Association of Preoperative Biliary Drainage with Postoperative Morbidity after Pancreaticoduodenectomy.
Association of Preoperative Biliary Drainage with Postoperative Morbidity after Pancreaticoduodenectomy.
复制标题
术前胆道引流与胰十二指肠切除术后发病率的关系。
DOI：
10.1155/2015/796893
复制
发表时间：
2015
影响因子：
2
通讯作者：
Zhang XF
中科院分区：
文献类型：
--
作者：
Liu C;Lu JW;Du ZQ;Liu XM;Lv Y;Zhang XF
背景资料。术前胆道引流(PBD)对胰腺十二指肠切除术(PD)的利弊尚不清楚。方法：研究方法。对2009至2013年间连续接受标准PD手术的335名患者的前瞻性维护数据库进行了查询。比较47例PBD患者和288例早期手术患者的临床资料和术后并发症。接受或不接受PBD(无PBD)的患者之间也进行了配对分析。结果。PBD的指征为严重梗阻性黄疸(81%)和胆管炎(26%)。47例 患者术前胆红素水平高于288例非PBD患者(363.2 μ/L对136.0 μ/L，p<；0.001)。尽管两组间的并发症发生率无显著差异，但术后胆汁培养阳性率和伤口感染例数均明显高于非术后患者(P分别为0.084和0.183)。在配对比较中，穿刺组的伤口感染发生率是非穿刺组的三倍(14.9%对4.3%，p=0.080)。结论。PBD似乎适度增加了术后伤口和胆道感染的风险。因此，PBD应在PD之前有选择地进行。
Background. The advantages or disadvantages of preoperative biliary drainage (PBD) prior to pancreaticoduodenectomy (PD) remain unclear. Methods. A prospectively maintained database was queried for 335 consecutive patients undergoing standard PD surgery between 2009 and 2013. Clinical data and postoperative complications of the 47 patients receiving PBD and 288 patients with early surgery were compared. A matching analysis was also performed between patients receiving or not receiving PBD (no-PBD). Results. The indication for PBD was severe obstructive jaundice (81%) and cholangitis (26%) at the time of PBD. 47 PBD patients had higher bilirubin level than 288 no-PBD patients preoperatively (363.2 μmol/L versus 136.0 μmol/L, p < 0.001). Although no significant difference of any complications could be observed between the two groups, positive intraoperative bile culture and wound infection seemed to be moderately increased in PBD compared to no-PBD patients (p = 0.084 and 0.183, resp.). In the matched-pair comparison, the incidence of wound infection was three times higher in PBD than no-PBD patients (14.9% versus 4.3%, p = 0.080). Conclusions. PBD seems to moderately increase the risk of postoperative wound and bile duct infection. Therefore, PBD should be selectively performed prior to PD.