术前减黄对伴有重度恶性梗阻性黄疸患者行胰十二指肠切除术的意义

Preoperative biliary drainage in patients with severe malignant obstructive jaundice in patients with pancreaticoduodenectomy

目的探讨术前减黄对伴有重度恶性梗阻性黄疸患者行胰十二指肠切除术的意义。方法通过回顾性分析2010—2014年于本院行胰十二指肠切除术患者70例,根据患者术前是否行经皮经肝胆管穿刺引流(PTCD)术,分为减黄组(n=24)与未减黄组(n=46),分析比较两组术后胰瘘发生率。结果减黄组行PTCD术前血清总胆红素(TBIL)及直接胆红素(DBIL)水平均显著高于未减黄组,差异有统计学意义;而减黄组与未减黄组血清谷丙转氨酶(Alt)及谷草转氨酶(Ast)水平相近,差异无统计学意义。减黄组行PTCD术后总胆红素、直接胆红素、谷丙转氨酶、谷草转氨酶均较减黄前减低,差异有统计学意义(P均<0.05);减黄组与未减黄组术后胰瘘发生率分别为54.12%、30.43%,差异无统计学意义(P均>0.05)。结论术前减黄不能降低胰十二指肠切除术后胰瘘的发生率,但可有效降低机体胆红素水平,改善患者肝功能。

Objective To evaluate the significance of preoperative biliary drainage onpancreatoduodenectomy（ PD） for s evere obstructive jaundice resulting from distal bile duct malignant tumors.Methods Through retrospective analysis of 70 cases of patients with pancreaticoduodenectomy in our hospital during 2010-2014,according to the patient ＇ s preoperative percutaneoustranshepatic biliary drainage（ PTCD）divided into the preoperative biliary drainage group（ n = 24） and the non preoperative biliary drainage group（ n =46）; In the two groups,relevant statistical methods were applicator to compare the incidence of postoperative pancreatic fistula.Results The serum total bilirubin（ TBIL） and direct bilirubin（ DBIL） were significantly higher in the preoperative biliary drainage group than in the non preoperative biliary drainage before biliary drainage,the difference was not statistically significant. But in preoperative biliary drainage group and non preoperative biliary drainage group,the serum Alt and Ast levels had no statistical significance. In preoperative biliary drainage group,the serum TBIL,DBIL,Alt and Ast were decreased after PTCD drainage,the difference was not statistically significant. The incidence of pancreatic fistula was 54. 12% and 30. 43% in the preoperative biliary drainage group and the non preoperative biliary drainage group, the difference was not statistically significant. Conclusions Preoperative biliary drainagecan not reduce the incidence of pancreatic fistula afterpancreatoduodenectomy,but it can effectively reduce the level of serum bilirubin and improve the liver function of patients.