Department of Surgery & Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.
J Korean Med Sci. 2012 Apr;27(4):356-62. doi: 10.3346/jkms.2012.27.4.356. Epub 2012 Mar 21.
The aim of this study was to compare the clinical outcome and cost-effectiveness of preoperative biliary drainage (BD) methods in periampullary cancer, and to suggest guidelines for selecting the appropriate preoperative BD method. Between October 2004 and August 2010, 211 patients underwent pancreatoduodenectomy after preoperative BD. Clinical outcome and cost-effectiveness of the preoperative BD methods were compared based on the final drainage method used and on intention-to-treat analysis. There was no significant difference in drainage duration between percutaneous transhepatic biliary drainage (PTBD) and endoscopic BD groups (14.2 vs 16.6 days, respectively; P = 0.121) but daily diminution of serum bilirubin level was higher in the PTBD group (0.7 vs 0.6 mg/dL/day, respectively; P = 0.041). Based on intention-to-treat analysis, drainage duration was shorter (13.2 vs 16.5 days, respectively; P = 0.049), daily diminution of serum bilirubin level was higher (0.7 vs 0.6 mg/dL/day, respectively; P = 0.041). Medical care cost was lower (14.2 vs 15.7 × 10(3) USD, respectively; P = 0.040) in the PTBD group than in the endoscopic BD group. When selecting the preoperative BD method, practitioners should consider that PTBD is more cost-effective and safer than endoscopic BD.
本研究旨在比较胰头十二指肠切除术（PD）前胆系引流（BD）方法的临床效果和成本效益，并为选择合适的术前 BD 方法提供建议。2004 年 10 月至 2010 年 8 月，211 例行 PD 患者术前接受 BD。根据最终引流方法和意向治疗分析比较术前 BD 方法的临床效果和成本效益。经皮肝穿刺胆道引流（PTBD）组和内镜 BD 组的引流时间无显著差异（分别为 14.2 和 16.6 天；P=0.121），但 PTBD 组血清胆红素水平的每日下降幅度更高（分别为 0.7 和 0.6 mg/dL/天；P=0.041）。基于意向治疗分析，PTBD 组引流时间更短（分别为 13.2 和 16.5 天；P=0.049），血清胆红素水平的每日下降幅度更高（分别为 0.7 和 0.6 mg/dL/天；P=0.041）。PTBD 组的医疗费用低于内镜 BD 组（分别为 14.2 和 15.7×103 美元；P=0.040）。在选择术前 BD 方法时，临床医生应考虑到 PTBD 比内镜 BD 更具成本效益和安全性。
