| 王学智,刘正才,张小晶,范 明,赖全友,王德盛.低位胆道恶性梗阻性黄疸术前胆红素异常的处理策略探讨(附134例报告)[J].,2018,(24):4656-4660 |
| 低位胆道恶性梗阻性黄疸术前胆红素异常的处理策略探讨(附134例报告) |
| Treatment Strategy of Preoperative Bilirubin Abnormality in the Patients with Jaundice Caused by Malignant Obstruction in the Low Bile Duct (Report of 134 Cases) |
| 投稿时间：2018-07-26 修订日期：2018-08-22 |
| DOI：10.13241/j.cnki.pmb.2018.24.011 |
| 中文关键词: 恶性梗阻性黄疸 术前减黄 胰十二指肠切除术 |
| 英文关键词: Malignant obstruction jaundice Preoperative biliary drainage Pancreaticoduodenectomy |
| 基金项目:国家自然科学基金项目(81672341) |
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| 中文摘要: |
| 摘要 目的：探讨低位胆道恶性梗阻性黄疸患者术前胆红素异常的处理策略，以提高该类患者的临床疗效。方法：回顾性分析西京医院肝胆外科2008年1月1日-2017年12月31日收治的符合研究条件的134例低位胆道恶性梗阻性黄疸(术前总胆红素≥171 ?滋mol/L)患者，按胆红素水平分为中、重度黄疸组，分析和比较两组术前黄疸的处理方法、术后肝功能、并发症情况等。结果：两组患者胆道引流后总胆红素水平均明显低于引流前，而肝功能Child-Pugh分级比较差异均无统计学意义(P>0.05)；两组行术前胆道引流患者与未行胆道引流患者的围手术期情况比较均无统计学差异(P>0.05)；两组行术前胆道引流患者与未行胆道引流患者的手术并发症的发生情况比较均无统计学差异(P>0.05)。结论：对于低位胆道恶性梗阻性黄疸患者，无论中度黄疸还是重度黄疸，原则上术前不必行胆道引流。对于伴有脏器功能不全、急性炎症或其他暂不宜手术的患者，可先行胆道引流处理，限期手术。若行术前胆道引流，采用PTCD方式，更为简单安全有效。 |
| 英文摘要: |
| ABSTRACT Objective: To explore the treatment strategy of preoperative bilirubin abnormality in patients with jaundice caused by malignant obstructive in the low bile duct and improve the clinical efficacy. Methods: The clinical data of 134 cases of patients with low malignant biliary obstructive jaundice (preoperative total bilirubin ≥171umol/L) admitted in the Department of Hepatobiliary Surgery of Xijing Hospital from January 1, 2008 to December 31, 2017 were retrospectively analyzed, these patients were divided into the medium and severe group according to the degree of jaundice, the preoperative treatment, postoperative liver function and complications were fur- ther analyzed. Results: After biliary drainage, the total bilirubin was significantly lower than those before biliary drainage, while no sig- nificant difference was found in the child-pugh classification of liver function(P>0.05) There was no statistically significant difference in the perioperative period between the preoperative biliary drainage(PBD) and the non-PBD (P>0.05). There was no statistically significant difference in the surgical complications between the PBD and the non-PBD group(P>0.05). Conclusion: For low biliary malignant ob- structive jaundice patients don't need PBD in principle regardless of moderate jaundice or severe jaundice, but for the associated with or- gan dysfunction, acute inflammation, or other temporary unfavorable surgical patients can PBD, confine operation. If preoperative biliary drainage performed, PTCD method is more simple, safe and effective. |
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