De Simone Walter, Crafa Francesco, Noviello Adele, Esposito Francesco, Zito Bruno, Manganelli Rocco, De Simone Antonella, Covotta Luigi, Palladino Giuseppe, De Simone Emanuele
UO Nefrologia AO Moscati Avellino.
UO Chirurgia generale AO Moscati Avellino.
G Ital Nefrol. 2017 Dec 5;34(Nov-Dec):2017-vol6.
Patients affected by hilar cholangiocarcinoma are eligible for surgery only in the 20-30% of the cases and postoperative mortality is 40-50%. Many specialists are involved in the treatment of this disease, like surgeons, gastroenterologists, oncologists and radiotherapists. Recent studies have shown that preoperative bilirubinaemia is a predictor of morbidity and mortality after surgery. Coupled Plasma Filtration and Adsorption (CPFA) is a blood purification extracorporeal therapy recommended for sepsis and able to reduce bilirubinaemia.
We treated 10 patients referred to our centre affected by hilar cholangiocarcinoma complicated by obstructive jaundice with 34 CPFA sessions to test its ability to reduce preoperative bilirubin levels and we checked for mortality at 90 days.
CPFA reduced preoperative bilirubin of 30% for session; it also improved others inflammation and coagulation tests. Mortality at 90 days was 40%.
CPFA is an effective therapy for hyperbilirubinaemia. Lowering preoperative bilirubinaemia and improvement of coagulation tests subsidized the management of the patients but in our study did not affect postoperative mortality. Further studies to evaluate the indications for treatments that remove bilirubin in this setting are needed.
肝门部胆管癌患者仅20% - 30%适合手术，术后死亡率为40% - 50%。许多专科医生参与该疾病的治疗，如外科医生、胃肠病学家、肿瘤学家和放疗科医生。最近的研究表明，术前胆红素血症是术后发病率和死亡率的预测指标。配对血浆滤过吸附（CPFA）是一种推荐用于脓毒症的血液净化体外治疗方法，能够降低胆红素血症。
我们对转诊至我院的10例合并梗阻性黄疸的肝门部胆管癌患者进行了34次CPFA治疗，以测试其降低术前胆红素水平的能力，并在90天时检查死亡率。
每次CPFA治疗可使术前胆红素降低30%；还改善了其他炎症和凝血指标。90天死亡率为40%。
CPFA是治疗高胆红素血症的有效疗法。降低术前胆红素血症和改善凝血指标有助于患者的管理，但在我们的研究中并未影响术后死亡率。需要进一步研究以评估在此情况下去除胆红素治疗的适应症。
