梗阻性黄疸术前减黄指征及方案的探讨

Clinical indication and program research of preoperative biliary drainage on obstructive jaundice patients

目的探讨梗阻性黄疸术前减黄的意义及具体实施方案。方法2（）07年9月至2012年9月期间67例行手术治疗的梗阻性黄疸患者，按自定的术前减黄指征：①血清总胆红素（TBlL）〉342．0μmol／L；②年龄〉65岁；③合并胆管炎、肝功能B～C级、心肺功能差、糖尿病血糖控制不理想并伴有其他并发症、营养不良患者。其中28例人选术前减黄组，行透视下经皮经肝胆管引流术（PT-BD）及内镜下鼻胆管引流术（ENBD），对减黄组置管后1～2周进行手术。未减黄组39例，常规术前准备后于入院4～6d进行手术。结果术前未减黄39例的手术时间、术中出血量、术后并发症的发生率、平均住院时间分别为（356±38）min、（656±72）ml、56．4％（22／39）、（25±6）d。28例术前进行了减黄，其手术时间、术中出血量、术后并发症的发生率、平均住院时间分别为（373±51）min、（634±61）ml、53．6％（15／28）、（34±8）d。术前减黄组与未减黄组手术时间、术中出血量、术后并发症的发生率差异无统计学意义（P〉0．05）。两组平均住院时间差异有统计学意义（P〈0．05）。结论选择性进行术前减黄治疗，降低了患者手术风险；建议TBIL〉342．0μmol／L，年龄〉65岁，伴胆管炎，一般条件差的患者行术前减黄治疗。

Objective To study the indication and program of preoperative biliary drainage on obstructive jaundice patients. Methods The clinical data of 67 cases of obstructive jaundice from Sept. 2007 to Sept. 20]2 were retrospectively analyzed. Twenty-eight cases were selected as jaundice-reducing group and given preoperative biliary drainage according to the following indications： TBIL2〉 342. 0 μmol/L; age〉65 years; combined cholangitis, hepatic function B-C level, and other complications, and subjected to PTBD and ENBD, and the operations were done 1-2 weeks after biliary drainage. The rest 39 cases serving as control group were given operations 4-6 days after admission. Results The operating time, perioperative blood loss, incidence of postoperative complications, mean hospital stay （days） in control group was （356 ±38） min, （656 ±72） ml, 56.4% （22/39）, （25 ± 6） days, and those in jaundice-reducing group were （373 ± 51） min, （634 ± 61） ml, 53. 6% （15/28）, （34 ±8） days, respectively. There was significant difference in mean hospital stay between the two groups （P 〈0. 05）. Conclusion Selectively preoperative jaundice-reducing drainage can decrease the incidence of complication. It is recommended that the preoperative biliary drainage is given to the patients with bilirubin more than 342. 0 μmol/L, over 65 years old, bad general conditions and combined cholangitis.