术前胆道引流可降低胰十二指肠切除术后重度阻塞性黄疸患者的总体术后并发症：回顾性和倾向评分匹配分析。

Preoperative biliary drainage of severely obstructive jaundiced patients decreases overall postoperative complications after pancreaticoduodenectomy: A retrospective and propensity score-matched analysis.

机构信息

Pancreatic Disease Center, Ruijin Hospital Shanghai Jiaotong University School of Medicine, Shanghai, China.

Pancreatic Disease Center, Ruijin Hospital Shanghai Jiaotong University School of Medicine, Shanghai, China; Research Institute of Pancreatic Disease, Shanghai Jiaotong University School of Medicine, Shanghai, China.

出版信息

Pancreatology. 2020 Apr;20(3):529-536. doi: 10.1016/j.pan.2020.02.002. Epub 2020 Feb 5.

DOI:10.1016/j.pan.2020.02.002

PMID:32107192

Abstract

OBJECTIVES

The influence of preoperative biliary drainage (PBD) for obstructive jaundiced patients before pancreaticoduodenectomy is debated in the past decades. The aim of this study is to assess the impact of preoperative biliary drainage on intraoperative and postoperative outcomes in patients with severely obstructive jaundice.

METHODS

Data were collected retrospectively from severely obstructive jaundiced patients with serum total bilirubin level exceeding 250 μmol/L and undergoing pancreaticoduodenectomy from January 2012 to December 2017. The univariate and multivariate analyses were performed to assess independent risk factors for overall postoperative complications. A propensity score-matched (PSM) analysis was performed to adjust baseline characteristics between PBD and direct surgery (DS) groups. After PSM, intraoperative data and postoperative complications were compared between the two groups.

RESULTS

A total of 200 patients were included. The rate of overall postoperative complication occurred in 119 (59.5%) patients, with prealbumin <150 mg/L (OR = 3.03; 95%CI = [1.63-5.62]; p < 0.001), ASA (American Society of Anesthesiology score) classification II-III (OR = 2.27; 95%CI = [1.21-4.27]; p = 0.011), and direct surgery (OR = 3.88; 95%CI = [1.67-8.99]; p = 0.002) identified as independent risk factors in multivariate analysis. After PSM, there was similar operative time and intraoperative transfusion between PBD and DS group. However, DS group had a higher incidence of overall postoperative complication (p = 0.005), grades B and C of post-pancreatectomy hemorrhage (PPH) (p = 0.032), and grades B and C of postoperative pancreatic fistula (POPF) (p = 0.045) compared to PBD group.

CONCLUSIONS

In this retrospective study, in order to reduce overall postoperative complications, PBD should be performed routinely for those patients with serum total bilirubin level exceeding 250 μmol/L and undergoing pancreaticoduodenectomy.

摘要

目的

术前胆道引流（PBD）在胰十二指肠切除术（PD）前对梗阻性黄疸患者的影响在过去几十年中一直存在争议。本研究旨在评估术前胆道引流对重度梗阻性黄疸患者术中及术后结局的影响。

方法

从 2012 年 1 月至 2017 年 12 月期间，收集血清总胆红素水平超过 250μmol/L 并接受胰十二指肠切除术的重度梗阻性黄疸患者的数据。采用单因素和多因素分析评估总体术后并发症的独立危险因素。采用倾向评分匹配（PSM）分析调整 PBD 组和直接手术（DS）组之间的基线特征。PSM 后，比较两组的术中数据和术后并发症。

结果

共纳入 200 例患者。119 例（59.5%）患者发生总体术后并发症，其中前白蛋白<150mg/L（OR=3.03；95%CI=[1.63-5.62]；p<0.001）、ASA（美国麻醉医师协会）分级 II-III（OR=2.27；95%CI=[1.21-4.27]；p=0.011）和直接手术（OR=3.88；95%CI=[1.67-8.99]；p=0.002）为多因素分析中的独立危险因素。PSM 后，PBD 组和 DS 组的手术时间和术中输血无差异。然而，DS 组总体术后并发症（p=0.005）、胰腺切除术后出血（PPH）分级 B 和 C（p=0.032）以及术后胰瘘（POPF）分级 B 和 C（p=0.045）的发生率均高于 PBD 组。