Park Seon-Young, Park Chang-Hwan, Cho Sung-Bum, Lee Wan-Sik, Kim Jung-Chul, Cho Chul-Kyun, Joo Young-Eun, Kim Hyun-Soo, Choi Sung-Kyu, Rew Jong-Sun
Department of Internal Medicine, Chonnam National University Medical School, Gwangju, South Korea.
Surg Laparosc Endosc Percutan Tech. 2011 Oct;21(5):344-8. doi: 10.1097/SLE.0b013e3182318d2f.
The aims of this study were to compare the clinical outcomes of the preoperative drainage methods in patients with obstructive jaundice awaiting panreaticoduodenectomy and to determine, which procedure would be more effective for preoperative drainage.
Among 239 patients undergoing pancreaticoduodenectomy for periampullary cancer, 77 with obstructive jaundice underwent percutaneous transhepatic biliary drainage (PTBD, n=34) or endoscopic biliary drainage (EBD, n=43).
Median rate of decrease in bilirubin was 0.65 mg/d in PTBD group and 0.34 mg/d in EBD group (P=0.003). Median interval from preoperative drainage to pancreaticoduodenectomy were 11 days in PTBD group and 18 days in EBD group (P=0.009). Overall indwelling catheter-related complication rates were higher in "EBD" group compared with "PTBD" group (23.3% vs. 2.9%, P=0.019). No catheter occlusion developed in "PTBD" group, but 6 stent occlusions (13.3%) developed in "EBD" group (P=0.031). The mortality rate was not significantly different between the 2 groups.
Percutaneous biliary drainage may be preferred for preoperative drainage in patients with obstructive jaundice awaiting pancreaticoduodenectomy due to rapid biliary decompression and lower frequency of catheter-related complications.
本研究旨在比较等待胰十二指肠切除术的梗阻性黄疸患者术前引流方法的临床疗效，并确定哪种方法对术前引流更有效。
在239例行胰十二指肠切除术治疗壶腹周围癌的患者中，77例梗阻性黄疸患者接受了经皮经肝胆道引流（PTBD，n = 34）或内镜下胆道引流（EBD，n = 43）。
PTBD组胆红素下降的中位数速率为0.65mg/d，EBD组为0.34mg/d（P = 0.003）。从术前引流到胰十二指肠切除术的中位间隔时间，PTBD组为11天，EBD组为18天（P = 0.009）。“EBD”组总的留置导管相关并发症发生率高于“PTBD”组（23.3%对2.9%，P = 0.019）。“PTBD”组未发生导管堵塞，但“EBD”组发生了6例支架堵塞（13.3%）（P = 0.031）。两组的死亡率无显著差异。
对于等待胰十二指肠切除术的梗阻性黄疸患者，经皮胆道引流可能更适合作为术前引流方法，因为其胆道减压迅速且导管相关并发症发生率较低。
