术前减黄在中度恶性梗阻性黄疸胰十二指肠切除中的价值

Value of preoperative reduction of jaundice in pancreaticoduodenectomy for moderate malignant obstructive jaundice

目的探讨术前减黄在中度恶性梗阻性黄疸患者胰十二指肠切除中的应用价值。方法回顾性分析2011年5月至2019年8月大连医科大学附属第一医院行胰十二指肠切除的86例壶腹周围癌伴中度梗阻性黄疸患者临床资料。其中男55例,女31例;年龄32-76岁,中位年龄61岁。患者均签署知情同意书,符合医学伦理学规定。患者入院时血清TB 171-342μmol/L,根据有无术前减黄,将患者分为减黄组(36例)与未减黄组(50例)。两组围手术期情况比较采用t检验或秩和检验,并发症发生率等比较采用χ^(2)检验。结果减黄组减黄操作相关并发症发生率为22%(8/36),其中胆系感染3例,胰腺炎2例,电解质紊乱2例,胆汁性腹膜炎1例。减黄组减黄后平均TB为(103±58)μmol/L,明显低于减黄前的(256±49)μmol/L(t=-12.145,P<0.05);减黄后ALT、AST分别为84(58,108)、54(41,84)U/L,明显低于减黄前的208(72,348)、135(65,209)U/L(Z=-3.672,-3.886;P<0.05)。减黄组胰十二指肠切除术后并发症发生率为50%(18/36),未减黄组为56%(28/50),差异无统计学意义(χ^(2)=0.303,P>0.05)。结论对于中度恶性梗阻性黄疸胰十二指肠切除患者,术前减黄能改善肝功能,但并未使患者在术后结局方面获益,且增加减黄操作相关并发症,诊断明确后应尽早行手术治疗。

Objective To evaluate the effect of preoperative reduction of jaundice in pancreaticoduodenectomy for patients with moderate malignant obstructive jaundice.Methods Clinical data of 86 patients with periampullary carcinoma complicated with moderate obstructive jaundice who underwent pancreaticoduodenectomy in the First Affiliated Hospital of Dalian Medical University from May 2011 to August 2019 were retrospectively analyzed.Among them,55 patients were male and 31 female,aged 32-76 years with a median age of 61 years.The informed consents of all patients were obtained and the local ethical committee approval was received.Upon admission,the serum total bilirubin(TB)levels of patients were ranged from 171 to 342μmol/L.All patients were divided into the jaundice reduction group(n=36)and non-jaundice reduction group(n=50).Perioperative conditions were statistically compared between two groups by using t test or rank-sum test.The incidence of complications was compared by Chi-square test.Results The incidence of complications induced by preoperative jaundice reduction was 22%(8/36),including 3 cases of biliary infection,2 cases of pancreatitis,2 cases of electrolyte disturbance and 1 case of biliary peritonitis.In jaundice reduction group,the mean TB level was(103±58)μmol/L,significantly lower than(256±49)μmol/L before jaundice reduction(t=-12.145,P<0.05).The ALT and AST levels after jaundice reduction were 84(58,108)and 54(41,84)U/L,significantly lower compared with 208(72,348)and 135(65,209)U/L before jaundice reduction(Z=-3.672,-3.886;P<0.05).In jaundice reduction group,the incidence of complications after pancreaticoduodenectomy was 50%(18/36),which did not differ from 56%(28/50)in the non-jaundice reduction group(χ^(2)=0.303,P>0.05).Conclusions For the patients with moderate malignant obstructive jaundice undergoing pancreaticoduodenectomy,preoperative jaundice reduction can improve liver function,whereas it brings no benefits to the postoperative prognosis of patients and increases the incidence of operation-related complications.Surgery should be performed as soon as the diagnosis is confirmed.