Heslin M J, Brooks A D, Hochwald S N, Harrison L E, Blumgart L H, Brennan M F
Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
Arch Surg. 1998 Feb;133(2):149-54. doi: 10.1001/archsurg.133.2.149.
A preoperative biliary stent is commonly used after the initial evaluation of the patient with a periampullary mass.
To evaluate the effect of a preoperative biliary stent on operative difficulty, postoperative complications, and length of hospital stay after a pancreatoduodenectomy.
A retrospective review of a prospectively collected consecutive series.
The Memorial Sloan-Kettering Cancer Center's Surgical Service, New York, NY.
Seventy-four patients underwent pancreatoduodenectomy between March 1, 1994, and February 15, 1996. Thirty-five did not receive a biliary stent, and 39 received a biliary stent prior to medical evaluation. We analyzed patient, nutritional, laboratory, and operating room factors. Univariate analysis was by Student t test, chi2 test, and Fisher exact test; multivariate analysis was by logistic regression. Significance was defined at P<.05.
Operative time, amount of blood loss, complications, and length of hospital stay. Wound complications were defined as cellulitis, superficial infections, and deep infections. Intra-abdominal complications were defined as intra-abdominal abscesses and pancreatic or biliary fistula.
Groups were equivalent for tumor size, risk of comorbidity, time spent in the operating room, and amount of blood loss. There was 1 perioperative death. Patients with a stent had significantly lower bilirubin (P<.03) and aspartate aminotransferase (P<.04) levels and a significantly increased risk of nodal positivity (P<.05). The patients with a biliary stent had an increased risk of wound or abdominal complications on univariate (P<.003) and multivariate (P<.02) analysis and tended toward a prolonged hospital stay (P<.04, Wilcoxon signed rank test).
A preoperative biliary stent was associated with an increased risk of wound or intra-abdominal complications; a stent may prolong the length of hospital stay. However, length of time under anesthesia, amount of blood loss, and transfusion requirements were not altered. A biliary stent should be used with a high degree of selectivity in the management of patients with resectable periampullary masses.
对壶腹周围肿块患者进行初步评估后，术前胆道支架置入术常用。
评估术前胆道支架置入术对胰十二指肠切除术后手术难度、术后并发症及住院时间的影响。
对前瞻性收集的连续系列病例进行回顾性分析。
纽约市斯隆凯特琳纪念癌症中心外科。
1994年3月1日至1996年2月15日期间，74例患者接受了胰十二指肠切除术。35例未接受胆道支架置入，39例在医学评估前接受了胆道支架置入。我们分析了患者、营养、实验室及手术室因素。单因素分析采用Student t检验、卡方检验和Fisher精确检验；多因素分析采用逻辑回归分析。显著性定义为P<0.05。
手术时间、失血量、并发症及住院时间。伤口并发症定义为蜂窝织炎、浅表感染和深部感染。腹腔内并发症定义为腹腔内脓肿及胰瘘或胆瘘。
两组在肿瘤大小、合并症风险、手术时间及失血量方面相当。围手术期死亡1例。置入支架的患者胆红素水平（P<0.03）和天冬氨酸转氨酶水平（P<0.04）显著较低，淋巴结阳性风险显著增加（P<0.05）。单因素分析（P<0.003）和多因素分析（P<0.02）显示，置入胆道支架的患者伤口或腹部并发症风险增加，住院时间有延长趋势（P<0.04，Wilcoxon符号秩检验）。
术前胆道支架置入与伤口或腹腔内并发症风险增加相关；支架可能延长住院时间。然而，麻醉时间、失血量及输血需求未改变。在可切除壶腹周围肿块患者的治疗中，应高度选择性地使用胆道支架。
