Hepato-biliary Pancreatic Surgery Unit, Nuffield House, Queen Elizabeth Hospital, Edgbaston, Birmingham B15 2TH, United Kingdom.
Int J Surg. 2011;9(2):145-9. doi: 10.1016/j.ijsu.2010.10.008. Epub 2010 Oct 25.
Whilst there are theoretical benefits from pre-operatively draining the biliary tree prior to pancreatoduodenectomy (PD), the current literature does not support this intervention. The aim of this study was to explore the relationship between pre-operative stenting, bactibilia and outcome in a large United Kingdom tertiary referral practice.
Patients undergoing PD were identified from a prospectively maintained database. The presence or absence of a stent prior to PD, and the results of bile cultures taken at PD were related to the subsequent post-operative course and the development of complications.
280 patients underwent PD for periampullary malignancies, all of whom presented with jaundice. 118 patients were stented prior to referral (98 ERCP, 20 PTC). Bile cultures were positive more frequently in the stent group (83% vs. 55%; p = 0.000002) and bactibilia was more common after ERCP than PTC (83% vs. 56%; p = 0.006). The overall prevalence of complications was 54% in the stented and 41% in the non-stented group (p = 0.03) with statistical significance achieved for pancreatic leak (p = 0.013) and haemorrhagic complications (p = 0.03). Comparing stent with no stent, there as no difference in the 30-day mortalities (8.5% vs. 6.8%; p = 0.6) or the 1-year mortality rates (35% vs. 28%; p = 0.21). Mortality rates in the infection versus no infection groups were comparable at 30 days (8.5% vs. 5.5%; p = 0.21), and at 1 year (30.7% vs. 26.4%; p = 0.25).
Pre-operative stent insertion prior to PD is associated with increased morbidity but not mortality and this is greatest for stents placed at ERCP.
尽管在胰十二指肠切除术（PD）前引流胆道树有理论上的益处，但目前的文献并不支持这种干预。本研究的目的是在英国的一家三级转诊中心探索术前支架置入、胆汁细菌培养与结果之间的关系。
从一个前瞻性维护的数据库中确定接受 PD 的患者。将 PD 前支架的存在与否以及 PD 时胆汁培养的结果与随后的术后过程和并发症的发展联系起来。
280 例壶腹周围恶性肿瘤患者接受 PD，所有患者均有黄疸。118 例患者在转诊前进行了支架置入（98 例 ERCP，20 例 PTC）。支架组胆汁培养阳性率较高（83%比 55%；p=0.000002），ERCP 后胆汁细菌培养阳性率高于 PTC（83%比 56%；p=0.006）。支架组和非支架组的并发症总发生率分别为 54%和 41%（p=0.03），其中统计学意义达到胰腺漏（p=0.013）和出血性并发症（p=0.03）。支架组与非支架组比较，30 天死亡率（8.5%比 6.8%；p=0.6）和 1 年死亡率（35%比 28%；p=0.21）无差异。感染组和非感染组的 30 天死亡率（8.5%比 5.5%；p=0.21）和 1 年死亡率（30.7%比 26.4%；p=0.25）相似。
PD 前支架置入与发病率增加相关，但与死亡率无关，而 ERCP 放置的支架发病率增加最大。
