Odongo Charles Newton, Dreque Carlos Cabrera, Mutiibwa David, Bongomin Felix, Oyania Felix, Sikhondze Mvuyo Maqhawe, Acan Moses, Atwine Raymond, Kirya Fred, Situma Martin
Department of Anatomy, Faculty of Medicine, Soroti University, Soroti, Uganda.
Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda.
Clin Exp Gastroenterol. 2022 Jun 11;15:79-90. doi: 10.2147/CEG.S356977. eCollection 2022.
The diagnosis of extrahepatic obstructive jaundice (EHOJ) remains a challenge and is often made late in low-resource settings. Systematic data are limited on the etiology and prognosis of patients with obstructive jaundice in Uganda. The objective of this study was to determine the etiology, clinical presentations, and short-term treatment outcomes of patients managed for EHOJ at Mbarara Regional Referral Hospital (MRRH) in south-western Uganda.
Between September 2019 and May 2020, we prospectively enrolled a cohort of patients who presented with EHOJ at MRRH. A pretested, semi-structured data collection tool was used to abstract data from both the study participants and their files.
A total of 72 patients, 42 (58.3%) of whom were male with a median age of 56 (range of 2 months to 95 years) were studied. Forty-two (58.3%) participants had malignancies: Pancreatic head tumors 20 (27.8%), cholangiocarcinoma 13 (18.1%), duodenal cancers 5 (6.94%), and gall bladder cancer 4 (5.6%). The remaining 30 (41.7%) participants had benign etiologies: choledocholithiasis 10 (13.9%), biliary atresia 7 (9.7%), pancreatic pseudo cyst 6 (8.3%), Mirizzi syndrome 5 (6.9%) and 1 (1.4%) each of chronic pancreatitis and choledochal cyst. Sixty-seven (93.1%) patients presented with right upper quadrant tenderness, 65 (90.3%) abdominal pain and 55 (76.3%) clay-colored stool. Cholecystectomy 11 (25.6%) and cholecystojejunostomy + jejunojejunostomy 8 (18.6%) were the commonest procedures performed. Twelve (17.0%) of cases received chemotherapy (epirubicin/cisplatin/capecitabine) for pancreatic head tumors and (gemcitabine/oxaliplatine) for cholangiocarcinoma. Mortality rate was 29.2% in the study, of which malignancy carried the highest mortality 20 (95.24%).
Malignancy was the main cause of EHOJ observed in more than half of the patients. Interventions aimed at early recognition and appropriate referral are key in this population to improve outcomes.
肝外阻塞性黄疸（EHOJ）的诊断仍然是一项挑战，在资源匮乏地区往往诊断较晚。关于乌干达阻塞性黄疸患者的病因和预后的系统数据有限。本研究的目的是确定乌干达西南部姆巴拉拉地区转诊医院（MRRH）接受EHOJ治疗的患者的病因、临床表现和短期治疗结果。
2019年9月至2020年5月期间，我们前瞻性招募了一组在MRRH表现为EHOJ的患者。使用经过预测试的半结构化数据收集工具从研究参与者及其病历中提取数据。
共研究了72例患者，其中42例（58.3%）为男性，中位年龄为56岁（范围为2个月至95岁）。42例（58.3%）参与者患有恶性肿瘤：胰头肿瘤20例（27.8%）、胆管癌13例（18.1%）、十二指肠癌5例（6.94 %）和胆囊癌4例（5.6%）。其余30例（41.7%）参与者有良性病因：胆总管结石10例（13.9%）、胆道闭锁7例（9.7%）、胰腺假性囊肿6例（8.3%）、Mirizzi综合征5例（6.9%）以及慢性胰腺炎和胆总管囊肿各1例（1.4%）。67例（93.1%）患者出现右上腹压痛，65例（90.3%）出现腹痛，55例（76.3%）出现陶土样大便。胆囊切除术11例（25.6%）和胆囊空肠吻合术+空肠空肠吻合术8例（18.6%）是最常见的手术。12例（17.0%）病例接受了针对胰头肿瘤的化疗（表柔比星/顺铂/卡培他滨）和针对胆管癌的化疗（吉西他滨/奥沙利铂）。本研究中的死亡率为29.2%，其中恶性肿瘤的死亡率最高，为20例（95.24%）。
恶性肿瘤是超过半数患者中观察到的EHOJ的主要原因。针对该人群，旨在早期识别和适当转诊的干预措施是改善预后的关键。
