术前减黄方式对壶腹周围癌胰十二指肠切除术后并发症的影响  

Effect of preoperative biliary drainage on complications after pancreaticoduodenectomy for periampullary cancer

作　　者：韩青雷 丛赟 李佳隆 邵英梅[2] Han Qinglei;Cong Yun;Li Jialong;Shao Yingmei(Xinjiang Medical University,Urumqi 830054,China;Department of Hepatobiliary Hydatid Surgery,the First Affiliated Hospital of Xinjiang Medical University,Urumqi 830054,China)

机构地区：[1]新疆医科大学,乌鲁木齐830054 [2]新疆医科大学第一附属医院肝胆包虫外科,乌鲁木齐830054

出　　处：《中华肝脏外科手术学电子杂志》2024年第5期665-669,共5页Chinese Journal of Hepatic Surgery(Electronic Edition)

基　　金：国家自然科学基金地区基金项目(82360111);省部共建中亚高发病成因与防治国家重点实验室开放课题(SKL-HIDCA-2020-B);新疆维吾尔自治区高校科研计划项目(XJEDU2021I016)

摘　　要：目的探讨术前减黄(PBD)方式对壶腹周围癌胰十二指肠切除术(PD)患者术后并发症的影响。方法回顾性分析2015年1月至2021年12月在新疆医科大学第一附属医院行PD的84例壶腹周围癌患者临床资料。其中男62例,女22例;年龄35~80岁,中位年龄61岁。患者均签署知情同意书,符合医学伦理学规定。36例未接受术前减黄(非PBD组),48例接受PBD,其中ERCP组和PTCD组各24例。观察3组患者临床资料、术后并发症、术后随访和生存情况,以及临床资料与术后并发症的关系。术后并发症发生率等比较采用χ^(2)检验、连续性校正χ^(2)检验或Fisher确切概率法。生存分析采用Kaplan-Meier法和Log-rank检验。结果PD术后总体并发症发生率37%(31/84),其中非PBD组39%(14/36),ERCP组42%(10/24),PTCD组29%(7/24),差异无统计学意义(χ^(2)=0.912,P>0.05)。ERCP组无术后死亡,PTCD组术后死亡1例,非PBD组术后死亡2例,3组死亡率差异无统计学意义(P=0.782)。3组中位生存时间分别为13、14、19个月,差异无统计学意义(χ^(2)=0.866,P>0.05)。术前TB>250 mmol/L时,PD患者术后并发症发生率明显增高(χ^(2)=3.939,P<0.05)。结论对于术前TB>250 mmol/L的壶腹周围癌梗阻性黄疸行PD患者,PBD治疗可降低术后并发症发生率,建议PBD治疗。不同PBD方式术后并发症和结局并无明显差别,PBD不应作为常规术前准备。Objective To evaluate the effect of preoperative biliary drainage(PBD)on postoperative complications in periampullary cancer patients undergoing pancreaticoduodenectomy(PD).Methods Clinical data of 84 patients with periampullary cancer who underwent PD in the First Affiliated Hospital of Xinjiang Medical University from January 2015 to December 2021 were retrospectively analyzed.Among them,62 patients were male and 22 female,aged from 35 to 80 years,with a median age of 61 years.The informed consents of all patients were obtained and the local ethical committee approval was received.36 patients did not receive PBD(non-PBD group),and 48 cases received PBD,including 24 cases in the endoscopic retrograde cholangiopancreatography(ERCP)group and 24 cases in the percutaneous transhepatic cholangial drainage(PTCD)group.Clinical data,postoperative complications,postoperative follow-up and survival were observed among three groups.The relationship between clinical data and postoperative complications was also analyzed.The incidence of postoperative complications was compared by Chi-square test,continuity correction Chi-square test or Fisher's exact test.Survival analysis was conducted by Kaplan-Meier method and Log-rank test.Results The overall incidence of postoperative complications after PD was 37%(31/84),including 39%(14/36)in the non-PBD group,42%(10/24)in the ERCP group and 29%(7/24)in the PTCD group,with no statistical significance(χ^(2)=0.912,P>0.05).No postoperative death was reported in the ERCP group,1 case in the PTCD group and 2 cases in the non-PBD group,respectively.No significant difference was found in the mortality rate among three groups(P=0.782).The median survival among the three groups was 13,14 and 19 months,respectively,with no statistical significance(χ^(2)=0.866,P>0.05).When preoperative TB level was>250 mmol/L,the incidence of postoperative complications in PD patients was increased significantly(χ^(2)=3.939,P<0.05).Conclusions For periampullary cancer patients complicated with obstructive ja

关 键 词：术前减黄 壶腹周围癌 胰十二指肠切除术 手术后并发症 

分 类 号：R735.7[医药卫生—肿瘤]