两种胆道引流策略在胆肠吻合围手术期中的应用对比研究

Comparative study of two biliary drainage strategies in perioperative period of cholangiojejunostomy

目的比较经皮经肝胆管引流(PTCD)和内镜逆行胰胆管造影(ERCP)联合术中T管两种胆道引流策略在中度以上梗阻性黄疸患者行胆肠吻合围手术期中的临床效用。方法采用回顾性队列的研究方法收集2015年3月—2021年12月于上海中医药大学附属曙光医院就诊的93例行胆肠吻合术(包括胰十二指肠切除术后重建)的中度以上梗阻性黄疸患者资料,根据围手术期引流策略分为PTCD组54例、ERCP联合术中T管引流组(简称ERCP组)39例,分析两组的胆管直径、术后住院时间、手术费用、减黄时间、减黄程度、术后平均胆汁引流量、术后胆漏、腹腔感染等情况。正态分布的计量资料以均数±标准差(±s)表示,组间比较采用t检验,偏态分布的计量资料以M(Q_(1),Q_(3))表示,组间比较采用非参数检验;计数资料组间比较采用χ^(2)检验。结果 PTCD组术前减黄时间、手术费用、术后7 d平均胆汁引流量、术后拔除胆道引流管时间、术后住院时间分别为(5.9±3.1) d、(59 846.3±9 129.7)元、210.0(170.0,325.0) mL/d、(18.4±5.6) d、(10.7±4.4) d,ERCP组分别为(9.5±4.4) d、(77 833.1±12 164.5)元、285.0(225.0,370.0) mL/d、(41.4±17.2)d、(15.3±5.6) d,两组比较差异具有统计学意义(P<0.05)。两组患者引流前一般情况、引流后胆管炎和出血、减黄程度、手术后胆漏、腹腔感染等差异均无统计学意义(P>0.05)。结论中度以上梗阻性黄疸患者行胆肠吻合术,PTCD或ERCP联合术中T管引流均是提升围手术期安全性的有效手段,PTCD在减黄效率、手术费用、术后快速康复上体现一定优势。

Objective To evaluate the clinical efficacy of PTCD and ERCP combined with T tube in the perioperative period of biliary anastomosis in patients with moderate to severe obstructive jaundice.Methods The data of 93 patients with moderate obstructive jaundice who met the inclusion criteria and planned to undergo cholangiojejunostomy(including reconstruction after pancreaticoduodenectomy)in Shuguang Hospital Affiliated to Shanghai University of traditional Chinese medicine from March 2015 to December 2021 were collected.According to the perioperative drainage strategy,54 cases were divided into PTCD group and 39 cases were divided into ERCP combined with intraoperative T-tube drainage group.Retrospective cohort method was used to analyze the bile duct diameter,postoperative hospital stay,operation cost,time of jaundice reduction,degree of jaundice reduction,average postoperative bile loss,postoperative bile leakage,abdominal infection of the two groups.The measurement data were expressed as mean±standard deviation(±s),and t test was used for comparison between groups.The data of skewed distribution were represented by M(Q1,Q3),and nonparametric rank sum test was used.Chi-square test was used for counting data.Results The preoperative yellowing reduction time,operation cost,mean bile loss 7 days after operation,time to remove biliary drainage tube,and postoperative hospital stay in PTCD group were(5.9±3.1)d,(59846.3±9129.7)yuan,210.0(170.0,325.0)mL/d,(18.4±5.6)d,and(10.7±4.4)d,respectively,while those in ERCP group were(9.5±4.4)d,(77833.1±12164.5)yuan,285.0(225.0,370.0)mL/d,(41.4±17.2)d and(15.3±5.6)d,respectively.The difference between the two groups was statistically significant(P<0.05).There was no significant difference between the two groups in general condition before drainage,cholangitis and hemorrhage after drainage,degree of jaundice reduction,bile leakage after surgery,abdominal infection,etc.Conclusions When performing biliary enterostomy in patients with moderate or above obstructive jaundice,PTCD and ERCP combined with intraoperative T-tube drainage are effective means to improve the safety of perioperative period.PTCD has some advantages in reducing jaundice efficiency,operation cost and rapid postoperative rehabilitation.