术前胆道引流桥是胰十二指肠切除术患者的一种有用的治疗方法。
Bridge of preoperative biliary drainage is a useful management for patients undergoing pancreaticoduodenectomy.
机构信息
Department of Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
Department of Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
出版信息
Pancreatology. 2019 Jul;19(5):775-780. doi: 10.1016/j.pan.2019.06.013. Epub 2019 Jun 23.
BACKGROUND/OBJECTIVES: The aims of this study were to clarify the effect of preoperative biliary drainage (PBD) on postoperative outcomes and the role of preoperative intentional exchange from endoscopic nasobiliary drainage (ENBD) to endoscopic retrograde biliary drainage (ERBD) for patients waiting to undergo pancreaticoduodenectomy (PD).
METHODS
We evaluated the effect of PBD and intentional exchange of PBD on the perioperative variables in 292 patients.
RESULTS
A total of 179 (61.3%) of 292 patients received PBD. There was no marked difference in the postoperative outcomes between the patients who did and did not receive PBD. Among the 160 patients who initially received endoscopic PBD, 10 (6.3%) underwent stent exchange for stent dysfunction, 59 (36.9%) who did not develop stent dysfunction underwent intentional stent exchange from ENBD to ERBD (bridge PBD group), and 91 (56.9%) did not receive any stent exchange (unchanged PBD group). The bridge PBD group had a longer duration of PBD (37 days) (p < 0.001) and a shorter preoperative hospital stay after PBD (32 days) (p < 0.001) than the unchanged PBD group (25 and 46 days, respectively); however, there were no significant differences in the postoperative variables. The incidence of stent exchange due to stent dysfunction in the bridge PBD group (11.9%) was lower than that in patients who initially received ERBD (36.0%) (p = 0.015).
CONCLUSIONS
Bridge PBD worked well for extending the duration of PBD without worsening the postoperative outcomes after PD.
背景/目的：本研究旨在阐明术前胆道引流（PBD）对术后结果的影响，以及对拟行胰十二指肠切除术（PD）的患者进行内镜下鼻胆管引流（ENBD）到内镜逆行胆管引流（ERBD）术前计划交换的作用。
方法
我们评估了 292 例患者中 PBD 对围手术期变量的影响。
结果
292 例患者中共有 179 例（61.3%）接受了 PBD。接受和未接受 PBD 的患者术后结果无明显差异。在最初接受内镜 PBD 的 160 例患者中，10 例（6.3%）因支架功能障碍进行了支架交换，59 例（36.9%）未发生支架功能障碍的患者进行了从 ENBD 到 ERBD 的计划支架交换（桥接 PBD 组），91 例（56.9%）未进行任何支架交换（未改变 PBD 组）。桥接 PBD 组 PBD 时间（37 天）（p<0.001）和 PBD 后术前住院时间（32 天）（p<0.001）均长于未改变 PBD 组（分别为 25 和 46 天）；然而，术后变量无显著差异。桥接 PBD 组因支架功能障碍而进行支架交换的发生率（11.9%）低于初始接受 ERBD 的患者（36.0%）（p=0.015）。
结论
桥接 PBD 可延长 PBD 时间而不加重 PD 后的术后结果。
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