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山东大学学报(医学版) ›› 2009, Vol. 47 ›› Issue (10): 118-121.

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术前减黄对胰头癌伴梗阻性黄疸患者行胰十二指肠切除术的影响

桑温昌,何庆泗,孙充兵   

  1. 山东大学齐鲁医院普外科,   济南 250012
  • 收稿日期:2009-01-01 出版日期:2009-10-16 发布日期:2009-10-16
  • 作者简介:桑温昌(1972- ),主治医师,主要从事普通外科 的临床研究与治疗。

Preoperative biliary drainage in patients with malignant obstructive
jaundice of carcinoma of the head of the pancreas

SANG Wenchang, HE Qingsi, SUN Chongbing    

  1. Department of Geoeral Surgery, Qilu Hospital of ShandongUniversity, Jinan 250012, China
  • Received:2009-01-01 Online:2009-10-16 Published:2009-10-16

摘要:

目的探讨术前减黄对胰头癌伴恶性梗阻性黄疸患者行胰十二指肠切除术的影响。方法回顾分析2000年1月至2007年12月间山东大学齐鲁医院收治的91例总胆红素>100?μmol/L的胰头癌伴梗阻性黄疸患者行胰十二指肠切除术的临床资料。结果在91例患者中,减黄组32例(32/91 ,35%),减黄前总胆红素水平为286±105?μmol/L, 减黄后下降为(115±92)μmol/L(t=20.15,P<0.001),术中失血(280±59)mL,术后并发症10例(31%)。未减黄组术前总胆红素水平为(279±133)μmol/L,术中失血(490±109)mL,术后并发症22例(37%),2例死亡。血清总胆红素水平>340?μmol/L、肝功能指标>正常值2倍时术后并发症发生率显著上升。减黄组中减黄顺利者术中出血量少于减黄缓慢者。结论胰头癌伴恶性梗阻性黄疸患者术前减黄并未降低术后并发症的发生率,但可减少术中出血,增加手术安全性;术前胆红素>340?μmol/L时术后并发症发生率显著增加。

关键词: 胰腺肿瘤, 术前减黄, 胰十二指肠切除术

Abstract:

To investigate the therapeutic effect of preoperative biliary drainage on morbidity and mortality of pancreaticoduodenectomy in patients with malignant obstructive jaundice in carcinoma of the head of the pancreas. MethodsClinical data of 91cases undergoing pancreaticoduodenectomy from January 2000 to December 2007 whose preoperative total bilirubin level was over 100?μmol/L were collected and analyzed. Results32 cases(35%) received preoperative biliary drainage, the total bilirubin level significantly decreased from 286±105?μmol/L to 115±92?μmol/L(t=20.15, P<0.001), and the average blood loss was 280±59?mL. In the nonpreoperative biliary drainage group, the average preoperative total bilirubin level was 279±133?μmol/L, and the average blood loss was 490±109?mL. Overall postoperative complications were found in 10 cases (31%,10/32) in the preoperative biliary drainage group and 22 cases (37%,22/59)  in the nonpreoperative biliary drainage group, and there was no significant difference in infectious complications and other complications between the two groups. Patients whose preoperative total bilirubin level was over 340?μmol/L and indication of the liver function was twice the normal had significantly increased postoperative complications. In the preoperative biliary drainage group, blood loss in patients successfully decreased and their jaundice was lower than that in patients whose jaundice decreased slowly. ConclusionPreoperative biliary drainage in patients with carcinoma of the head of the pancreas does not help to reduce postoperative complications, but can reduce the blood loss and make operations safer. Postoperative total complications were significantly increased when preoperative total bilirubin was over 340?μmol/L.

Key words: Pancreatic neoplasms; Preoperative biliary drainage; Pancreaticoduodenectomy

中图分类号: 

  • R6
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