低位胆道梗阻行胰十二指肠切除术前不同胆管引流方式疗效观察  

Effects of different biliary drainage methods before pancreaticoduodenectomy for low biliary obstruction

作　　者：张喜龙 卢冰 李海[1] 王修齐[2] 刘健[3] ZHANG Xi-long;LU Bing;LI Hai;WANG Xiu-qi;LIU Jian(Department of Hepatobiliary and Pancreatic Surgery,Henan University People’s Hospital,Henan Provincia l People’s Hospital,Zhengzhou,Henan 450003,China;Department of Gastroenterology,Henan Provincial People’s Hospital,Henan University People’s Hospital,Zhengzhou,Henan 450003,China;Department of Comprehensive Intervention,Henan Provincial People’s Hospital,Henan University People’s Hospital,Zhengzhou,Henan 450003,China;不详)

机构地区：[1]河南大学人民医院河南省人民医院肝胆胰腺外科,河南郑州450003 [2]河南省人民医院消化内科河南大学人民医院,河南郑州450003 [3]河南省人民医院综合介入科河南大学人民医院,河南郑州450003

出　　处：《中华实用诊断与治疗杂志》2021年第4期394-397,共4页Journal of Chinese Practical Diagnosis and Therapy

基　　金：河南省科技厅科技攻关项目(112102310606)。

摘　　要：目的观察低位胆道梗阻合并高胆红素血症患者行胰十二指肠切除术前不同引流方式对血清总胆红素水平及围术期并发症的影响。方法低位胆道梗阻合并高胆红素血症患者94例,行胰十二指肠切除术前均行胆管引流降低血清总胆红素水平,其中53例行经皮经肝穿刺胆管引流(percutaneous transhepatic biliary drainage, PTBD)术者为PTBD组,41例行内镜鼻胆管引流(endoscopic naso-biliary drainage, ENBD)术者为ENBD组;ENBD组38例因影像学诊断不明确者ENBD术中行活检组织病理检查。比较2组胆管引流后血清总胆红素水平及并发症发生情况;比较2组胰十二指肠切除术手术时间、术中出血量、术中输血史、术后并发症及Clavien-Dindo分级。结果 2组患者胆管引流术后血清总胆红素、谷丙转氨酶水平及胆管炎、胰腺炎发生率比较差异均无统计学意义(P>0.05);ENBD组引流时间[(8.5±1.9)d]长于PTBD组[(5.9±1.4)d](P<0.05);ENBD组38例活检组织病理结果显示,十二指肠乳头癌28例,壶腹癌6例,均与胰十二指肠切除术后组织病理结果一致,另4例未发现恶性肿瘤细胞。ENBD组胰十二指肠切除术后切口感染(17.1%)、腹腔感染(19.5%)、胆漏(17.1%)、脓毒症(14.6%)、Clavien-DindoⅠ~Ⅲa级并发症(48.8%)发生率均高于PTBD组(3.8%、3.8%、3.8%、1.9%、17.0%)(P<0.05),住院时间[(32.0±5.1)d]长于PTBD组[(26.0±3.3)d](P<0.05);2组手术时间、术中出血量及术中输血比率、发生胰漏、术后出血、胃排空延迟、Clavien-DindoⅢb~Ⅴ级并发症比率比较差异均无统计学意义(P>0.05)。结论 PTBD和ENBD均可有效降低低位胆道梗阻合并高胆红素血症患者血清总胆红素水平,对术前尚未明确组织病理诊断的患者可行ENBD,但应重视胰十二指肠切除术围术期感染并发症的预防及治疗。Objective To observe the influences of different drainage methods before pancreaticoduodenectomy on serum total bilirubin levels and perioperative complications in patients with low biliary obstruction and hyperbilirubinemia. Methods Ninety-four patients with low biliary obstruction and hyperbilirubinemia underwent biliary drainage before pancreaticoduodenectomy to reduce serum total bilirubin levels, in which 53 patients underwent percutaneous transhepatic biliary drainage(PTBD)(PTBD group), and 41 patients underwent endoscopic nasal-biliary drainage(ENBD)(ENBD group). Thirty-eight patients in ENBD group received tissue biopsy and pathological examination due to unclear imaging diagnosis. The serum total bilirubin levels and complications after biliary drainage were compared between two groups. The lasting time of pancreaticoduodenectomy, intraoperative blood loss, intraoperative blood transfusion, postoperative complications and Clavien-Dindo classification were compared between two groups. Results There were no significant differences in serum total bilirubin level, alanine aminotransferase level, and the incidences of cholangitis and pancreatitis between two groups after biliary drainage(P>0.05).The drainage time was longer in ENBD group((8.5±1.9)d)than that in PTBD group((5.9±1.4)d)(P<0.05).The histopathological results of 38 cases in ENBD group showed 28 cases of duodenal papillary carcinoma and 6 cases of ampullary carcinoma, which were in accordance with the histopathological results after pancreaticoduodenectomy,and no malignant tumor cells were found in the other 4 cases.The incidences of incision infection(17.1%),abdominal cavity infection(19.5%),bile leakage(17.1%),sepsis(14.6%),and Clavien-Dindo gradeⅠ-Ⅲa complications(48.8%)after pancreaticoduodenectomy in ENBD group were higher than those in PTBD group(3.8%,3.8%,3.8%,1.9%,17.0%)(P<0.05),and the hospital stay was longer in ENBD group((32.0±5.1)d)than that in PTBD group((26.0±3.3)d)(P<0.05).There were no significant differences in the operati

关 键 词：低位胆道梗阻 高胆红素血症 胰十二指肠切除术 内镜下鼻胆管引流 经皮经肝穿刺胆管外引流 并发症 

分 类 号：R735.9[医药卫生—肿瘤] R735.0[医药卫生—临床医学]