PTCD与ENBD减轻黄疸对腹腔镜胰十二指肠切除术围手术期影响的比较研究  

A study comparing PTCD with ENBD on jaundiced patients before laparoscopic pancreaticoduodenectomy

作　　者：杜成旭 李佳璇 李冬瑞[1] 苏明浩 牙学强 王文斌[1] 刘建华[1] Du Chengxu;Li Jiaxuan;Li Dongrui;Su Minghao;Ya Xueqiang;Wang Wenbin;Liu Jianhua(Department of Hepatobiliary Surgery,the Second Hospital of Hebei Medical University,Shijiazhuang 050000,China;Hebei Medical University,Shijiazhuang 050011,China)

机构地区：[1]河北医科大学第二医院肝胆外科,石家庄050000 [2]河北医科大学,石家庄050011

出　　处：《中华肝胆外科杂志》2022年第2期113-116,共4页Chinese Journal of Hepatobiliary Surgery

基　　金：河北省自然科学基金(H2019206571);河北省重点研发计划项目(19277758D)。

摘　　要：目的对比分析经皮经肝胆管引流(PTCD)与内镜鼻胆管引流(ENBD)减轻黄疸对腹腔镜胰十二指肠切除术(LPD)患者围手术期的影响。方法回顾性分析2016年1月至2020年12月河北医科大学第二医院收治的173例减黄后行LPD患者的临床资料,其中男性100例,女性73例,年龄(60.4±10.8)岁。根据减黄方式不同分为PTCD组(n=126)和ENBD组(n=47)。比较分析两组患者的手术时间、术中出血量及输血量、R0切除率、术后并发症等临床资料。结果两组患者均顺利完成LPD,无中转开腹病例。两组患者行LPD的手术时间、术中出血量及输血量、R0切除率、肿瘤性质、住院时间比较差异无统计学意义(P>0.05)。术后PTCD组胰瘘发生率10.3%(13/126)低于ENBD组25.5%(12/47),差异有统计学意义(P=0.011)。PTCD组术后出血发生率8.7%(11/126)低于ENBD组25.5%(12/47),差异有统计学意义(P=0.004)。两组患者并发症Clavien-Dindo系统分级比较,差异有统计学意义(P=0.008)。结论对于合并黄疸拟行LPD的患者,术前行PTCD减黄较ENBD减黄可降低LPD术后胰瘘发生率及术后出血的风险,更有利于术后恢复。Objective To compare and analyze the perioperative outcomes of jaundiced patients undergoing laparoscopic pancreaticoduodenectomy(LPD)using preoperative percutaneous transhepatic cholangial drainage(PTCD)versus endoscopic nasobiliary drainage(ENBD).Methods The perioperative data of 173 patients who underwent LPD at the Second Hospital of Hebei Medical University from January 2016 to December 2020 and were treated preoperatively with either PTCD versus ENBD to alleviate jaundiced were retrospectively analyzed.There were 100 males and 73 females,with age of(60.4±10.8)years old.These patients were divided into the PTCD group(n=126)and the ENBD group(n=47).Clinical data including operation time,blood loss,transfusion volume,R0 resection,and postoperative complications were compared.Results There was no convension to open surgery.There were no significant differences in operation time,blood loss,transfusion volume,R0 resection rate,pathological results and hospital stay between the two groups(P>0.05).For the PTCD group,the pancreatic fistula rate was 10.3%(13/126)and the post-operative hemorrhage rate was 8.7%(11/126).They were both significantly lower than those of the ENBD group[25.5%(12/47)and 25.5%(12/47)respectively,P<0.05].There were also significant differences in the postoperative complications according to the Clavien-Dindo classification system between the two groups(P=0.008).Conclusion Compared with ENBD,PTCD had the advantages of lower post-operative pancreatic fistula and post-operative hemorrhage rates,resulting in a better postoperative recovery.

关 键 词：黄疸 腹腔镜检查 胰十二指肠切除术 经皮经肝胆管引流 内镜鼻胆管引流 

分 类 号：R657.5[医药卫生—外科学]