胰十二指肠切除术前胆道引流在不同程度梗阻性黄疸患者中的应用价值分析  

Evaluation of the application value of preoperative biliary drainage in patients with different degrees of obstructive jaundice undergoing pancreaticoduodenectomy

作　　者：马洪运 莫代海 何达 宋彬 MA Hongyun;MO Daihai;HE Da;SONG Bin(Department of Hepatopancreatobiliary and Splenic Surgery,the First Affiliated Hospital of Naval Medical University,Shanghai 200433,China)

机构地区：[1]中国人民解放军海军军医大学第一附属医院肝胆胰脾外科,上海200433

出　　处：《中国普通外科杂志》2024年第3期330-340,共11页China Journal of General Surgery

基　　金：国家自然科学基金资助项目(8207111884,6190030641)。

摘　　要：背景与目的:梗阻性黄疸是胰头及壶腹周围恶性肿瘤常见的临床特征,可引起机体各种病理生理变化,从而增加胰十二指肠切除术(PD)后并发症发生风险。然而,对此类患者行术前胆道引流(PBD)是否有益以及行PBD的指征,以往一些研究结果存在较大差异,因此,本研究进一步在不同程度黄疸患者中分析行PBD的必要性及应用指征。方法:回顾性分析中国人民解放军海军军医大学第一附属医院肝胆胰脾外科2016—2018年358例行PD的梗阻性黄疸患者(包括行PBD患者与直接手术患者)的临床资料。根据术前血清总胆红素(TBIL)水平(行PBD患者引流前TBIL水平),将患者分为轻度黄疸组(TBIL<250μmol/L)与重度黄疸组(TBIL≥250μmol/L),分别比较两组患者中行PBD的患者与直接手术患者间的相关临床指标。结果:轻度黄疸组183例,其中行PBD 34例、直接手术149例;重度黄疸组175例,其中行PBD 75例、直接手术组100例。轻度黄疸组与重度黄疸组中,行PBD的患者与直接手术患者间的术前基本资料、术中指标、术后病理方面部分存在差异(部分P<0.05)。术后结局指标方面,轻度黄疸组中行PBD的患者与直接手术患者间术后总并发症、严重并发症、各项并发症与围手术期死亡的发生率,以及术后输血率与术后住院时间的差异均无统计学意义(均P>0.05),但重度黄疸组中行PBD患者的总体并发症发生率、术后出血发生率、术后输血率、胃排空障碍发生率均明显低于直接手术患者(均P<0.05)。多因素回归分析显示,PBD是重度梗阻性黄疸患者PD术后总体并发症(OR=0.444,95%CI=0.237~0.832,P=0.011)和术后出血(OR=0.293,95%CI=0.088~0.978,P=0.046)的独立影响因素。结论:对于轻度黄疸患者,PD术前行PBD受益有限,不建议常规行PBD;对于重度黄疸患者,行PBD能有效改善PD术后的结局指标,建议以TBIL≥250μmol/L为行PBD的指征。Background and Aims:Obstructive jaundice is a common clinical feature of malignant tumors of the head of the pancreas and periampullary region,which can lead to various pathophysiological changes in the body,thereby increasing the risk of complications after pancreaticoduodenectomy(PD).However,there have been significant discrepancies in previous studies regarding the benefits of preoperative biliary drainage(PBD) in such patients and the indications for PBD.Therefore,this study was conducted to further analyze the necessity and indications for PBD in patients with different degrees of jaundice.Methods:The clinical data of 358 patients with obstructive jaundice who underwent PD in the First Affiliated Hospital of Naval Medical University from 2016 to 2018 were retrospectively analyzed(including patients undergoing PBD and those undergoing direct surgery).Based on preoperative serum total bilirubin(TBIL) level(TBIL level before drainage for patients undergoing PBD),the patients were divided into mild jaundice group(TBIL <250 μmol/L) and severe jaundice group(TBIL ≥250 μmol/L).The main clinical variables between patients undergoing PBD and those undergoing direct surgery were compared in both groups separately.Results:There were 183 cases in the mild jaundice group,including 34 cases undergoing PBD and 149 cases undergoing direct surgery,and 175 cases in the severe jaundice group,including 75 cases undergoing PBD and 100 cases undergoing direct surgery.In both the mild and severe jaundice groups,there were some differences in preoperative baseline data,intraoperative indicators,and postoperative pathology between patients who underwent PBD and those who underwent direct surgery(some P<0.05).Regarding postoperative outcomes,there were no statistically significant differences in the incidence rates of total complications,severe complications,specific complications,and perioperative death,as well as transfusion rate,and length of hospital stay between patients who underwent PBD and those who underwent direct surge

关 键 词：黄疸 阻塞性 胰十二指肠切除术 引流术 手术后并发症 

分 类 号：R657.5[医药卫生—外科学]