恶性梗阻性黄疸患者黄疸程度对胰十二指肠切除术后并发症的影响

Study on postoperative complications and prognosis after pancreaticoduodenectomy in patients with malignant obstructive jaundice

目的探讨恶性梗阻性黄疸患者黄疸程度对胰十二指肠切除术(PD)后并发症的影响。方法回顾性分析2005年1月-2013年5月行PD治疗的梗阻性黄疸患者184例,根据黄疸严重程度分为轻度黄疸组42例,中度黄疸组58例,重度黄疸组84例,其中重度黄疸组又根据术前减黄与否分为未减黄亚组43例和减黄、亚组41例,比较各组术后并发症、病死率。结果 184例PD手术患者发生术后并发症(出血、腹腔感染、胆漏、胰漏、切口感染)32例(17.4%),轻度黄疸组发生率为4.8%(2/42),中度黄疸组为15.5%(9/58),重度末减黄亚组为39.5%(17/43),重度减黄亚组为9.8%(4/41);重度减黄亚组出血、腹腔感染、胆漏、胰漏的发生率低于未减黄亚组(P<0.05),切口感染的发生率高于未减黄亚组(P<0.05);重度未减黄亚组病死率为2.3%,,中度黄疸组为1.7%,轻度黄疸组和重度减黄亚组无死亡病例。结论梗阻性黄疸患者行PD术后的并发症及预后与黄疸程度密切相关,术前减黄可有效改善机体状态和耐受力,尤其对于重度黄疸患者。

Objective To explore the postoperative complications and prognosis after pancreaticoduodenectomy （PD） in patients with malignant obstructive jaundice. Methods A retrospective review was performed of the medical records of 184 patients who underwent PD from January 2005 to May 2013. Complications and mortality after PD were compared among the different groups which were classified according to the degree of obstructive jaundice, including mild jaundice group （ n = 42 ）,moderate jaundice group（ n = 58 ） , and severe jaundice group（ n = 84 ）, and the severe jaundice group was divided into un- relieving subgroup（ n = 43 ） and relieving subgroup（ n = 41 ） according to whether undergoing preoperative biliary drainage or not. Results There was 32 cases （ 17.4% ） of post operative complications in 184 PD patients. The incidence of post opera- tive complications including hemorrhage, intra-peritoneal infection, bile leakage, pancreatic leakage, incision infection was 4.8% （2/42） in mild jaundice group, 15.5% （9/58） in moderate jaundice group, 39.5% （17/43） in severe jaundice group un-relieving subgroup, 9.8% （4/41） in severe jaundice group jaundice-relieving subgroup. The incidence of hemor- rhage, intra-peritoneal infection, bile leakage, pancreatic leakage in jaundice-relieving subgroup was significantly lower than those in un-relieving subgroup （ P 〈 0.05 ）, and incision infection was higher in jaundice-relieving subgroup （ P 〈 0.05 ）. The mortality in un-relieving subgroup, moderate jaundice group was 2.3%, 1.7% , and there was no death case in mild jaundice group and severe jaundice group jaundice-relieving subgroup. Conclusion Complications and prognosis after PD in patients with obstructive jaundice is closely related to the degree of jaundice. Preoperative biliary drainage can contribute to improve the body state and tolerance, especially for serious patients with severe jaundice.