French J J, Mansfield S D, Jaques K, Jaques B C, Manas D M, Charnley R M
Department of Hepato-Pancreato-Biliary Surgery, Freeman Hospital, Newcastle upon Tyne, UK.
Ann R Coll Surg Engl. 2009 Apr;91(3):201-4. doi: 10.1308/003588409X391893. Epub 2009 Feb 13.
To avoid the risk of complications of biliary drainage, a feasibility study was carried out to determine whether it might be possible to fast-track surgical treatment, with resection before biliary drainage, in jaundiced patients with proximal pancreatic/peri-ampullary malignancy.
Over an 18-month period, based on their presenting bilirubin levels and other logistical factors, all jaundiced patients who might be suitable for fast-track management were identified. Data on complications and hospital stay were compared with those patients in whom a conventional pathway (with biliary drainage) was used during the same time period. Data were also compared with a group of patients from the preceding 6 months.
Nine patients were fast-tracked and 49 patients treated in the conventional pathway. Fast-track patients mean (SD) serum bilirubin level was 265 micromol/l (81.6) at the time of the operation compared to 43 micromol/l (51.3; P > or = 0.0001) in conventional patients. Mean (SD) of time from referral to operation, 14 days (9) versus 59 days (36.9), was significantly shorter in fast-track patients than conventional patients (P < or = 0.0001). Length of hospital stay mean (SD) at 17 (6) days versus 22 days (19.6; P = 0.2114), surgical complications and mortality in fast-track patients were similar to conventional patients. Prior to surgery, the 49 conventional patients underwent a total of 73 biliary drainage procedures resulting in seven major complications. Comparison with the group of patients from the previous 6 months indicated that the conventional group were not disadvantaged.
Fast-track management by resection without biliary drainage of selected patients with distal biliary strictures is safe and has the potential to reduce the waiting time to surgery, overall numbers of biliary drainage procedures and the complications thereof.
为避免胆道引流并发症的风险，开展了一项可行性研究，以确定对于近端胰腺/壶腹周围恶性肿瘤的黄疸患者，在胆道引流前进行手术切除的快速治疗方案是否可行。
在18个月期间，根据患者的胆红素水平及其他后勤因素，确定所有可能适合快速治疗的黄疸患者。将这些患者的并发症及住院时间数据与同期采用传统治疗途径（进行胆道引流）的患者进行比较。数据还与前6个月的一组患者进行了比较。
9例患者接受了快速治疗，49例患者采用传统治疗途径。快速治疗组患者手术时的平均（标准差）血清胆红素水平为265微摩尔/升（81.6），而传统治疗组患者为43微摩尔/升（51.3；P≥0.0001）。快速治疗组患者从转诊到手术的平均（标准差）时间为14天（9天），明显短于传统治疗组患者的59天（36.9天）（P≤0.0001）。快速治疗组患者的平均（标准差）住院时间为17天（6天），与传统治疗组患者的22天（19.6天）相比（P = 0.2114），手术并发症及死亡率相似。术前，49例传统治疗患者共接受了73次胆道引流手术，导致7例严重并发症。与前6个月的一组患者比较表明，传统治疗组并无劣势。
对部分远端胆管狭窄患者不进行胆道引流而直接切除的快速治疗方案是安全的，并且有可能减少手术等待时间、胆道引流手术的总数及其并发症。
