Cai Yulong, Tang Qi, Xiong Xianze, Li Fuyu, Ye Hui, Song Peipei, Cheng Nansheng
Department of Bile Duct Surgery, West China Hospital, Sichuan University.
Department of Social Medicine and Medical Service Management, School of Public Health, Shandong University.
Biosci Trends. 2017 Jul 24;11(3):319-325. doi: 10.5582/bst.2017.01107. Epub 2017 May 22.
Perihilar cholangiocarcinoma (pCC, also known as a Klatskin tumor) is the most common type of cholangiocarcinoma (CC). Preoperative biliary drainage (PBD) is indicated for pCC patients with acute cholangitis or patients who need portal vein embolization (PVE). However, the routine performance of PBD in other patients with pCC is still controversial. The current study retrospectively examined patients with pCC who did not undergo PVE and who did not have cholangitis who were seen at this Hospital to assess the advantages and disadvantages of PBD. This study also sought to find an optimal value of total bilirubin (TB) to indicate performing PBD. Between 2009 and 2014, after excluding patients with acute cholangitis and PVE, patients who had undergone hepatectomy for pCC were enrolled in this study. First, the surgical outcomes and postoperative outcomes were compared between PBD group and direct surgery group. Second, ROC curve analysis of a subgroup of patients was performed to find the best cut off value of TB for indicating the PBD. Third, the costs for patients, including the total charges and the charges per day were compared between the two groups. Subjects were 218 patients in total. Fifty-five patients underwent PBD. This group had a longer operative time [390 (210-700) vs. 360 (105-730) min, p = 0.013], and a longer hospital stay [20 (9-48) vs. 17 (6-93) days, p = 0.007], but underwent vascular resection and reconstruction less often [8 (14.5%) vs. 50 (30.7%), p = 0.019]. Mortality and morbidity were comparable between the two groups. ROC curve analysis of a subgroup of patients indicated that the cut-off value for total bilirubin was 218.75 μmol/L (12.4 mg/dL). The total hospital charges and the charges per day did not differ significantly for the two groups. Disadvantages of PBD were a longer operating time and a longer duration of hospitalization, but the short-term surgical outcomes and hospital charges of PBD group were comparable to the direct surgery group. PBD should be considered for patients when the diagnosis is still suspicious of pCC. Based on the current data, the optimal cut-off value for preoperative TB was 218.75 μmol/L (12.4 mg/dL) to indicate PBD for patients with pCC.
肝门部胆管癌（pCC，也称为Klatskin瘤）是胆管癌（CC）最常见的类型。术前胆道引流（PBD）适用于患有急性胆管炎的pCC患者或需要门静脉栓塞（PVE）的患者。然而，在其他pCC患者中常规进行PBD仍存在争议。本研究回顾性检查了本院收治的未接受PVE且无胆管炎的pCC患者，以评估PBD的优缺点。本研究还试图找到一个总胆红素（TB）的最佳值来指导PBD的实施。2009年至2014年，在排除急性胆管炎和PVE患者后，将接受pCC肝切除术的患者纳入本研究。首先，比较PBD组和直接手术组的手术结果和术后结果。其次，对一组患者进行ROC曲线分析，以找到指示PBD的TB的最佳临界值。第三，比较两组患者的费用，包括总费用和每日费用。总共有218例患者。55例患者接受了PBD。该组手术时间更长[390（210 - 700）分钟 vs. 360（105 - 730）分钟，p = 0.013]，住院时间更长[20（9 - 48）天 vs. 17（6 - 93）天，p = 0.007]，但血管切除和重建的频率较低[8（14.5%） vs. 50（30.7%），p = 0.019]。两组的死亡率和发病率相当。对一组患者的ROC曲线分析表明，总胆红素的临界值为218.75 μmol/L（12.4 mg/dL）。两组的总住院费用和每日费用无显著差异。PBD的缺点是手术时间更长和住院时间更长，但PBD组的短期手术结果和住院费用与直接手术组相当。当诊断仍怀疑为pCC时，应考虑对患者进行PBD。基于目前的数据，术前TB的最佳临界值为218.75 μmol/L（12.4 mg/dL），以指示pCC患者进行PBD。
