不同黄疸程度和胆道引流方式对梗阻性黄疸患者围手术期相关指标的影响  

Effect of different degrees of jaundice and biliary drainage methods on perioperative related indicators in patients with obstructive jaundice

作　　者：汪栋[1] 呼昱衡 林华骏 管成剑 张小东 张轶西 郭伟[1] WANG Dong;HU Yu-heng;LIN Hua-jun(Department of General Surgery,Beijing Friendship Hospital,Capital Medical University,National Clinical Research Center for Digestive Disease,Clinical Center for Colorectal Cancer,Beijing 100050,China)

机构地区：[1]首都医科大学附属北京友谊医院普通外科国家消化系统疾病临床研究中心结直肠肿瘤临床诊疗与研究中心,北京100050

出　　处：《临床和实验医学杂志》2024年第12期1280-1284,共5页Journal of Clinical and Experimental Medicine

摘　　要：目的分析不同黄疸程度和胆道引流方式对梗阻性黄疸患者的围手术期相关指标的影响。方法回顾性收集2014年1月至2023年3月在首都医科大学附属北京友谊医院确诊梗阻性黄疸,并在术前胆道引流后进行胰十二指肠切除术的患者作为研究对象。共纳入148例梗阻性黄疸患者,其中轻度黄疸组(总胆红素<250μmol/L)77例,严重黄疸组(总胆红素≥250μmol/L)71例。比较轻度黄疸组和严重黄疸组患者的围手术期相关指标(手术时间、术中失血量、胆肠及胰肠引流管留置时间)和病理特征[美国癌症联合委员会(AJCC)分期、肿瘤病理类型、是否有淋巴结转移等]。按照引流方式不同分为内镜下鼻胆管引流术(ENBD)、内镜下胆道支架引流术(ERBD)和经皮肝穿刺胆道引流术(PTCD),分析不同引流方式对患者围手术期相关指标的影响。结果严重黄疸组ERBD患者比例为31.2%,低于轻度黄疸组(9.9%),PTCD患者比例为52.1%,高于轻度黄疸组(19.5%),差异均有统计学意义(P<0.05);轻度黄疸组与严重黄疸组的手术时间、术中出血量、胰肠及胆肠引流天数比较,差异均无统计学意义(P>0.05)。轻度黄疸组的良性疾病患者比例为7.8%,显著高于严重黄疸组(0),差异有统计学意义(P<0.05);两组在AJCC分期、其他类型肿瘤及有无淋巴结转移方面比较,差异均无统计学意义(P>0.05)。轻度黄疸组、重度黄疸组中不同引流方式的手术时间、术中出血量、胰肠引流及胆肠引流天数比较,差异均无统计学意义(P>0.05)。结论不同黄疸程度及胆道引流方式对梗阻性黄疸患者的围手术期相关指标无明显影响。轻度黄疸患者采用ERBD较多,而重度黄疸患者采用PTCD较多,且轻度黄疸患者的良性疾病较多。Objective To analyze the effect of different degrees of jaundice and biliary drainage methods on perioperative related indicators in patients with obstructive jaundice.Methods Patients diagnosed with obstructive jaundice at Beijing Friendship Hospital,Capital Medical University from January 2014 to March 2023 who underwent pancreaticoduodenectomy after preoperative biliary drainage were retrospectively collected as research subjects.A total of 148 patients with obstructive jaundice were included,including 77 cases in the mild jaundice group(total bilirubin<250μmol/L)and 71 cases in the severe jaundice group(total bilirubin≥250μmol/L).The perioperative related indicators(operative time,intraoperative blood loss,biliary and pancreatic drainage tube retention time)and pathological characteristics[American Joint Committee on Cancer(AJCC)staging,tumor pathological type,presence of lymph node metastasis,etc.]of patients with the mild and severe jaundice groups were compared.According to different drainage methods,it was divided into endoscopic nasal bile drainage(ENBD),endoscopic retrograde biliary drainage(ERBD),and percutaneous transhepatic cholangial drainage(PTCD).The impact of different drainage methods on perioperative related indicators of patients was analyzed.Results The proportion of ERBD patients in the severe jaundice group was 31.2%,which was lower than that in the low bilirubin group(9.9%),the proportion of PTCD patients in the severe jaundice group was 52.1%,which was higher than that in the low bilirubin group(19.5%),and the differences were statistically significant(P<0.05).There were no statistically significant differences between the mild jaundice group and the severe jaundice group in the operative time,intraoperative bleeding,and biliary and pancreatic drainage tube retention time(P>0.05).The proportion of benign disease patients in the mild jaundice group was 7.8%,significantly higher than that in the severe jaundice group(0),and the difference was statistically significant(P<0.05);There were

关 键 词：胰十二指肠切除术 术前胆道引流 梗阻性 黄疸 

分 类 号：R657.4[医药卫生—外科学]