Lai E C, Chu K M, Lo C Y, Mok F P, Fan S T, Lo C M, Wong J
Department of Surgery, University of Hong Kong, Queen Mary Hospital.
Surgery. 1992 Nov;112(5):891-6.
Surgery on patients with malignant obstructive jaundice carries formidable morbidity and mortality rates. Clinical records of 120 consecutive patients who had a serum total bilirubin levels of 100 mumol/L or greater before exploration were analyzed retrospectively to provide guidelines for better management. Although most patients underwent bilienteric bypass to either the extrahepatic (n = 45) or intrahepatic ductal system (n = 28), resection was possible in 32 (26.7%). Complications developed in 42 patients (35%), among whome 12 (10%) required reexploration and 32 (26.7%) died within the same hospitalization. Identification of risk factors associated with hospital deaths after surgery was conducted on 84 of the 120 (group A) patients randomly selected from the entire study period. Based on multivariate analysis, age greater than 65 years, a raised serum aspartate transaminase value greater than 90 IU, and serum urea level greater than 7 mmol/L before surgery were the risk factors selected from 39 different clinical (n = 6), laboratory (n = 26), and operative (n = 7) parameters studied. The predictive value was validated in the remaining 36 patients (group B), and a high-risk patient population had been isolated. Because both serum urea and aspartate transaminase values correlated significantly with the necessity of urgent exploration, aggressive nonoperative treatment should be used to control the emergency. Alternative therapeutic options or perioperative management should be considered for the selected high-risk patients before definitive surgical biliary decompression.
对恶性梗阻性黄疸患者进行手术，其发病率和死亡率都很高。对120例术前血清总胆红素水平≥100μmol/L的连续患者的临床记录进行回顾性分析，以提供更好的治疗指导。尽管大多数患者接受了肝外胆管（n = 45）或肝内胆管系统（n = 28）的胆肠吻合术，但仍有32例（26.7%）可行切除术。42例患者（35%）出现并发症，其中12例（10%）需要再次手术探查，32例（26.7%）在同一住院期间死亡。在整个研究期间随机选取的120例患者中的84例（A组）中，对与术后医院死亡相关的危险因素进行了识别。基于多因素分析，从研究的39个不同临床（n = 6）、实验室（n = 26）和手术（n = 7）参数中，筛选出年龄大于65岁、术前血清天冬氨酸转氨酶值大于90 IU以及血清尿素水平大于7 mmol/L作为危险因素。在其余36例患者（B组）中验证了预测价值，从而确定了高危患者群体。由于血清尿素和天冬氨酸转氨酶值均与紧急探查的必要性显著相关，因此应采用积极的非手术治疗来控制急症。对于选定的高危患者，在进行确定性手术胆道减压之前，应考虑其他治疗选择或围手术期管理。
