恶性梗阻性黄疸伴急性化脓性胆管炎一期行胰十二指肠切除术的可行性分析

Feasibility of primary pancreatoduodenectomy for malignant obstructive jaundice with acute suppurative cholangitis

目的对恶性梗阻性黄疸伴急性化脓性胆管炎一期行胰十二指肠切除术进行可行性分析。方法回顾分析我院1999年至2004年施行PD手术治疗恶性梗阻性黄疸病人128例,其中,PD手术治疗恶性梗阻性黄疸伴ASC24例(A组),PD手术治疗不伴有ASC病例104例(B组)。术前按Knaus法计算每例APACHEⅢ评分,对比分析两组术后并发症的发生率和死亡率,以及APACHEⅢ不同计分段下死亡率的差异。结果A组术后并发症发生率为45．8％,死亡率8．3％;B组术后并发症发生率为34．6％,死亡率7．7％。两组术后并发症发生率有显著性差异(P<0．05),死亡率无显著性差异(P>0．05)。APACHEⅢ计分段分别为40分以下、41～70分、71分以上统计死亡率,两组死亡率差异无显著性(P>0．05),组内比较,不同计分段死亡率有显著性差异(P<0．05)。结论恶性梗阻性黄疸伴ASC病例术前全面和客观的评估、及时的手术探查和决断、术中的精细操作和围手术期的综合处理是保证一期PD术良好预后的决定因素。

Objective To evaluate the primary pancreatoduodenectomy （PD） for malignant obstructive jaundice （MOJ） with acute suppurative cholangitis （ASC）. Methods The clinical data of 128 patients with MOJ treated with PD in our hospital from 1999 to 2004 were retrospectively analyzed. Of the 128 patients, 24 had MOJ with ASC （group A） and 104 without. APACHE Ⅲ scores were calculated by Knaus method before the operation. The postoperative complication rate and mortality were determined and the difference of mortality in patients with different grades of APACHE Ⅲ scores were evaluated. Results The postoperative complication rate and mortality were 45.8% and 8.3% in group A and 34. 6% and 7.7% in group 13. There was significant difference in postoperative complication rate （P〈0.05） but no marked difference in mortality between the 2 groups （P〉0.05）. Based on different scores （《40, 41-70, 》71）, there was no remarkable difference in the mortality between the 2 groups （P〉0. 05）. However, there was significant difference in the mortality among different subgroups based on the score in the same group （P〈0.05）. Conclusions The overall and objective preoperative evaluation, exploratory laparotomy, making the decision in time and careful operation and appropriate treatment are the determinative factors for obtaining better efficacy in primary PD for MOJ with ASC.