McPherson G A, Benjamin I S, Hodgson H J, Bowley N B, Allison D J, Blumgart L H
Br J Surg. 1984 May;71(5):371-5. doi: 10.1002/bjs.1800710522.
The operative mortality for biliary tract obstruction due to malignancy is high. In 1981 a controlled clinical trial of pre-operative percutaneous drainage was started at the Royal Postgraduate Medical School. At the time of percutaneous transhepatic cholangiography patients were randomized either to laparotomy or to pre-operative percutaneous transhepatic biliary drainage ( PTBD ) followed by laparotomy. Only patients with malignant biliary tract obstruction and serum bilirubin greater than 100 mumol/l were included. Seventy patients entered the trial, and five were withdrawn. Of the 65 remaining, 31 underwent laparotomy and 34 had pre-operative PTBD followed by laparotomy. The median duration of drainage was 18 days and during this time the median bilirubin fell from 305 to 115 mumol/l. Five patients required early surgery for complications of PTBD and two died within 30 days of surgery. The mortality for laparotomy was 19 per cent (6/31) compared with 32 per cent (11/34) for drainage plus laparotomy. This trial highlights the hazards of PTBD in high risk patients and has failed to demonstrate a reduction in mortality with the use of pre-operative PTBD .
恶性肿瘤所致胆道梗阻的手术死亡率很高。1981年，皇家研究生医学院启动了一项术前经皮引流的对照临床试验。在经皮肝穿刺胆管造影时，患者被随机分为接受剖腹手术组或先进行术前经皮肝穿刺胆道引流（PTBD）再行剖腹手术组。仅纳入恶性胆道梗阻且血清胆红素大于100μmol/L的患者。70例患者进入试验，5例退出。其余65例中，31例行剖腹手术，34例先进行术前PTBD再行剖腹手术。引流的中位持续时间为18天，在此期间，胆红素中位数从305μmol/L降至115μmol/L。5例患者因PTBD并发症需要早期手术，2例在术后30天内死亡。剖腹手术的死亡率为19%（6/31），而引流加剖腹手术的死亡率为32%（11/34）。该试验突出了PTBD在高危患者中的风险，且未能证明术前使用PTBD可降低死亡率。
