伴重度阻塞性黄疸胰十二指肠切除术术前引流对术后并发症影响的研究

Influence of preoperative biliary drainage on morbidity rate of severely obstructive jaundice patients after pancreaticoduodenectomy

目的:研究术前引流对重度阻塞性黄疸患者胰十二指肠切除术后并发症的影响。方法:2010年2月—2015年10月98例重度阻塞性黄疸(总胆红素>300μmol/L)行胰十二指肠切除术的患者根据是否行术前引流、分为对照组(52例)和术前引流组(46例),比较两组患者手术时间、术中出血量、术后并发症发生率、病死率及术后住院时间。结果:两组患者一般资料、术前检查结果及病理结果无明显差异(P>0.05)。对照组患者手术时间明显长于术前引流组患者[(379.44±88.57)min vs(346.98±57.17)min,P<0.05]。对照组患者术中出血量明显高于术前引流组患者[(346.98±57.17)mL vs(297.83±139.57)mL,P<0.05]。对照组与术前引流组患者病死率无明显差异(3.85%vs 2.17%,P>0.05)。两组患者总体并发症发生率无明显差异(53.85%vs 43.48%,P>0.05),但对照组患者胰瘘发生率明显高于术前引流组患者(30.77%vs 13.04%,P<0.05)。结论:术前引流可降低胰十二指肠切除术手术时间、术中出血量及术后胰瘘发生率,且病死率及总体并发症发生率与对照组无明显差别。

Objective： To investigate the influence of preoperative biliary drainage （PBD） on morbidity of severely obstructive jaundice patients after pancreaticoduodenectomy （PD）. Methods：A total of 98 severely obstructive jaundice（Serum total bilirubin〉300 p mol/L） patients underwent PD between February 2010 and October 2015 were enrolled in the study. The patients were divided into two groups based on undergoing PBD or not. The no-PBD group comprised 52 patients and the PBD group comprised another 46 patients. Perioperatives parameters, including operative time, intraoperative blood loss, postoperative mortality and morbidity and postoperative hospital stay were compared between the two groups. Results： The demographics, preoperative examinations and pathological results were similar between the two groups （P〉0.05）. Operative time of the no-PBD group was statistically longer than the PBD group （379.44 ± 88.57min vs 346.98 ± 57.17 min, P〈0.05）. Besides, intraoperative blood loss of the no-PBD group were much more than the PBD group （365.00 ± 187.07mL vs 297.83 ± 139.57 mL, P〈0.05）. There was no statistical difference of mortality rate between the no-PBD group and the PBD group（3.85% vs 2.17%, P〉0.05）. The overall morbidity rate of the 2 groups were similar （53.85% vs 43.48%, P〉0.05）, but the pancreatic fistula rate of no-PBD group was significantly higher than the PBD group （30.77% vs 13.04%, P〈0.05）. Conclusion： PBD could reduce operative time, intraoperative blood loss and pancreatic fistula rate after PD. Meanwhile, the mortality and overall morbidity rates were similar between the two groups. PBD should be considered for severely obstructive jaundice patients.