术前减黄对重症黄疸患者行胰十二指肠切除术的影响

Influence of preoperative biliary drainage on severe jaundice patients undergoing pancreaticoduodenectomy

目的 探讨术前以手术方法减轻梗阻性黄疸 (减黄 )对壶腹周围癌伴重度黄疸患者行胰十二指肠切除术 (PD )的影响。方法 回顾分析对比 2 2例壶腹周围癌伴重度黄疸患者PD术前行减黄手术 (减黄组 ) ,与 3 0例直接行PD手术 (未减黄组 )患者的临床资料。结果 两组临床资料具有可比性 (P >0 .0 5 )。两组均行经典式PD手术 ,减黄组手术时间及术中出血量分别为 3 44(2 40～5 70 )min及 10 5 7(60 0～ 2 10 0 )ml ,较未减黄组的 3 0 6(2 10～ 490 )min及 90 8(2 0 0～ 2 0 0 0 )ml有增多趋势 ,但无统计学差异 (P >0 .0 5 )。减黄组术中输血量为 13 0 0 (80 0～ 2 40 0 )ml ,较未减黄组的93 9(0～ 2 40 0 )ml明显增多 (t =2 .0 5 7,P <0 .0 5 )。术后并发症发生率减黄组为 5 9.1% (13 /2 2 ) ,未减黄组为 5 3 .3 % (16/3 0 ) ,手术死亡率减黄组为 4.5 % (1/2 2 ) ,未减黄组为 6.7% (2 /3 0 ) ,两组比较差异均无显著性 (均P >0 .0 5 )。但在总住院时间上减黄组为 71(4 3～ 10 1)d ,较未减黄组的 47(2 9～ 81)d明显延长 (t =-3 .3 2 2 ,P <0 .0 5 )。结论 对伴有重度梗阻性黄疸的壶腹周围癌患者 ,若能充分进行术前准备 ,一期行PD手术利大于弊。

Objective To explore the influence of preoperative biliary drainage on peri-ampullary carcinoma patients with severe jaundice undergoing pancreaticoduodenectomy(PD) Methods The clinical data of 22 patients received biliary drainage (drainage group) before PD,and 30 patients underwent PD without preoperative biliary drainage (non-drainage group) were analysed retrospectively and compared . Results The clinical background of two groups was comparable (P>0.05). All of the patients underwent standard PD.Operative time and intraoperative blood loss were 344(240-570)min and 1057(600-2 100)ml in drainage group,and 306(210-490)min and 908(200-2 000)ml in non-drainage group,but there was no significant difference between the two groups(all P>0.05). Intraoperative blood transfusion in drainage group (1 300ml) was significantly increased than that in non-drainage group( 939ml)(P< 0.05). Postoperative complications was 59.1%(13/22) in drainage group and 56.5%(16/30)in non-drainage group;mortality was 4.5%(1/22) in drainage group,and 6.7%(2/30)in non-drainage group respectively,these parameters were no significant difference between the two groups(P>0.05). The hospital stay in drainage group[ average 71(43-101)days] was significantly longer than that in non- drainage group [ average 47(29-81)days](P=0.05). Conclusions If a sufficient preoperative preparation is performed,one stage PD operation is a benificial method for peri-ampullar carcinoma patients complicated with severe obstructive jaundice.