Guo-Qiang Zhang, Yong Li, Yu-Ping Ren, Nan-Tao Fu, Hai-Bing Chen, Jun-Wu Yang, Wei-Dong Xiao, Department of General Surgery, the First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China.
World J Gastroenterol. 2017 Aug 7;23(29):5386-5394. doi: 10.3748/wjg.v23.i29.5386.
To compare the outcomes of preoperative endoscopic nasobiliary drainage (ENBD) and endoscopic retrograde biliary drainage (ERBD) in patients with malignant distal biliary obstruction prior to pancreaticoduodenectomy (PD).
Data from 153 consecutive patients who underwent preoperative endoscopic biliary drainage prior to PD between January 2009 and July 2016 were analyzed. We compared the clinical data, procedure-related complications of endoscopic biliary drainage (EBD) and postoperative complications of PD between the ENBD and ERBD groups. Univariate and multivariate analyses with odds ratios (ORs) and 95% confidence intervals (95%CIs) were used to identify the risk factors for deep abdominal infection after PD.
One hundred and two (66.7%) patients underwent ENBD, and 51 (33.3%) patients underwent ERBD. Endoscopic sphincterotomy was less frequently performed in the ENBD group than in the ERBD group ( = 0.039); the EBD duration in the ENBD group was shorter than that in the ERBD group ( = 0.036). After EBD, the levels of total bilirubin (TB) and alanine aminotransferase (ALT) were obviously decreased in both groups, and the decreases of TB and ALT in the ERBD group were greater than those in the ENBD group ( = 0.004 and = 0.000, respectively). However, the rate of EBD procedure-related cholangitis was significantly higher in the ERBD group than in the ENBD group ( = 0.007). The postoperative complications of PD as graded by the Clavien-Dindo classification system were not significantly different between the two groups ( = 0.864). However, the incidence of deep abdominal infection after PD was significantly lower in the ENBD group than in the ERBD group ( = 0.019). Male gender (OR = 3.92; 95%CI: 1.63-9.47; = 0.002), soft pancreas texture (OR = 3.60; 95%CI: 1.37-9.49; = 0.009), length of biliary stricture (≥ 1.5 cm) (OR = 5.20; 95%CI: 2.23-12.16; = 0.000) and ERBD method (OR = 4.08; 95%CI: 1.69-9.87; = 0.002) were independent risk factors for deep abdominal infection after PD.
ENBD is an optimal method for patients with malignant distal biliary obstruction prior to PD. ERBD is superior to ENBD in terms of patient tolerance and the effect of biliary drainage but is associated with an increased risk of EBD procedure-related cholangitis and deep abdominal infection after PD.
比较术前内镜下鼻胆管引流（ENBD）和内镜逆行胆管引流（ERBD）在胰十二指肠切除术（PD）前治疗恶性远端胆道梗阻患者的疗效。
分析 2009 年 1 月至 2016 年 7 月期间 153 例接受 PD 术前内镜胆道引流的连续患者的数据。我们比较了 ENBD 和 ERBD 组的临床资料、内镜胆道引流（EBD）相关并发症和 PD 术后并发症。使用比值比（OR）和 95%置信区间（95%CI）的单变量和多变量分析来确定 PD 术后深部腹部感染的危险因素。
102 例（66.7%）患者行 ENBD，51 例（33.3%）患者行 ERBD。ENBD 组行内镜下括约肌切开术的比例低于 ERBD 组（ = 0.039）；ENBD 组的 EBD 时间短于 ERBD 组（ = 0.036）。EBD 后，两组总胆红素（TB）和丙氨酸氨基转移酶（ALT）水平均明显降低，ERBD 组的 TB 和 ALT 降低幅度大于 ENBD 组（ = 0.004 和 = 0.000，分别）。然而，ERBD 组 EBD 相关胆管炎的发生率明显高于 ENBD 组（ = 0.007）。PD 术后并发症按 Clavien-Dindo 分级系统分级在两组之间无显著差异（ = 0.864）。然而，PD 术后深部腹部感染的发生率在 ENBD 组明显低于 ERBD 组（ = 0.019）。男性（OR = 3.92；95%CI：1.63-9.47； = 0.002）、胰腺质地柔软（OR = 3.60；95%CI：1.37-9.49； = 0.009）、胆管狭窄长度（≥1.5 cm）（OR = 5.20；95%CI：2.23-12.16； = 0.000）和 ERBD 方法（OR = 4.08；95%CI：1.69-9.87； = 0.002）是 PD 术后深部腹部感染的独立危险因素。
ENBD 是 PD 前恶性远端胆道梗阻患者的最佳方法。ERBD 在患者耐受性和胆道引流效果方面优于 ENBD，但与 EBD 相关胆管炎和 PD 术后深部腹部感染的风险增加相关。
