El-Hanafy Ehab
Gastroenterology Surgical Center, Mansoura University, Mansoura, Egypt.
Hepatogastroenterology. 2010 May-Jun;57(99-100):414-9.
BACKGROUND/AIMS: Post-operative hepatic insufficiency is a critical complication after hepatic resection in jaundiced patients with hilar cholangiocarcinoma (hilar CC). Attempts to reduce the post operative risks associated with biliary obstruction by preoperative biliary drainage (PBD) remain controversial.
This study comparing 100 patients with hilar CC who underwent different types of hepatectomy with PBD (46%) [through percutaneous transhepatic drainage (PTD), endoscopic retrograde cholangiopancreatography (ERCP), or both] and without PBD (54%). Morbidity and mortality were analyzed.
Morbidity was 58.6% in the drained group and 20.3% in the undrained group (p = 0.001). Wound infection, abdominal collection and pneumonia were frequent in the drained group. Biliary leakage had a significant occurrence in the drained group (p = 0.02). Transfusion requirement was more common in the drained group (p = 0.04). Post operative hospital stay was prolonged in the drained group (p = 0.01). However, transient liver cell failure was more common in the undrained group (14.8% vs. 10.8%). In contrast, there were no significant differences for mortality (10.8% vs. 5.5%, p = 0.14), survival (22.6 +/- 17 vs. 19.7 +/- 16.6 months, p = 0.27) and recurrence (26% vs. 18.5%, p = 0.65).
Major liver resections in hilar CC without PBD are safe in most patients. PBD increases morbidity, biliary leakage, transfusion requirement and hospital stay. In our experience, PBD is recommended in selected patients with: cholangitis, long standing jaundice, impaired renal function and severe malnourishment state.
背景/目的：术后肝功能不全是肝门部胆管癌（肝门部CC）黄疸患者肝切除术后的一种严重并发症。术前胆道引流（PBD）降低与胆道梗阻相关的术后风险的尝试仍存在争议。
本研究比较了100例行不同类型肝切除术的肝门部CC患者，其中46%接受了PBD（通过经皮经肝引流（PTD）、内镜逆行胰胆管造影（ERCP）或两者联合），54%未接受PBD。分析了发病率和死亡率。
引流组的发病率为58.6%，未引流组为20.3%（p = 0.001）。引流组伤口感染、腹腔积液和肺炎较为常见。引流组胆漏发生率显著较高（p = 0.02）。引流组输血需求更常见（p = 0.04）。引流组术后住院时间延长（p = 0.01）。然而，未引流组短暂性肝细胞衰竭更常见（14.8%对10.8%）。相比之下，死亡率（10.8%对5.5%，p = 0.14）、生存率（22.6±17对19.7±16.6个月，p = 0.27）和复发率（26%对18.5%，p = 0.65）无显著差异。
大多数肝门部CC患者不行PBD进行大肝切除术是安全的。PBD会增加发病率、胆漏、输血需求和住院时间。根据我们的经验，建议对以下特定患者进行PBD：胆管炎、长期黄疸、肾功能受损和严重营养不良状态。
