Hodul Pamela, Creech Steve, Pickleman Jack, Aranha Gerard V
Divisions of Surgical Oncology, Surgical Service Hines VA Hospital, Hines, IL, USA.
Am J Surg. 2003 Nov;186(5):420-5. doi: 10.1016/j.amjsurg.2003.07.005.
Preoperative biliary drainage (PBD) in jaundiced patients undergoing pancreaticoduodenectomy remains controversial.
Patients presenting with obstructive jaundice who subsequently underwent pancreaticoduodenectomy from January 1996 to June 2002 were included in the study (n = 212). Patients with preoperative biliary stents (n = 154) were compared with patients without preoperative drainage (n = 58).
Patients in the stented group required a longer operative time (mean 6.8 hours versus 6.5 hours) and had greater intraoperative blood loss (mean 1207 mL versus 1122 mL) compared with the unstented group, (P = 0.046 and 0.018). No differences were found with respect to operative mortality (2%), incidence of pancreatic fistula (10% versus 14%), or intraabdominal abscess (7% versus 5%). Wound infection occurred more often in the stented group (8% versus 0%, P = 0.039).
PBD was associated with increased operative time, intraoperative blood loss, and incidence of wound infection. Although PBD did not increase major postoperative morbidity and mortality, it should be used selectively in patients undergoing pancreaticoduodenectomy.
对于接受胰十二指肠切除术的黄疸患者，术前胆道引流（PBD）仍存在争议。
纳入1996年1月至2002年6月期间出现梗阻性黄疸并随后接受胰十二指肠切除术的患者（n = 212）。将术前放置胆道支架的患者（n = 154）与未进行术前引流的患者（n = 58）进行比较。
与未放置支架的组相比，放置支架组的患者手术时间更长（平均6.8小时对6.5小时），术中失血量更大（平均1207 mL对1122 mL），（P = 0.046和0.018）。在手术死亡率（2%）、胰瘘发生率（10%对14%）或腹腔内脓肿（7%对5%）方面未发现差异。伤口感染在放置支架组中更常见（8%对0%，P = 0.039）。
PBD与手术时间延长、术中失血量增加和伤口感染发生率增加有关。虽然PBD并未增加术后主要并发症和死亡率，但在接受胰十二指肠切除术的患者中应选择性使用。
