胰十二指肠切除术后梗阻性黄疸患者的最佳胆管引流类型和管理。
The Optimal Type and Management of Biliary Drainage in Patients With Obstructive Jaundice Who Undergo Pancreaticoduodenectomy.
机构信息
Department of Gastroenterological Surgery, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
Department of Gastroenterological Surgery, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan.
出版信息
In Vivo. 2022 Jan-Feb;36(1):391-397. doi: 10.21873/invivo.12716.
BACKGROUND/AIM: The aims of this study were to clarify optimal type and management of preoperative biliary drainage (PBD) in patients with obstructive jaundice who underwent pancreatoduodenectomy (PD).
PATIENTS AND METHODS
A total of 156 patients with obstructive jaundice who underwent PD were enrolled. We compared clinical variables and postoperative complications between patients who underwent endoscopic retrograde biliary drainage (ERBD) and those who underwent endoscopic nasobiliary drainage (ENBD).
RESULTS
All patients underwent PBD, with ERBD in 117 and ENBD in 39. The incidence of infectious complications and clinically relevant pancreatic fistula (CR-PF) were significantly higher in the ERBD group (39% vs. 13%, p=0.012 and 39% vs. 10%, p<0.00001, respectively). However, there was no significant difference in the postoperative complications between two groups when the duration of drainage exceeded 30 days.
CONCLUSION
ERBD should not be performed in patients with obstructive jaundice prior to PD because of the increased rates of infectious complications and CR-PF following PD, and ENBD should be chosen instead. Furthermore, PD should be performed within 30 days of drainage period in patients with ENBD.
背景/目的：本研究旨在阐明行胰十二指肠切除术（PD）的梗阻性黄疸患者行术前胆道引流（PBD）的最佳类型和管理方法。
患者和方法
共纳入 156 例梗阻性黄疸行 PD 的患者。我们比较了行内镜逆行胰胆管造影术胆道引流（ERBD）和内镜鼻胆管引流（ENBD）的患者的临床变量和术后并发症。
结果
所有患者均行 PBD，其中 117 例行 ERBD，39 例行 ENBD。ERBD 组感染性并发症和临床相关胰瘘（CR-PF）的发生率明显更高（39%比 13%，p=0.012 和 39%比 10%，p<0.00001）。然而，当引流时间超过 30 天时，两组之间的术后并发症无显著差异。
结论
由于 PD 后 ERBD 患者的感染性并发症和 CR-PF 发生率增加，因此 ERBD 不应在 PD 前行，应选择 ENBD。此外，对于行 ENBD 的患者，引流时间应在 30 天内进行 PD。
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