Kitahata Yuji, Kawai Manabu, Tani Masaji, Hirono Seiko, Okada Ken-ichi, Miyazawa Motoki, Shimizu Atsushi, Yamaue Hiroki
Second Department of Surgery, Wakayama Medical University School of Medicine, 811-1 Kimiidera, Wakayama 641-8510, Japan.
Second Department of Surgery, Wakayama Medical University School of Medicine, 811-1 Kimiidera, Wakayama 641-8510, Japan.
Am J Surg. 2014 Jul;208(1):1-10. doi: 10.1016/j.amjsurg.2013.10.021. Epub 2014 Jan 17.
It remains controversial how preoperative biliary drainage affects occurrence of severe complications after pancreaticoduodenectomy (PD).
One hundred twenty-seven patients (60 external drainage and 67 internal drainage) required biliary drainage before PD were retrospectively reviewed.
Preoperative cholangitis in internal drainage group (22.4%) occurred significantly more often than in external drainage group (1.7%; P < .001). The incidence of severe complications (grade III or more) was significantly higher in patients with cholangitis (62.5%) than in those without it (25.2%; P = .002). The incidence of delayed gastric emptying was significantly higher in patients with cholangitis (31.2%) than in those without it (5.4%; P = .001). A multivariate logistic regression analysis revealed that preoperative cholangitis (odds ratio 4.61, 95% confidence interval 1.3 to 16.5; P = .019) was the independent risk factor for severe complications after PD.
Preoperative cholangitis during biliary drainage significantly increases incidence of severe complications after PD.
术前胆道引流如何影响胰十二指肠切除术（PD）后严重并发症的发生仍存在争议。
回顾性分析127例在PD前行胆道引流的患者（60例行外引流，67例行内引流）。
内引流组术前胆管炎发生率（22.4%）显著高于外引流组（1.7%；P <.001）。胆管炎患者严重并发症（III级及以上）的发生率（62.5%）显著高于无胆管炎患者（25.2%；P =.002）。胆管炎患者胃排空延迟的发生率（31.2%）显著高于无胆管炎患者（5.4%；P =.001）。多因素logistic回归分析显示，术前胆管炎（比值比4.61，95%置信区间1.3至16.5；P =.019）是PD后严重并发症的独立危险因素。
胆道引流期间的术前胆管炎显著增加PD后严重并发症的发生率。
