术前胆道支架置入对胰腺癌的影响：来自德国全国胰腺外科登记处（DGAV StuDoQ|Pancreas）的病例匹配研究。
The impact of preoperative biliary stenting in pancreatic cancer: A case-matched study from the German nationwide pancreatic surgery registry (DGAV StuDoQ|Pancreas).
机构信息
Department of Surgery, University Medical Center Luebeck, Germany.
DGAV STuDoQ|Pancreas Registry of the German Association for General and Visceral Surgery, Germany; Department of General, Visceral and Transplantation Surgery, Ludwig-Maximilians University Munich, Germany.
出版信息
Pancreatology. 2019 Oct;19(7):985-993. doi: 10.1016/j.pan.2019.09.007. Epub 2019 Sep 18.
BACKGROUND/OBJECTIVE: The impact of preoperative biliary stenting (PBS) before pancreatoduodenectomy (PD) for pancreatic ductal adenocarcinoma (PDAC) is controversial.
METHODS
Patients undergoing PD with or without PBS for PDAC were identified from the German DGAV-StuDoQlPancreas registry. The impact of PBS on perioperative complications was analyzed.
RESULTS
1133 patients undergoing PD for PDAC were identified from the registry. After matching, 480 PBS patients vs. 480 patients without PBS were analyzed. Postoperative complications Clavien-Dindo classification (CDC) grade IIIa-IVb were higher in PBS patients (PBS 27% vs. no PBS 22%, p = 0.027). 320 PBS patients (66%) had no history of jaundice. In these patients, PBS was associated with higher morbidity. In contrast, PBS was not associated with higher complication rates in patients with history of jaundice. Serum bilirubin levels of 15 mg/dl and higher lead to more CDC IIIa-IVb (24% vs. 28%, p = 0.053) and higher mortality (3% vs. 7%, p < 0.001). PBS in patients with serum bilirubin levels of >15 mg/dl increased CDC IIa-IVb complications (21% vs. 50%, p = 0.001), mortality was equivalent.
CONCLUSION
Most PBS procedures were performed in patients with no history of jaundice and increased morbidity. Serum bilirubin levels >15 mg/dl lead to higher morbidity and mortality. PBS correlated with higher complication rates in these patients.
背景/目的：术前胆道支架置入（PBS）对胰头十二指肠切除术（PD）治疗胰腺导管腺癌（PDAC）的影响存在争议。
方法
从德国 DGAV-StuDoQlPancreas 注册中心确定了接受 PD 治疗 PDAC 并接受或未接受 PBS 的患者。分析 PBS 对围手术期并发症的影响。
结果
从该注册中心确定了 1133 例接受 PD 治疗 PDAC 的患者。匹配后，分析了 480 例 PBS 患者与 480 例无 PBS 患者。PBS 患者术后并发症 Clavien-Dindo 分级（CDC）IIIa-IVb 更高（PBS 为 27%，无 PBS 为 22%，p=0.027）。480 例 PBS 患者中有 320 例（66%）无黄疸史。在这些患者中，PBS 与更高的发病率相关。相反，在有黄疸史的患者中，PBS 与更高的并发症发生率无关。血清胆红素水平为 15mg/dl 及以上时，更易发生 CDC IIIa-IVb（24%比 28%，p=0.053）和更高的死亡率（3%比 7%，p<0.001）。血清胆红素水平>15mg/dl 的患者 PBS 增加了 CDC IIa-IVb 并发症（21%比 50%，p=0.001），死亡率相当。
结论
大多数 PBS 手术是在无黄疸史的患者中进行的，且增加了发病率。血清胆红素水平>15mg/dl 导致更高的发病率和死亡率。在这些患者中，PBS 与更高的并发症发生率相关。
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