Karsten T M, Allema J H, Reinders M, van Gulik T M, de Wit L T, Verbeek P C, Huibregtse K, Tytgat G N, Gouma D J
Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands.
Eur J Surg. 1996 Nov;162(11):881-8.
To analyse the outcome of preoperative biliary drainage in patients being operated on for a tumour in the pancreatic head.
Retrospective study.
University hospital, The Netherlands.
Consecutive series of 241 patients.
Decline in bilirubin concentrations and bacterial contamination of bile as a result of preoperative drainage. Incidence of postoperative complications in patients who underwent preoperative drainage and those who did not.
184/241 patients underwent preoperative biliary drainage. Endoscopic drainage was the most effective, shown by a median reduction in bilirubin concentrations of 82%, 74%, and 50% after endoscopic drainage (n = 149), papillotomy (n = 25) and external drainage (n = 10), respectively. Bacterial contamination of bile was significantly more common when an endoprosthesis was used, but did not result in a higher rate of infective complications. 163 Whipple's resections, 33 total pancreatectomies, and 45 biliary-enteric bypasses were performed. 137/241 (57%) patients had postoperative complications. There was no significant difference in the incidence of postoperative complications between patients who had preoperative biliary drainage and those who did not (p = 0.4).
分析胰头肿瘤手术患者术前胆道引流的效果。
回顾性研究。
荷兰大学医院。
连续纳入241例患者。
术前引流导致的胆红素浓度下降及胆汁细菌污染情况。术前引流患者与未进行术前引流患者术后并发症的发生率。
241例患者中184例接受了术前胆道引流。内镜引流最为有效，内镜引流（n = 149）、乳头切开术（n = 25）和外引流（n = 10）后胆红素浓度的中位数分别下降了82%、74%和50%。使用内置支架时胆汁细菌污染明显更常见，但并未导致更高的感染性并发症发生率。共进行了163例胰十二指肠切除术、33例全胰切除术和45例胆肠吻合术。241例患者中有137例（57%）出现术后并发症。术前进行胆道引流的患者与未进行术前引流的患者术后并发症发生率无显著差异（p = 0.4）。
