经皮经肝胆道引流术对腹腔镜胰十二指肠切除术治疗恶性梗阻性黄疸患者临床结局的影响。

Impact of Percutaneous Transhepatic Biliary Drainage on Clinical Outcomes of Patients with Malignant Obstructive Jaundice Undergoing Laparoscopic Pancreaticoduodenectomy.

机构信息

Department of Biliary-Pancreatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.

出版信息

Curr Med Sci. 2021 Apr;41(2):375-380. doi: 10.1007/s11596-021-2357-7. Epub 2021 Apr 20.

DOI:10.1007/s11596-021-2357-7

PMID:33877556

Abstract

Preoperative biliary drainage may increase the morbidity and mortality of pancreaticoduodenectomy. Studies on percutaneous transhepatic biliary drainage (PTBD) before laparoscopic pancreaticoduodenectomy (LPD), however, are scarce. The aim of this study was to examine the impact of PTBD on clinical outcomes of patients with malignant obstructive jaundice undergoing LPD. Clinical data of 172 patients who had malignant obstructive jaundice and underwent LPD from 2014 to 2017 in our hospital were retrospectively analyzed. Demographics, catheter-related complications, postoperative complications, and oncological outcomes were collected and analyzed. Propensity score matching was performed to minimize selection bias associated with the comparison of data between patients who underwent PTBD and then LPD (PTBD group), and those given LPD alone (LPD group). The results showed that, in the PTBD group relative to the LPD group, the operating time was significantly shortened (250.28±69.95 vs. 278.58±86.51 min, P=0.0196), the intraoperative blood loss was markedly reduced (271.96±403.47 vs. 429.72±482.47 mL, P=0.022), and overall rates of complications (16.33% vs. 36.49%, P=0.0025) including postoperative haemorrhage (2.04% vs. 12.16%, P=0.0072) and delayed gastric emptying (4.08% vs. 13.51%, P=0.0251) were greatly decreased. The propensity score-matched analysis, with 48 patients enrolled in each group, revealed no statistically significant differences in operating duration (262.71±68.64 vs. 280.25±83.52 min, P=0.264), intraoperative blood loss (290.21±407.71 vs. 373.75±422.33 mL, P=0.327) and delayed gastric emptying (4.17% vs. 12.50%, P=0.1396). PTBD group had lower incidences in overall complications (22.92% vs. 39.58%, P=0.0481) and postoperative haemorrhage (2.08% vs. 12.50%, P=0.0497) than LPD group. In conclusion, patients with malignant obstructive jaundice may benefit from PTBD procedure before LPD in terms of perioperative outcomes.

摘要

术前胆道引流可能会增加胰十二指肠切除术的发病率和死亡率。然而，关于腹腔镜胰十二指肠切除术（LPD）前经皮经肝胆道引流（PTBD）的研究却很少。本研究旨在探讨 PTBD 对恶性梗阻性黄疸患者行 LPD 后的临床结局的影响。回顾性分析了 2014 年至 2017 年我院 172 例恶性梗阻性黄疸患者的临床资料，这些患者均行 LPD。收集并分析了患者的人口统计学、导管相关并发症、术后并发症和肿瘤学结局等数据。采用倾向评分匹配法，对接受 PTBD 后再行 LPD（PTBD 组）和仅行 LPD（LPD 组）患者的数据进行比较，以尽量减少选择偏倚。结果显示，与 LPD 组相比，PTBD 组的手术时间明显缩短（250.28±69.95 比 278.58±86.51min，P=0.0196），术中出血量明显减少（271.96±403.47 比 429.72±482.47mL，P=0.022），并发症总发生率（16.33%比 36.49%，P=0.0025）包括术后出血（2.04%比 12.16%，P=0.0072）和胃排空延迟（4.08%比 13.51%，P=0.0251）明显降低。在每组纳入 48 例患者的倾向评分匹配分析中，两组患者的手术时间（262.71±68.64 比 280.25±83.52min，P=0.264）、术中出血量（290.21±407.71 比 373.75±422.33mL，P=0.327）和胃排空延迟（4.17%比 12.50%，P=0.1396）无统计学差异。PTBD 组的总并发症发生率（22.92%比 39.58%，P=0.0481）和术后出血发生率（2.08%比 12.50%，P=0.0497）均低于 LPD 组。总之，恶性梗阻性黄疸患者在行 LPD 前接受 PTBD 治疗可能会获得更好的围手术期结局。