肝门部胆管癌合并梗阻性黄疸患者术前胆道引流疗效分析  

Efficacy of preoperative biliary drainage for hilar cholangiocarcinoma complicated with obstructive jaundice

作　　者：顾海涛[1] 张金彦[1] 王兆文[1] 陈国庆[1] 徐军明[1] Gu Haitao;Zhang Jinyan;Wang Zhaowen;Chen Guoqing;Xu Junming(Department of General Surgery,Shanghai General Hospital Affiliated to Shanghai Jiao Tong University,Shanghai 200080,China)

机构地区：[1]上海交通大学附属第一人民医院普通外科,200080

出　　处：《中华肝脏外科手术学电子杂志》2021年第1期29-32,共4页Chinese Journal of Hepatic Surgery(Electronic Edition)

基　　金：国家自然科学基金(81400661,81670595,81970568)。

摘　　要：目的探讨术前胆道引流(PBD)对肝门部胆管癌合并梗阻性黄疸患者疗效的影响。方法回顾性分析2010年1月至2019年12月在上海交通大学附属第一人民医院行肝门部胆管癌根治术的204例患者临床资料。其中男99例,女105例;平均年龄(63±13)岁。患者均签署知情同意书,符合医学伦理学规定。根据术前是否行胆道引流分为PBD组(142例)和对照组(62例)。根据不同引流方式将PBD组分为PTCD组(60例)和ERCP组(82例)。观察各组一般情况及围手术期情况。两组住院时间等比较采用t检验,并发症发生率比较采用χ^2检验。结果PBD组术后肝衰竭发生率、围手术期死亡率分别为12.7%(18/142)、5.6%(8/142),明显低于对照组的27.4%(17/62)、14.5%(9/62)(χ^2=6.600,4.457;P<0.05),而术后胆道感染发生率31.7%(45/142)明显高于对照组的17.7%(11/62)(χ^2=4.216,P<0.05),术后住院时间(14±6)d明显长于对照组的(12±5)d(t=2.367,P<0.05)。PTCD组术后出血、胆道感染发生率分别为3.3%(2/60)、21.7%(13/60),明显低于ERCP组的13.4%(11/82)、39.0%(32/82)(χ^2=4.234,4.822;P<0.05)。结论PBD可降低术后肝衰竭发生率和围手术期死亡率,提高手术安全性。PTCD术后胆道感染、出血发生风险较ERCP低。Objective To evaluate the efficacy of preoperative biliary drainage(PBD)in the treatment of hilar cholangiocarcinoma complicated with obstructive jaundice.Methods Clinical data of 204 patients undergoing radical resection of hilar cholangiocarcinoma in Shanghai General Hospital Affiliated to Shanghai Jiao Tong University from January 2010 to December 2019 were retrospectively analyzed.Among them,99 patients were male and 105 female,aged(63±13)years on average.The informed consents of all patients were obtained and the local ethical committee approval was received.All patients were divided into the PBD group(n=142)and control group(n=62)according to whether PBD was performed before operation.According to different drainage methods,patients in the PBD group were divided into the percutaneous transhepatic cholangio drainage(PTCD)subgroup(n=60)and endoscopic retrograde cholangiopancreatography(ERCP)subgroup(n=82).The baseline data and perioperative conditions of patients in each group were observed.The length of hospital stay between two groups were compared by t test.The incidence of postoperative complications between two groups were compared using Chi-square test.Results In the PBD group,the incidence of liver failure and perioperative mortality were 12.7%(18/142)and 5.6%(8/142),significantly lower than 27.4%(17/62)and 14.5%(9/62)in the control group(χ^2=6.600,4.457;P<0.05).The incidence of postoperative biliary infection in the PBD group was 31.7%(45/142),significantly higher than 17.7%(11/62)in the control group(χ^2=4.216,P<0.05).In the PBD group,the length of postoperative hospital stay was(14±6)d,significantly longer than(12±5)d in the control group(t=2.367,P<0.05).The incidence of hemorrhage and biliary infection in PTCD subgroup was 3.3%(2/60)and 21.7%(13/60),significantly lower than 13.4%(11/82)and 39.0%(32/82)in ERCP subgroup(χ^2=4.234,4.822;P<0.05).Conclusions PBD can reduce the incidence of liver failure and perioperative mortality and improve the surgical safety.The risk of biliary infection and b

关 键 词：胆管肿瘤 肝门部胆管癌 黄疸 阻塞性 引流术 

分 类 号：R735.8[医药卫生—肿瘤]