术前胆道引流治疗恶性胆道梗阻：来自国家数据库的结果。

Preoperative biliary drainage for malignant biliary obstruction: results from a national database.

机构信息

Division of Gastroenterology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon.

Clinical Research Institute, Biostatistics Unit, American University of Beirut Medical Center, Beirut, Lebanon.

出版信息

J Hepatobiliary Pancreat Sci. 2017 Nov;24(11):637-642. doi: 10.1002/jhbp.505. Epub 2017 Oct 23.

DOI:10.1002/jhbp.505

PMID:28902473

Abstract

BACKGROUND

The impact of preoperative biliary drainage (PBD) on postoperative morbidity and mortality in patients with malignant biliary obstruction is still unclear. We examined short-term surgical outcomes among drained and non-drained patients.

METHODS

Patients who underwent surgical resection for their malignancies with biliary obstruction were identified using the American College of Surgeons National Surgical Quality Improvement Program Participant Use Files from 2014 to 2015. Mortality and morbidity were compared among patients who had PBD to those who did not undergo biliary drainage prior to surgery.

RESULTS

A total of 2,306 patients were included; of these 1,803 (77.8%) had PBD. The postoperative mortality was 3.0% and 2.2% among direct surgery (DS) group and PBD group, respectively (P = 0.3). Postoperative complications were higher in the PBD group compared to the DS group (27.1% vs. 19.5%; P = 0.0005). Patients in the PBD group had higher risk of sepsis (13.5% vs. 7.2%; P = 0.0001), wound infections (16.5% vs. 10.9%; P = 0.002) and pancreatic fistula (17.5% vs. 12.4%; P = 0.006) compared to the DS group.

CONCLUSION

Preoperative biliary drainage is associated with increased risk of sepsis and wound infections, but does not impact the postoperative mortality of patients undergoing PBD.

摘要

背景

术前胆道引流（PBD）对恶性胆道梗阻患者术后发病率和死亡率的影响仍不清楚。我们检查了引流和未引流患者的短期手术结果。

方法

使用美国外科医师学会国家手术质量改进计划参与者使用文件，从 2014 年至 2015 年确定因恶性胆道梗阻而行手术切除的患者。比较行 PBD 与术前未行胆道引流的患者的死亡率和发病率。

结果

共纳入 2306 例患者；其中 1803 例（77.8%）行 PBD。直接手术（DS）组和 PBD 组的术后死亡率分别为 3.0%和 2.2%（P=0.3）。与 DS 组相比，PBD 组术后并发症发生率更高（27.1%比 19.5%；P=0.0005）。与 DS 组相比，PBD 组患者发生脓毒症（13.5%比 7.2%；P=0.0001）、伤口感染（16.5%比 10.9%；P=0.002）和胰腺瘘（17.5%比 12.4%；P=0.006）的风险更高。