Huang Xin, Liang Bin, Zhao Xiang-Qian, Zhang Fu-Bo, Wang Xi-Tao, Dong Jia-Hong
From the Department and Institute of Hepatobiliary Surgery (XH, BL, XQZ, FBZ, XTW, JHD), Chinese PLA General Hospital, Beijing, China; and School of Medicine (XH, FBZ, XTW), Nankai University, Tianjin, China.
Medicine (Baltimore). 2015 Apr;94(14):e723. doi: 10.1097/MD.0000000000000723.
The objective of this study was to investigate the effects of different preoperative biliary drainage (PBD) methods on complications in jaundiced patients following pancreaticoduodenectomy. We retrospectively analyzed 270 extrahepatic bile duct cancer patients who underwent pancreaticoduodenectomy. A total of 170 patients without PBD treatment were defined as the non-PBD group. According to different PBD methods, 45, 18, and 37 patients were classified into the percutaneous transhepatic biliary drainage (PTBD), endoscopic nasobiliary drainage (ENBD), and endoscopic retrograde biliary stent (ERBS) groups, respectively. Clinical characteristics and complications were compared among the 4 groups. Preoperative cholangitis occurred in 14 (8.2%) and 8 (21.6%) patients in the non-PBD and ERBS group, respectively (P = 0.04). Compared with the non-PBD group, delayed gastric emptying (DGE) and wound infection occurred significantly more often in the ERBS group. The incidence of severe complications was significantly lower in the PTBD group than the non-PBD group (P = 0.03). Postoperative hospital stay and complication rates were significantly higher in the ERBS group than the PTBD group. There were no significant differences in complications between ENBD and other groups. In conclusion, PTBD can improve surgical outcomes by reducing severe complication rate in jaundiced patients following pancreaticoduodenectomy. ERBS increased the rates of DGE and wound infection due to high incidence of cholangitis before operative intervention and should be avoided. ENBD carried no special effect on complications and needs further analysis.
本研究的目的是探讨不同术前胆道引流（PBD）方法对胰十二指肠切除术后黄疸患者并发症的影响。我们回顾性分析了270例行胰十二指肠切除术的肝外胆管癌患者。共有170例未接受PBD治疗的患者被定义为非PBD组。根据不同的PBD方法，45例、18例和37例患者分别被分为经皮经肝胆道引流（PTBD）组、内镜鼻胆管引流（ENBD）组和内镜逆行胆道支架（ERBS）组。比较4组患者的临床特征和并发症情况。非PBD组和ERBS组分别有14例（8.2%）和8例（21.6%）患者术前发生胆管炎（P = 0.04）。与非PBD组相比，ERBS组延迟胃排空（DGE）和伤口感染的发生率明显更高。PTBD组严重并发症的发生率明显低于非PBD组（P = 0.03）。ERBS组术后住院时间和并发症发生率明显高于PTBD组。ENBD组与其他组之间并发症无显著差异。总之，PTBD可通过降低胰十二指肠切除术后黄疸患者的严重并发症发生率来改善手术结局。ERBS由于术前胆管炎发生率高而增加了DGE和伤口感染的发生率，应避免使用。ENBD对并发症无特殊影响，需要进一步分析。
