Cherqui D, Benoist S, Malassagne B, Humeres R, Rodriguez V, Fagniez P L
Department of Digestive Surgery, Hôpital Henri Mondor, Université Paris XII, Créteil, France.
Arch Surg. 2000 Mar;135(3):302-8. doi: 10.1001/archsurg.135.3.302.
The role of preoperative biliary drainage (PBD) before liver resection in the presence of obstructive jaundice remains controversial. Our patients with proximal duct carcinoma undergo noninvasive assessment followed by rapid laparotomy without PBD if the lesion is deemed resectable.
Our aim was to report operative outcome of these patients and to analyze their specific features by comparison with patients without biliary obstruction who underwent major liver resection.
A case-comparison study.
A tertiary care university hospital in a metropolitan area.
Twenty consecutive jaundiced patients underwent major liver resection without PBD. The jaundiced patients were matched with 27 nonjaundiced patients with normal underlying liver selected from a computer bank of 261 patients undergoing liver resections and identical for age, tumor size, type of liver resection, and vascular occlusion.
Postoperative course including mortality, morbidity, transfusion rates, and results of liver function tests.
Seventeen jaundiced patients (85%) and 13 nonjaundiced patients (48%) received blood transfusions (P = .03). Morbidity was 50% in jaundiced and 15% in nonjaundiced patients (P = .006), mainly resulting from subphrenic collections and bile leaks occurring only in jaundiced patients. In contrast, there were no significant differences for mortality (5% vs 0%) and liver failure (5% vs 0%). Postoperative changes in liver function test results were comparable between groups.
Major liver resections without PBD are safe in most patients with obstructive jaundice. Recovery of hepatic synthetic function is identical to that of nonjaundiced patients. Transfusion requirements and incidence of postoperative complications, especially bile leaks and subphrenic collections, are higher in jaundiced patients. Whether PBD could improve these results remains to be determined.
在存在梗阻性黄疸的情况下，肝切除术前胆道引流（PBD）的作用仍存在争议。我们的近端胆管癌患者接受无创评估，如果病变被认为可切除，则在不进行PBD的情况下进行快速剖腹手术。
我们的目的是报告这些患者的手术结果，并通过与接受大肝切除的无胆道梗阻患者进行比较来分析他们的具体特征。
病例对照研究。
大都市地区的一家三级医疗大学医院。
连续20例黄疸患者在未进行PBD的情况下接受了大肝切除。将黄疸患者与27例无黄疸且肝脏正常的患者进行匹配，这些无黄疸患者是从261例接受肝切除的患者数据库中挑选出来的，在年龄、肿瘤大小、肝切除类型和血管闭塞情况方面相同。
术后病程，包括死亡率、发病率、输血率和肝功能检查结果。
17例黄疸患者（85%）和13例无黄疸患者（48%）接受了输血（P = 0.03）。黄疸患者的发病率为50%，无黄疸患者为15%（P = 0.006），主要是由于膈下积液和胆汁漏仅发生在黄疸患者中。相比之下，死亡率（5%对0%）和肝衰竭（5%对0%）没有显著差异。两组间肝功能检查结果的术后变化相当。
对于大多数梗阻性黄疸患者，不进行PBD的大肝切除是安全的。肝脏合成功能的恢复与无黄疸患者相同。黄疸患者的输血需求和术后并发症发生率，尤其是胆汁漏和膈下积液，更高。PBD是否能改善这些结果仍有待确定。
