术前减黄对行开腹胰十二指肠切除术的胰头癌或壶腹部癌病人围手术期影响分析  

Effect of preoperative biliary drainage on perioperative period in patients with pancreatic head or periampullary carcinoma undergoing open pancreaticoduodenectomy

作　　者：胡啸 胡朝全 Hu Xiao;Hu Chaoquan(Department of Hepatobiliary Surgery,Sun Yat-sen Memorial Hospital,Guangdong Guangzhou 510120,China;Department of Hepatobiliary Surgery,Affiliated Hospital,Guizhou Medical University,Guizhou Guiyang 550004,China)

机构地区：[1]中山大学孙逸仙纪念医院肝胆外科,广东广州510120 [2]贵州医科大学附属医院肝胆外科,贵州贵阳550004

出　　处：《腹部外科》2024年第4期271-275,286,共6页Journal of Abdominal Surgery

摘　　要：目的探讨术前减黄对胰头癌或壶腹周围癌行开腹胰十二指肠切除术病人围手术期(住院期间或术后≤30 d)的影响。方法回顾性分析贵州医科大学附属医院2019年10月1日到2022年10月1日胰头癌或壶腹周围癌行胰十二指肠切除术73例,其中术前减黄33例(减黄组),未减黄病人40例(不减黄组)。比较减黄组(n=33)减黄前(入院时)与减黄后(手术前)总胆红素、谷丙转氨酶、谷草转氨酶、白蛋白、肌酐水平的变化,评估减黄对减黄组病人疗效。分析减黄组与不减黄组在术后并发症上有无统计学差异。采用统计学软件SPSS(21.0版)进行统计学分析。结果减黄组病人术前总胆红素、谷丙转按酸、谷草转氨酸、白蛋白较入院时有所下降(均P<0.05),术前肌酐水平较入院肌酐水平无明显变化(P>0.05)。和不减黄组比较,减黄组可能面临更高的Ⅲ级以上并发症发生率(P<0.05),更长的入院到手术时间(P<0.05),更长的总住院时间(P<0.05)。两组在手术时长、术中出血量、术中输血量、胆漏、胃瘫、腹腔感染、胰瘘、出血、伤口感染、死亡率、其他并发症发生率及总并发症发生率、术后住院时间上无明显统计学差异(均P>0.05)。结论术前减黄能降低胰头癌或壶腹周围癌引起的重度黄疸病人的胆红素水平,改善肝功能,但不影响病人肌酐水平。术前减黄会导致病人血清白蛋白水平下降;术前减黄可能不能减少手术时长、降低术中出血量和术中输血量;不能降低胆漏、胃瘫、腹腔感染、胰瘘、术后出血、伤口感染等发生率,不能降低其他并发症发生率、总并发症发生率及死亡率;不能减少术后住院时间;可能面临着更高的Ⅲ级以上并发症发生率,更长的总住院时间及入院到手术时间。胰头癌或壶腹周围癌引起的重度黄疸(总胆红素≥250μmol/L)病人不宜常规术前减黄。Objective To explore the effect of preoperative biliary drainage on perioperative period(during hospitalization or 30 days post-operation)in patients with pancreatic head or periampullary carcinoma undergoing open pancreaticoduodenectomy.Methods From October 1,2019 to October 1,2022,retrospective analysis was performed for 73 patients of pancreatic head or periampullae carcinoma undergoing pancreaticoduodenectomy including biliary drainage(n=33)and without biliary drainage(n=40).The changes of total bilirubin(TBIL),alanine transaminase(ALT),glutamic oxalacetic transaminase(GOT),albumin and creatinine before yellowing(at admission)and after yellowing(pre-operation)were compared for evaluating the effect of biliary drainage biliary drainage group.Then statistical differences were examined in postoperative complications between biliary drainage and without biliary drainage groups.Statistical software SPSS21 was used for statistical processings.Results The preoperative levels of TBIL,albumin,ALT and AST declined as compared with admission(P<0.05).The preoperative level of creatinine had no significant change as compared with admission(P>0.05).Biliary drainage group was more prone to have a higher incidence of tertiary complications(P<0.05),a longer time from admission to surgery(P<0.05)and a longer total hospitalization stay(P<0.05).No significant differences existed in operative duration,intraoperative volume of blood loss,intraoperative unit of blood transfusion,bile leakage,gastroparesis,peritoneal infection,pancreatic leakage,hemorrhage,wound infection,mortality,incidence of complications or postoperative hospitalization stay(P>0.05).Conclusion Preoperative biliary drainage may lower the level of bilirubin in patients with severe jaundice caused by periampullary carcinoma,improve liver function and have no effect upon the level of creatinine.Preoperative biliary drainage may cause a decline of serum albumin.Preoperative biliary drainage may not reduce operative duration,volume of intraoperative blood loss and uni

关 键 词：胰头癌 壶腹周围癌 梗阻性黄疸 术前减黄 并发症 

分 类 号：R73[医药卫生—肿瘤]