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胰十二指肠切除术前行胆管支架置入术对壶腹周围肿瘤术后结果的影响:单中心106例连续病例的回顾性分析

The effect of biliary stents implanted before pancreaticoduodenectomy in periampullary tumors on postoperative results: a retrospective analysis of 106 consecutive cases at a single medical center.

作者信息

Özdemir Yılmaz, Peksöz Rıfat, Tör İbrahim Hakkı, Fakirullahoğlu Mesud, Temiz Ayetullah, Kara Salih, Binarbaşı Cemil, Akgül Gökhan Giray, Atamanalp Sabri Selçuk

机构信息

Department of Gastrointestinal Surgery, Erzurum City Hospital, Erzurum, Turkey.

Department of Gastrointestinal Surgery, Gülhane Training and Research Hospital, Ankara, Turkey.

出版信息

Surg Today. 2023 Apr;53(4):499-506. doi: 10.1007/s00595-022-02589-2. Epub 2022 Sep 18.

Abstract

PURPOSE

The present study evaluated the potential effects of biliary drainage before pancreaticoduodenectomy on postoperative outcomes and presented the details of a surgeon's 6 years of experience.

METHODS

All consecutive pancreatoduodenectomies performed from 2015 to 2021 were retrospectively analyzed. The study population was divided into two groups: the stented group (Group I) and the nonstented group (Group II). Patient demographic data and clinical characteristics were compared between the two groups.

RESULTS

This study comprised 106 individuals who underwent pancreaticoduodenectomy for periampullary tumors. The median age of the patients was 64.41 ± 11.67 years, and 65 (61.3%) were males. Sixty-seven patients (63.2%) received biliary drains (stented group), and 39 (36.8%) patients did not (nonstented group). Total bilirubin values (6.39 mg/dl) were higher in the nonstented patient group than in the stented group. The rate of total complications was significantly higher in the stented group than in the nonstented group [please check this carefully] (p < 0.05). The length of stay, operation time and pancreatic fistula were found to be higher in the stented group than in the nonstented group.

CONCLUSIONS

Although the total bilirubin value was higher in the nonstented patient group than in the stented group, preoperative biliary drainage increased postoperative complication rates, operation time, and hospital stay. An advanced age and the presence of stents were independent risk factors influencing morbidity development according to the multivariate analysis.

摘要

目的

本研究评估了胰十二指肠切除术前胆道引流对术后结局的潜在影响,并介绍了一位外科医生6年的经验细节。

方法

对2015年至2021年期间连续进行的所有胰十二指肠切除术进行回顾性分析。研究人群分为两组:支架置入组(I组)和无支架组(II组)。比较两组患者的人口统计学数据和临床特征。

结果

本研究包括106例行胰十二指肠切除术治疗壶腹周围肿瘤的患者。患者的中位年龄为64.41±11.67岁,男性65例(61.3%)。67例患者(63.2%)接受了胆道引流(支架置入组),39例(36.8%)患者未接受(无支架组)。无支架患者组的总胆红素值(6.39mg/dl)高于支架置入组。支架置入组的总并发症发生率显著高于无支架组[请仔细核对](p<0.05)。发现支架置入组的住院时间、手术时间和胰瘘发生率均高于无支架组。

结论

尽管无支架患者组的总胆红素值高于支架置入组,但术前胆道引流增加了术后并发症发生率、手术时间和住院时间。多因素分析显示,高龄和支架置入是影响发病的独立危险因素。

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