Department of General Surgery, Visceral, Vascular and Pediatric Surgery, Saarland University Medical Center, Homburg, Germany.
Department of General Surgery, Visceral, Vascular and Pediatric Surgery, Saarland University Medical Center, Homburg, Germany -
Minerva Surg. 2022 Dec;77(6):550-557. doi: 10.23736/S2724-5691.22.09414-X. Epub 2022 Mar 1.
Utilization of preoperative biliary drainage prior to pancreatoduodenectomy for patients with pancreatic ductal adenocarcinoma and obstructive jaundice remains controversial.
All patients that underwent pancreatoduodenectomy for pancreatic ductal adenocarcinoma at the authors' institution were analyzed retrospectively to evaluate the effect of endoscopic biliary drainage on postoperative outcomes and long-term survival. Age, gender, ASA-Score, operative time, blood loss, intraoperative transfusion rate, and postoperative complications, including postoperative pancreatic fistula, delayed gastric emptying, bleeding, bile fistula, wound infections, sepsis, pulmonary and cardiac complications as well as the need for relaparotomy were analyzed.
Two hundred eighty-five patients with similar baseline characteristics underwent pancreatoduodenectomy, 151 patients with biliary drainage (group 1) and 134 without drainage (group 2). More than 60% of patients had one or more postoperative complications, without significant difference between the two groups (P=0.140). The overall incidence of pancreatic fistula was 21.75% in both groups (group 1: 19.87% vs. group 2: 23.88%, P=0.659). Wound healing impairment was the only postoperative complication that differed significantly between the two groups (group 1: 24.50% vs. group 2: 8.96%, P<0.001). In multivariate risk analysis, biliary drainage was the only independent risk factor for wound healing impairment (OR 4.126; 95% CI: 1.295-13.143; P=0.017). The median overall survival was similar in both groups.
Preoperative endoscopic biliary drainage is associated with an increased risk for wound healing impairment and wound infections. Therefore, biliary drainage should not be used routinely in patients with obstructive jaundice prior to pancreatoduodenectomy.
对于患有胰管腺癌和阻塞性黄疸的患者，在胰十二指肠切除术前行术前胆道引流的作用仍存在争议。
回顾性分析了作者所在机构行胰十二指肠切除术治疗胰管腺癌的所有患者，以评估内镜胆道引流对术后结果和长期生存的影响。分析了年龄、性别、ASA 评分、手术时间、出血量、术中输血率以及术后并发症，包括术后胰瘘、胃排空延迟、出血、胆瘘、伤口感染、脓毒症、肺部和心脏并发症以及再次剖腹手术的需要。
285 例具有相似基线特征的患者接受了胰十二指肠切除术，其中 151 例有胆道引流（组 1），134 例无胆道引流（组 2）。两组患者均有超过 60%的患者发生了一种或多种术后并发症，但两组之间无显著差异（P=0.140）。两组的总体胰瘘发生率均为 21.75%（组 1：19.87% vs. 组 2：23.88%，P=0.659）。只有伤口愈合不良是两组之间有显著差异的术后并发症（组 1：24.50% vs. 组 2：8.96%，P<0.001）。在多变量风险分析中，胆道引流是伤口愈合不良的唯一独立危险因素（OR 4.126；95%CI：1.295-13.143；P=0.017）。两组的中位总生存期相似。
术前内镜胆道引流与伤口愈合不良和伤口感染的风险增加相关。因此，在胰十二指肠切除术前行胆道引流不应用于阻塞性黄疸患者。
