经皮肝胆囊穿刺置管引流在高危胰十二指肠切除术前的应用

Use of percutaneous transhepatic gallbladder drainage prior to surgery in high risk patients undergoing pancreaticoduodenal resection

目的：评价术前运用经皮肝胆囊穿刺置管引流（PTGD）对高危胰十二指肠切除术（PD）的价值。方法：回顾性分析2008年1月-2012年12月收治的15例伴有高危因素的壶腹周围癌及胰头癌患者的临床资料。患者术前均采用PTGD改善一般情况后再行PD。结果：15例患者均成功实施PTGD，无胆瘘、气胸或内出血等并发症。引流均通畅，引流量800～2500mL／d。减黄效果满意，经引流10～14d后血胆红素均低于200gmol／L。随后PD均成功实施。全组术后均无严重并发症发生，恢复顺利。结论：对于术前合并重度黄疸、严重胆系感染、合并严重内科疾病或营养不良的壶腹周围癌及胰头癌患者，先采用PTGD后再行PD，可以明显降低术后并发症的发生率，增加手术安全性。

Objective： To evaluate the value of percutaneous transhepatic gallbladder drainage （PTGD） in high-risk patients prior to undergoing pancreaticoduodenectomy （PD）. Methods： The clinical data of 15 patients with pancreatic head or periampullary cancer who had high risk factors and treated from January 2008 to December 2012 were retrospectively analyzed. All these patients received PTGD to improve their general condition prior to undergoing PD procedure. Results： PTGD was carried out successfully in all 15 patients with no occurrence of complications such as bile leakage, pneumothorax or internal bleeding. Drainage tubes in all patients remained patent with a daily drainage volume of 800 to 2 500 mL. Jaundice reduction effect was satisfactory, and the serum bilirubin concentration in all patients was less than 200 ~tmol/L after drainage for 10 to14 d. Subsequently, PD procedure was performed successfully in all patients. No serious postoperative complications occurred in any patient of the entire group, and all patients recovered. Conclusion： For patients with pancreatic head or periampullary cancer who have high-risk factors such as severe jaundice, severe biliary infection, severe medical problems or malnutrition, the use of PTGD prior to PD can reduce the incidence of postoperative complications and increase surgical safety.