术前黄疸程度对胰十二指肠切除术后并发症的影响

Influence of jaundice levels in preoperation on complications of pancreaticoduodenectomy

[目的]探讨术前黄疸程度对胰十二指肠切除术（pancreaticoduodenectomy,PD）后并发症的影响。[方法]回顾性分析大连医科大学附属第一医院2004年1月~2010年1月行PD术的患者118例,据黄疸程度分四组：无黄疸组（A组）：总胆红素（total bilirubin,TB）≤34.20μmol/L;轻度黄疸组（B组）：34.20μmol/L〈TB≤171.00μmol/L;中度黄疸组（C组）：171.00μmol/L〈TB≤342.00μmol/L;重度黄疸组（D组）：TB〉342.00μmol/L,将各组术后并发症比较分析。再据黄疸患者（n=87）术前是否减黄分为减黄组（n=36）和非减黄组（n=51）,比较术后并发症及死亡率。[结果]B、C、D组术后并发症发生率分别为54.05%、60.97%、77.78%,高于A组（32.26%）,P〈0.05;D组与B组比较差异也有显著性意义,P〈0.05。减黄组与非减黄组术后并发症发生率（66.11%vs60.78%）、死亡率（0.03%vs 0.04%）差异均无显著性意义（P〉0.05）。[结论]术前黄疸程度是影响PD术后并发症发生的危险因素之一,故术前是否减黄要慎重考虑。

【Objective】 To investigate the influence of preoperative jaundice on complications occurrences of pancreaticoduodenectomy（PD）.【Methods】 To study the clinical data of 118 cases underwent PD in the first affiliated hospital of Dalian Medical University from January,2004 to January,2010 retrospectively.The patients were divided into four groups according to clinical manifestation with or without jaundice and the level of total bilirubin（TB）：group A,the patients who had no jaundice,TB≤34.20 μmol/L;group B,the patients who had light jaundice,34.20 μmol/L〈TB≤171.00 μmol/L;group C,the patients who had medium jaundice,171.00 μmol/L〈TB≤342.00 μmol/L,and group D,the patients who had severe jaundice,TB〉342.00 μmol/L.To investigate the influence of the level of preoperative jaundice on complications after PD.The cases of 87 who had jaundice were divided into two groups：the group drainage： the cases underwent preoperative drainage（n=36）;the group nondrainage： the cases without preoperative drainage.To study wheather preoperative drainage was benefit for PD through analyzing the compications and morbidity.【Results】 The cases of group B、group C and group D had a predominate higher incidences of complications than that of group A（P〈0.05）.Also the incidence of group D was higher than that of group B（P〈0.05）.There was no predominate difference on the postoperative complications and morbidity between group drainage and group nondrainage（P〉0.05）.【Conclusion】 The level of preoperative jaundice maybe a risk factor of postoperative complications.The incidence of complications lie on the level of jaundice before operation.Pre-operative drainage should be used cautiously.