Farooqui Waqas, Penninga Luit, Burgdorf Stefan Kobbelgaard, Krohn Paul Suno, Storkholm Jan Henrik, Hansen Carsten Palnæs
Department of Surgery, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
Ann Med Surg (Lond). 2022 Nov 13;84:104894. doi: 10.1016/j.amsu.2022.104894. eCollection 2022 Dec.
Obstructive jaundice is a common problem in pancreatic and periampullary tumors, but preoperative biliary drainage in patients with hyperbilirubinemia is still controversial. This study aimed to assess the risk of complications after preoperative drainage of biliary obstruction in patients who underwent pancreaticoduodenectomy.
A retrospective cohort study of all patients who underwent pancreaticoduodenectomy from January 1st, 2015 to September 30th, 2021. Patients who had preoperative bile duct drainage were compared to patients without intervention. Type of interventions, complications, and outcomes after surgery were compared using univariate and multivariate analysis.
Of 722 patients who underwent pancreatoduodenectomy, 389 patients had preoperative drainage of the bile ducts by ERC or PTC. There was an incidence of 27% drainage-related complications, all categorized as minor (Clavien-Dindo <3) and mainly related to PTC-aided drainage. After pancreaticoduodenectomy, 23% of patients who had a preoperative biliary drain, had minor complications. Patients without biliary drainage had a higher risk of a complicated postoperative course (p = 0.001) and had a higher 30-day (p = 0.002) and 90-day mortality (p = 0.025).
Our study found preoperative bile duct drainage to be a safe procedure without severe complications. Patients undergoing preoperative bile duct drainage had fewer post-pancreatoduodenectomy complications and lower mortality.
梗阻性黄疸是胰腺和壶腹周围肿瘤的常见问题，但高胆红素血症患者术前胆道引流仍存在争议。本研究旨在评估接受胰十二指肠切除术患者术前胆道梗阻引流术后的并发症风险。
对2015年1月1日至2021年9月30日期间所有接受胰十二指肠切除术的患者进行回顾性队列研究。将术前进行胆管引流的患者与未接受干预的患者进行比较。使用单因素和多因素分析比较干预类型、并发症和术后结局。
在722例接受胰十二指肠切除术的患者中，389例患者通过内镜逆行胰胆管造影（ERC）或经皮肝穿刺胆管造影（PTC）进行了术前胆管引流。引流相关并发症发生率为27%，均归类为轻度（Clavien-Dindo<3级），主要与PTC辅助引流有关。胰十二指肠切除术后，术前进行胆管引流的患者中有23%发生轻度并发症。未进行胆管引流的患者术后病程复杂的风险更高（p=0.001），30天（p=0.002）和90天死亡率更高（p=0.025）。
我们的研究发现术前胆管引流是一种安全的手术，无严重并发症。接受术前胆管引流的患者胰十二指肠切除术后并发症较少，死亡率较低。
