jiao Tong University School of Medicine,Shanghai 200025,China)

机构地区：[1]上海交通大学医学院附属瑞金医院外科,胰腺疾病诊疗中心 [2]上海交通大学医学院胰腺疾病研究所,上海200025

出　　处：《外科理论与实践》2020年第4期301-305,共5页Journal of Surgery Concepts & Practice

基　　金：国家自然科学基金(81670581)。

摘　　要：目的:研究术前胆道引流方式对围术期并发症发生的影响。方法:回顾本中心2012年1月至2019年12月共448例术前胆道引流低位恶性梗阻性黄疸病人完成胰十二指肠切除术的临床资料。238例行经皮肝穿刺胆道引流术(percutaneous transhepatic cholangial drainage,PTCD),210例行内镜逆行胰胆管造影术(endoscopic retrograde cholangiopancreatography,ERCP)引流。行ERCP引流的病人中,101例行内镜胆道支架置入术(endoscopic biliary stenting,EBS),其余109例接受鼻胆管胆道引流术。分析不同胆道引流方式的操作失败率及围术期并发症发生。结果:相比于PTCD,ERCP的操作失败率较高(P=0.034)。ERCP术后胰瘘及再次手术发生率较高(P=0.005和P=0.025)。亚组分析,EBS组的术后总体并发症发生率比PTCD组高(P=0.014),主要体现在胰瘘及再次手术发生率(P<0.001和P=0.041)。其他并发症发生率差异无统计学意义。结论:对于低位恶性梗阻性黄疸病人,在胰十二指肠切除术前使用PTCD进行胆道引流比ERCP有更大的优势。Objective To explore the impact of preoperative biliary drainage methods on perioperative complications.Methods Clinical data of 448 patients of malignant distal biliary obstruction with jaundice who underwent pancreaticoduodenectomy and received preoperative biliary drainage were collected from January 2012 to December 2019.Among them,238 patients received percutaneous transhepatic cholangial drainage(PTCD)as PTCD group and 210 patients received endoscopic retrograde cholangiopancreatography(ERCP)as ERCP group,including 101 cases with endoscopic biliary stenting(EBS)as EBS group and 109 cases with endoscopic nasobiliary drainage.The intervention unsuccess rate and perioperative complications of different biliary drainage methods were analyzed.Results Intervention unsuccess rate of ERCP was higher than that of PTCD(P=0.034).Postoperative pancreatic fistula rate and reoperation rate were higher in ERCP group than those in PTCD group,respectively(P=0.005 and P=0.025).In analysis of subgroup,overall postoperative complication rate in EBS group was higher than that in PTCD group(P=0.014),and pancreatic fistula rate and reoperation rate in EBS group were higher than those in PTCD group(P<0.001 and P=0.041).There was no statistical difference in other complications between groups.Conclusions PTCD could be used as biliary drainage method with greater advantage than ERCP for the patients of malignant distal biliary obstruction with jaundice before pancreaticoduodenectomy.

关 键 词：梗阻性黄疸 胆道引流 经皮肝穿刺胆道引流术 内镜逆行胰胆管造影术 内镜胆道支架置入术 

分 类 号：R575[医药卫生—消化系统]