Li Shao-qiang, Chen Dong, Liang Li-jian, Peng Bao-gang, Yin Xiao-yu
Department of Hepatobiliary Surgery, First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China.
Zhonghua Wai Ke Za Zhi. 2009 Aug 1;47(15):1134-7.
To evaluate the impact of preoperative biliary drainage on surgical morbidity in hilar cholangiocarcinoma patients underwent surgery.
One hundred and eleven consecutive patients with hilar cholangiocarcinoma whose serum total bilirubin (TBIL) level > 85 micromol/L and underwent surgery in the period from June 1998 to August 2007 were enrolled. There were 67 male and 44 female patients, aged from 26 to 82 years old with a mean of 56 years old.
Fifty-five patients underwent preoperative biliary drainage with a mean of 11.4 d of drainage period (drainage group), the other (n = 56) were the non-drainage group. The preoperative TBIL level of drainage group was (154 +/- 69) micromol/L, which was significantly lower than the value of pre-drainage (256 +/- 136) micromol/L (P = 0.000) and the value of non-drainage group (268 +/- 174) micromol/L (P = 0.005). ALT and GGT levels could be lowered by preoperative biliary drainage. The postoperative complications of these two groups were comparable (36.3% vs. 28.6%, P = 0.381). Four patients in drainage group and 5 patients in non-drainage group died of liver failure. Multivariate logistic regression indicated that hepatectomy (OR = 0.284, P = 0.003) was the independent risk factor associated with postoperative morbidity. Bismuth-Corlette classification (OR = 0.211, P = 0.028) was the independent risk factor linked to postoperative mortality.
Preoperative biliary drainage could alleviate liver injury due to hyperbilirubin, but it could not decrease the surgical morbidity and postoperative mortality. Concomitant hepatectomy and Bismuth-Corlette classification were independent risk factors linked to surgical risks.
评估术前胆道引流对接受手术的肝门部胆管癌患者手术并发症的影响。
纳入1998年6月至2007年8月期间连续收治的111例血清总胆红素（TBIL）水平>85微摩尔/升且接受手术的肝门部胆管癌患者。其中男性67例，女性44例，年龄26至82岁，平均56岁。
55例患者接受了术前胆道引流，平均引流时间为11.4天（引流组），其余56例为非引流组。引流组术前TBIL水平为（154±69）微摩尔/升，显著低于引流前（256±136）微摩尔/升（P = 0.000）及非引流组（268±174）微摩尔/升（P = 0.005）。术前胆道引流可降低ALT和GGT水平。两组术后并发症相当（36.3%对28.6%，P = 0.381）。引流组4例患者和非引流组5例患者死于肝衰竭。多因素logistic回归分析表明，肝切除术（OR = 0.284，P = 0.003）是与术后并发症相关的独立危险因素。Bismuth-Corlette分型（OR = 0.211，P = 0.028）是与术后死亡率相关的独立危险因素。
术前胆道引流可减轻高胆红素所致的肝损伤，但不能降低手术并发症及术后死亡率。肝切除术及Bismuth-Corlette分型是与手术风险相关的独立危险因素。
