术前不同减黄策略对胰腺癌手术疗效及预后的影响研究

Effect of different preoperative yellowing reduction strategies on the surgical efficacy and prognosis ofpancreatic cancer

目的 观察术前不同减黄策略对胰腺癌患者手术疗效及预后的影响。方法 本研究为前瞻性研究,以郑州大学第一附属医院2021年1月至2022年12月收治的119例胰腺癌患者为研究对象,基于随机、对照原则,采用电脑分组法将入组患者分为A组(60例)、B组(59例),A组术前采用内镜下逆行胆管引流术(ERBD)治疗,B组术前采用经皮肝胆管穿刺引流术(PTBD)治疗,所有患者术后开展为期1年随访,比较2组患者的肝功能、凝血功能、营养状态、并发症发生、治疗及远期生存情况。结果 在不同术前减黄策略下,A组患者的丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、总胆红素(TBil)分别为(35±5)U/L、(35±5)U/L、(15±3)μmol/L,均低于B组[(39±5)U/L、(38±5)U/L、(18±3)μmol/L];A组患者的活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)、凝血时间(TT)分别为(28±5)s、(11±3)s、(17±3)s,均低于B组[(32±5)s、(13±3)s、(19±3)s];A组患者的血红蛋白(Hb)、总蛋白(TA)、白蛋白(ALB)分别为(118±20)g/L、(66±10)g/L、(45±10)g/L,均高于B组[(104±20)g/L、(60±10)g/L、(40±10)g/L];A组患者的并发症发生率6.7%(4/60)低于B组20.3%(12/59);A组患者的减黄时间、住院时间、30 d内死亡率分别为(14±3)d、(35±5)d、1.7%(1/60),均低于B组[(17±3)d、(39±5)d、15.2%(9/59)];中位无进展生存期(PFS)、中位总生存期(OS)分别为(10.2±2.2)月、(11.5±3.2)月,均高于B组[(8.3±1.3)月、(9.4±2.2)月](P<0.05)。结论 术前实施ERBD能有效改善胰腺癌患者的肝功能、凝血功能及营养状态,对加快患者康复进程、降低并发症发生风险并延长生存周期均有积极意义。

Objective To observe the effect of different preoperative yellowing reduction strategies on the surgical efficacy and prognosis of pancreatic cancer patients.Methods This study is a prospective study.One hundred and nineteen patients with pancreatic cancer admitted from January 2021 to December 2022 were taken as the research object..Based on the principle of randomization and control,the enrolled patients were divided into group A(60 cases)and group B(59 cases)by computer grouping.Group A was treated with ERBD before surgery,and group B was treated with PTBD before surgery.All patients were followed up for one year after surgery to compare the liver function,coagulation function,nutritional status The occurrence of complications,treatment status,and long-term survival.,Results Under different preoperative yellowing reduction strategies,the ALT,AST,and TBil of Group A patients were(35±5)U/L,(35±5)U/L,and(15±3)μmol/L,lower than group B[(39±5)U/L,(38±5)U/L,(18±3)μmol/L].The APTT,PT,and TT of patients in Group A were(28±5)s,(11±3)s,and(17±3)s,lower than Group B[(32±5)s,(13±3)s,and(19±3)s].The Hb,TA,and ALB of Group Apatients were(118±20)g/L,(66±10)g/L,and(45±10)g/L,higher than Group B[(104±20)g/L,(60±10)g/L,(40±10)g/L].The incidence of complications in Group A patients was 6.7%(4/60),which was lower than that in Group B patients 20.3%(12/59),The time to reduce jaundice,length of hospital stay,and mortality rate within 30 days in Group A were(14±3)days,(35±5)days,and 1.7%(1/60),which were lower than those in Group B[(17±3)days,(39±5)days,and 15.2%(9/59)].The median PFs and median Os were(10.2±2.2)months and(11.5±3.2)months,which were higher than those in Group B[(8.3±1.3)months and(9.4±2.2)months](P<0.05).Conclusion Preoperative implementation of ERBD can effectively improve the liver function,blood coagulation function and nutritional status of patients with pancreatic cancer,which is of positive significance in accelerating the rehabilitation process of patients,reducing the risk of complications and prolonging the life cycle.