摘要
目的探讨术前胆道引流对恶性梗阻性黄疸患者的临床价值及其对术后并发症的影响。方法回顾性分析2006年6月至2018年6月期间在广东医科大学附属高州市人民医院肝胆外科行胰十二指肠切除术的101例患者的临床资料,根据胆红素水平分为胆红素正常组及胆红素异常组,胆红素异常组再依据是否术前引流进一步分为未引流组和引流组。比较3组的并发症发生情况及其严重程度。结果3组患者的术中失血量、手术时间和术后住院时间比较差异均无统计学意义(P>0.05)。3组的胆汁漏发生情况、肺部感染情况和并发症综合指数(CCI)值比较差异均有统计学意义(P<0.05)。术后胆红素正常组、未引流组和引流组的凝血时间、血清白蛋白和血红蛋白变化趋势基本一致;胆红素正常组和胆道引流组术后7d的谷丙转氨酶和谷草转氨酶恢复良好,优于未引流组。结论合并高胆红素血症、胆管炎及肝功能异常的恶性梗阻性黄疸患者行术前胆道引流虽未明显改善各并发症的发生率,但可明显改善整体并发症发生的严重程度。
Objective To investigate the clinical value of preoperative biliary drainage in patients with malignant obstructive jaundice and its influence on postoperative complications. Methods This study retrospectively analyzed patients from June 2006 to June 2018 at Department of Hepatobiliary Surgery of Gaozhou People’s Hospital, Guangdong Medical University, who had underwent pancreaticoduodenal surgery. In this study, bilirubin was divided into bilirubin normal group and bilirubin abnormal group according to the level of bilirubin, then the bilirubin abnormal group was divided into non-drainage group and drainage group. The main observation indexes were the incidence of complications and their severity. Results There was no difference in intraoperative blood loss, operative time, and postoperative hospitalization among the three groups (P>0.05), but there was significant difference among the three groups on incidence of bile leakage, pulmonary infection, and the comprehensive complication index (CCI) value (P<0.05). The trend of clotting time, serum albumin, and hemoglobin in the bilirubin normal group, non-drainage group, and drainage group after operation were basically the same. The transaminase was recovered after operation in the bilirubin normal group and the drainage group, which were better than that of the non-drainage group within 7 days . Conclusions The preoperative biliary drainage in patients with malignant obstructive jaundice complicated with hyperbilirubinemia, cholangitis, and hepatic dysfunction do not significantly improve the incidence of complications, but could significantly improve the severity of the overall complication.
作者
赖泽如
阮梓康
陈国良
车斯尧
LAI Zeru;RUAN Zikang;CHEN Guoliang;CHE Siyao(Department of Hepatobiliary Surgery, Gaozhou People’s Hospital, Guangdong Medical University, Gaozhou, Guangdong 525200, P. R. China)
出处
《中国普外基础与临床杂志》
CAS
2019年第6期696-701,共6页
Chinese Journal of Bases and Clinics In General Surgery
关键词
黄疸
术前胆道引流
并发症
并发症综合指数
jaundice
preoperative biliary drainage
complication
the comprehensive complication index
