Russolillo Nadia, Massobrio Andrea, Langella Serena, Lo Tesoriere Roberto, Carbonatto Paolo, Ferrero Alessandro
Department of General and Oncological Surgery, Mauriziano Hospital "Umberto I", Largo Turati, 62, 10128, Turin, Italy.
Department of Interventional Radiology, Mauriziano Hospital "Umberto I", Turin, Italy.
World J Surg. 2017 Jun;41(6):1595-1600. doi: 10.1007/s00268-017-3885-y.
Percutaneous transhepatic biliary drainage (PTBD) has a crucial role in treatment of proximal biliary cancer (PBC). We assessed the incidence, risk factors, and impact of acute pancreatitis (AP) post-PTBD.
Forty patients with PBC scheduled for PTBD from January 2005 to December 2015 were enrolled. Exclusion criteria were missing clinical data, PTBD performed in other institutions, and palliative PTBD.
The 40 patients comprised 8 (20%) with gallbladder cancer, 6 (15%) with intrahepatic cholangiocarcinoma, and 26 (65%) with perihilar cholangiocarcinoma. A median of 1 PTBD procedure was performed per patient; 16 (40%) patients underwent PTBD more than once. PTBD was left-sided in 14 (35.0%) patients, right-sided in 21 (52.5%), and bilobar in 5(12.5%). Seventeen (42.5%) patients had one or more drainage-related complications. Five (12.5%) patients developed AP. A significantly higher percentage of patients with than without AP developed sepsis (60.0 vs. 11.4%, respectively) and did not undergo the planned liver resection [2 (40.0%) vs. 0 (0.0%), respectively]. Significantly more patients with than without AP underwent left-sided PTBD [10 (28.6%) vs. 4 (80.0%), respectively].
PTBD is frequently complicated by AP. AP plays a key role in the development of sepsis. Nearly half of patients with AP lose the opportunity for surgical treatment.
经皮经肝胆道引流术（PTBD）在近端胆管癌（PBC）的治疗中起着关键作用。我们评估了PTBD术后急性胰腺炎（AP）的发生率、危险因素及影响。
纳入2005年1月至2015年12月计划行PTBD的40例PBC患者。排除标准为临床资料缺失、在其他机构进行的PTBD以及姑息性PTBD。
40例患者中，8例（20%）为胆囊癌，6例（15%）为肝内胆管癌，26例（65%）为肝门周围胆管癌。每位患者平均接受1次PTBD手术；16例（40%）患者接受了不止1次PTBD。14例（35.0%）患者的PTBD为左侧，21例（52.5%）为右侧，5例（12.5%）为双侧。17例（42.5%）患者发生了一种或多种与引流相关的并发症。5例（12.5%）患者发生了AP。发生AP的患者发生脓毒症的比例显著高于未发生AP的患者（分别为60.0%和11.4%），且未进行计划中的肝切除术[分别为2例（40.0%）和0例（0.0%）]。发生AP的患者接受左侧PTBD的比例显著高于未发生AP的患者[分别为10例（28.6%）和4例（80.0%）]。
PTBD常并发AP。AP在脓毒症的发生中起关键作用。近一半的AP患者失去了手术治疗的机会。
