腹腔镜胰十二指肠切除术术前PTCD减黄的临床效果观察(附视频)

Observation of clinical efficacy of PTCD to decrease bilirubin before laparoscopic pancreaticoduodenectomy(with video)

背景与目的:多数研究证明,行经皮肝穿刺胆管引流术(PTCD)减黄可改善黄疸患者术后免疫力和消化功能,但开放胰十二指肠切除术(OPD)中行PTCD减黄与否对术后并发症发生率的影响不明显。然而,PTCD在腹腔镜胰十二指肠切除术(LPD)中应用效果目前仍有待研究。因此,本研究旨在探讨术前PTCD在LPD患者中应用的有效性和安全性。方法:回顾性分析陕西省宝鸡市人民医院2019年1月—2021年12月42例行LPD患者的临床资料。42例患者中,25例患者在手术前行PTCD减黄(PTCD组),其余17例LPD患者术前未行PTCD(非PTCD组),比较两组患者基线特征及围术期相关指标。结果:PTCD组平均退黄时间(6.81±1.52) d。PTCD组术中出血量明显少于非PTCD组(322.21 mL vs.435.17mL, P=0.000),胆汁漏发生率(0.00vs.23.53%, P=0.012)及总体并发症发生率(16.00%vs.47.06%,P=0.029)明显降低。PTCD组与非PTCD组的LPD手术时间(366.26 min vs. 381.21 min)、首次排气时间(2.36 d vs. 2.51 d)、腹腔引流拔管时间(4.46 d vs. 4.25 d)、总住院时间(15.27 d vs. 13.58 d)、30 d内再入院率(16.00%vs. 17.65%)及其他各类并发症发生率差异均无统计学意义(均P>0.05)。结论:对于拟行LPD患者术前常规行PTCD减黄,可减少术中出血量,降低总体并发症及胆汁漏发生率,推荐临床使用,但仍需进一步开展大样本研究深入探讨其适应证及验证其安全性。

Background and Aims: A number of studies have proved that percutaneous transhepatic cholangial drainage(PTCD) for jaundice reduction can improve the immunity and digestive function of patients with jaundice after surgery, but the effect of using PTCD during open pancreaticoduodenectomy(OPD) on the incidence of postoperative complications is not significant. However, the application efficacy of PTCD in laparoscopic pancreaticoduodenectomy(LPD) still needs to be studied. Therefore, this study was performed to investigate the effectiveness and safety of preoperative PTCD in patients undergoing LPD.Methods: The clinical data of 42 patients undergoing LPD in Baoji People’s Hospital from January 2019 to December 2021 were retrospectively analyzed. Of the 42 patients, 25 patients underwent PTCD to decrease bilirubin before surgery(PTCD group), and the remaining 17 patients did not undergo preoperative PTCD(non-PTCD group). The baseline characteristics and perioperative variables of the two groups were compared.Results: The mean time of preoperative biliary drainage in PTCD group was(6.81±1.52) d. The intraoperative blood loss was significantly less(322.21 mL vs. 435.17 mL, P=0.000), and the incidence rates of bile leakage(0.00 vs. 23.53%, P=0.012) and the overall complications(16.00% vs. 47.06%, P=0.029) were significantly lower in PTCD group than those in non-PTCD group. There were no significant differences between PTCD group and non-PTCD group in terms of operative time for LPD(366.26 min vs. 381.21 min), time to first postoperative bowel movement(2.36 d vs. 2.51 d), time to drainage tube removal(4.46 d vs. 4.25 d), length of total hospital stay(15.27 d vs. 13.58 d), readmission rate within 30 d(16.00% vs. 17.65%) and incidence rates of other specific complications(all P>0.05).Conclusion: Routine performance of preoperative PTCD to decrease bilirubin in patients scheduled to undergo LPD can reduce the amount of intraoperative blood loss, reduce the incidence rates of overall complications and bile leakage, and it is recommended to be used in clinical practice. However, its indications and safety still need to be further investigated and verified by studies with large sample size.