恶性梗阻性黄疸的围手术期处理及其对并发症的影响

PERIOPERATIVE MANAGEMENT FOR COMPLICATIONS IN PATIENTS WITH MALIGNANT OBSTRUCTIVE JAUNDICE

目的 探讨恶性梗阻性黄胆围手术期处理对术后并发症的影响。方法 对 1992～ 1997年间 78例恶性梗阻性黄疸患者进行回顾分析 ,并对术后并发症发生原因和采取治疗方法进行总结。结果 1认为与梗阻性黄疸患者的高胆红素血症 ,内毒素血症及肝功能受损有密切关系。 2术前行减黄手术与并发症发生率无关 (P>0 .0 5 )。 3外引流术作为姑息手术并不理想 ,内引流术才是减黄的理想方法。4完全性胆道引流手术和部分胆道引流手术对并发症的发生率有明显影响 (P<0 .0 5 )。结论 加强围手术期处理可提高恶性梗阻性黄疸患者的手术耐受性 ,降低术后并发症。

Objective To evaltuate the effect of perioperative management for complications in patinets with malignant obstructive jaundice.Methods A retrospective analysis was made on 78 patients with maligent obstructive jaundice admitted from 1992 to 1997 in order to evaluate the reasons of postoperative complications and management.Results (1)Occurrence of complications was related with hyperbilirubinemia and endotoxemia,liver dysfunction.(2)Occurrence of complicatiobns was not related with decompression of biliduct(p>0.05).(3)External drainage was not better than interanal drainage for palliative therapy.(4)Total and a part of bili duct drainage was effect for occurrence of the complications(p<0.05).Conclusion In order to enhance the operative to lerace of the patients and decrease occurrence of complications,it is important to intensify the periopterative management.