中重度黄疸的壶腹部周围癌患者根治术前PTCD对康复效果的影响

Effects of PTCD on patients with periampullary carcinoma with moderate and severe jaundice before radical treatment

目的分析中重度黄疸的壶腹部周围癌患者在接受胰十二指肠切除术前行经皮肝穿刺胆道引流对康复效果的影响。方法回顾性分析西宁市第一人民医院2015年1月至2018年12月收治的176例中重度黄疸的壶腹部周围癌患者的临床资料,根据治疗方法将其分为对照组(114例)和观察组(62例),对照组患者行胰十二指肠切除术治疗,观察组患者行经皮肝穿刺胆道引流+胰十二指肠切除术治疗,比较两组患者围术期相关指标和术后并发症发生情况。结果观察组患者手术时间、肠道功能恢复正常时间、白细胞恢复正常时间均显著短于对照组(均P<0.05),术后1周胆红素水平显著低于对照组(P<0.05);但住院天数和住院费用均显著高于对照组(均P<0.05)。观察组患者术后出血发生率显著低于对照组(P<0.05),术后感染发生率显著高于对照组(P<0.05);两组患者术后胰漏、胆漏、胃瘫发生率比较差异均无统计学意义(均P>0.05)。结论中重度黄疸的壶腹部周围癌患者在行胰十二指肠切除术前接受经皮肝穿刺胆道引流,虽增加了住院天数、住院费用和术后感染率,但可有效降低患者血清胆红素水平和术后出血发生率,有助于患者术后恢复,具有一定的临床应用价值。

Objective To analyze the effect of percutaneous transhepatic cholangial drainage on patients with periampullary carcinoma with moderate and severe jaundice before pancreatoduodenectomy.Method Clinical data of 176 patients with periampullary carcinoma with moderate and severe jaundice admitted to Xining First People's Hospital from January 2015 to December 2018 were retrospectively analyzed.According to the treatment methods,the patients were divided into control group(114 cases)and observation group(62 cases).Patients in control group received pancreatoduodenectomy,and patients in observation group received percutaneous transhepatic cholangial drainage+pancreatoduodenectomy.The perioperative indexes and postoperative complications were compared between the two groups.Result The operation time,intestinal function recovery time and white blood cell recovery time of patients in observation group were shorter than those in control group(all P<0.05),and the bilirubin level was lower than that of control group one week after operation(P<0.05).But hospital days time and hospitalization expenses were higher than those of control group(all P<0.05).The incidence of bleeding in observation group was lower than that in control group(P<0.05),and the incidence of infection in observation group was higher than that in control group(P<0.05).There were no significant differences in the incidence of pancreatic leakage,biliary leakage and gastroparesis between the two groups(all P>0.05).Conclusion The patients with periampullary cancer with moderate or severe jaundice receired percutaneous transhepatic cholangial drainage before pancreatoduodenectomy,although percutaneous transhepatic cholangial drainage increases hospital days,hospitalization costs and postoperative infection rate,it can effectively reduce the level of serum bilirubin and the incidence of postoperative bleeding.It is helpful to the recovery of patients after pancreatoduodenectomy and has certain clinical application value.