合并梗阻性黄疸的壶腹周围癌患者不同术前胆道减压方式的比较

基础医学与临床 ›› 2021, Vol. 41 ›› Issue (7): 1030-1034.

合并梗阻性黄疸的壶腹周围癌患者不同术前胆道减压方式的比较

曹洪滔¹, 赵邦博¹, 周星彤², 王苑阳¹, 李天浩¹, 秦骋¹, 王维斌^1*

1.中国医学科学院北京协和医学院北京协和医院基本外科,北京 100730;
2.中国医学科学院北京协和医学院北京协和医院乳腺外科,北京 100730

收稿日期:2021-03-29 修回日期:2021-05-18 出版日期:2021-07-05 发布日期:2021-06-17
通讯作者: *wwb_xh@163.com

Comparison of different preoperative decompression of biliary tract methods for patients with periampullary carcinoma complicated with obstructive jaundice

CAO Hong-tao¹, ZHAO Bang-bo¹, ZHOU Xing-tong², WANG Yuan-yang¹, LI Tian-hao¹, QIN Cheng¹, WANG Wei-bin^1*

1. Department of General Surgery;
2. Department of Breast Surgery, Peking Union Medical College Hospital, CAMS & PUMC, Beijing 100730, China

Received:2021-03-29 Revised:2021-05-18 Online:2021-07-05 Published:2021-06-17
Contact: *wwb_xh@163.com

摘要/Abstract

摘要： 目的探讨不同胆道减压(以下称减黄)方式在合并梗阻性黄疸的壶腹周围癌患者中术前减黄效能的优劣。方法回顾性分析2015年1月至2020年9月北京协和医院收治的128例胰十二指肠切除术的胰头癌、十二指肠壶腹癌和胆总管下段癌患者的临床资料。根据胆道减压方式分组:经内镜逆行性胰胆管造影术(ERCP)放置支胆管架引流组,纳入80例患者;经皮肝穿刺胆道引流术(PTCD)组,纳入48例患者。分别在减黄前(TBpre)及手术前1周内检测血清总胆红素(TB)等指标,比较两种方式的减黄效能,进一步按照肿瘤组织学类型分组进行对照分析。结果 ERCP组减黄后(TBpost),TB指标、TB下降率、减黄充分率(TB减黄后≤100 μmol/L占比)均优于PTCD组[分别为(68±45)μmol/L vs (114±69)μmol/L; 73.9%±16.9% vs 64.2%±21.2%;83.8% vs 56.3%]。十二指肠壶腹癌中,ERCP组TB减黄后,TB指标、TB下降率、减黄充分率均优于PTCD组[分别为(51±20)μmol/L vs (103±49)μmol/L;78.6%±10.9% vs 67.2%±14.8%;100% vs 58.3%]。在胆总管下段腺癌中,ERCP组减黄后(TBport),TB指标、TB下降率、减黄充分率均优于PTCD组[分别为(76±52)μmol/L vs (161±51)μmol/L;70.6%±18.5% vs 56.5%±10.4%;82.1% vs 11.1%]。结论对于合并梗阻性黄疸的壶腹周围癌患者,建议首选ERCP放置胆管支架术前减黄,尤其对十二指肠壶腹腺癌和胆总管下段腺癌患者更为适合。

关键词: 梗阻性黄疸, 经皮肝穿刺胆道引流术(PTCD), 内镜逆行性胰胆管造影术(ERCP), 胰十二指肠切除术

Abstract: Objective To investigate the efficacy of different methods in decompression of biliary tract(jaundice reduction) for patients with periampullary carcinoma combined with obstructive jaundice. Methods The clinical data of 128 patients with malignant jaundice treated by preoperative biliary decompression before pancreaticoduodenectomy were retrospectively analyzed in Peking Union Medical College Hospital from January 2015 to September 2020. Patients were divided into endoscopic retrograde cholangiopancreatography (ERCP) with stent placement group including 80 cases and percutaneous transhepatic cholangial drainage (PTCD) group including 48 cases according to different methods of jaundice reduction. Serological indicators including total bilirubin (TB) were monitored before jaundice reduction(TBpre) and surgery within one week respectively. The efficacy of jaundice reduction in two groups was compared and further categories were carried out according to the histological types. Results TB after jaundice reduction(TBpost), TB reduction rate and the reduction adequacy rate (the percentage of postoperative TB≤100 μmol/L) in ERCP group were significantly better than those in PTCD group [(68±45)μmol/L vs (114±69)μmol/L; 73.9%±16.9% vs 64.2%±21.2%;83.8% vs 56.3%]. In patients with duodenal ampullary carcinoma,TBpost, TB reduction rate and the reduction adequacy rate in ERCP group were better than those in PTCD group [(51±20)μmol/L vs (103±49)μmol/L;78.6%±10.9% vs 67.2%±14.8%;100% vs 58.3%]. In patients with distal cholangiocarcinoma with TBpost, TB reduction rate and the reduction adequacy rate of ERCP group were better than those of PTCD group [(76±52)μmol/L vs (161±51)μmol/L;70.6%±18.5% vs 56.5%±10.4%;82.1% vs 11.1%]. Conclusions For patients with malignant obstructive jaundice, stent placement by ERCP is recommended as the first choice for preoperative jaundice reduction, especially for those with ampler carcinoma or distal cholangiocarcinoma.

Key words: obstructive jaundice, percutaneous transhepatic cholangial drainage(PTCD), endoscopic retrograde cholangiopancreatography(ERCP), pancreaticoduodenectomy

中图分类号:

R605

曹洪滔, 赵邦博, 周星彤, 王苑阳, 李天浩, 秦骋, 王维斌. 合并梗阻性黄疸的壶腹周围癌患者不同术前胆道减压方式的比较[J]. 基础医学与临床, 2021, 41(7): 1030-1034.

CAO Hong-tao, ZHAO Bang-bo, ZHOU Xing-tong, WANG Yuan-yang, LI Tian-hao, QIN Cheng, WANG Wei-bin. Comparison of different preoperative decompression of biliary tract methods for patients with periampullary carcinoma complicated with obstructive jaundice[J]. Basic & Clinical Medicine, 2021, 41(7): 1030-1034.

参考文献

[1]Pavlidis ET, Pavlidis TE. Pathophysiological conse-quences of obstructive jaundice and perioperative management[J]. Hepatobiliary Pancreat Dis Int, 2018, 17: 17-21.
[2]Tempero MA, Malafa MP, Chiorean EG, et al. Panc-reatic adenocarcinoma, version 1.2019[J]. J Natl Compr Canc Netw, 2019, 17: 202-210.
[3]中国抗癌协会胰腺癌专业委员会. 中国胰腺癌综合诊治指南(2020版)[J]. 中华外科杂志, 2020, 59: 81-100.
[4]Wu CH, Ho TW, Wu JM, et al. Preoperative biliary drainage associated with biliary stricture after pancreaticoduodenectomy: a population-based study[J]. J Hepatobiliary Pancreat Sci, 2018, 25: 308-318.
[5]曹伟, 沈越, 马传荣. 预见性护理有利于稳定恶性梗阻性黄疸患者经PTCD术后情绪及降低术后并发症[J]. 基础医学与临床, 2021, 41: 250-253.
[6]Moole H, Bechtold M, Puli SR. Efficacy of preoperative biliary drainage in malignant obstructive jaundice: a meta-analysis and systematic review[J]. World J Surg Oncol, 2016, 14, doi: 10.1186/s12957-016-0933-2.
[7]尹磊, 阮祥, 张协群, 等. 肝门部胆管癌行大范围肝切除术后并发症危险因素分析[J]. 中国实用外科杂志, 2019, 39: 939-943.
[8]胆管癌诊断与治疗——外科专家共识[J]. 临床肝胆病杂志, 2015, 31: 12-16.
[9]王冬冬, 徐建中, 付琴, 等. 术前减黄对Bismuth-Corlette Ⅲ、Ⅳ型肝门部胆管癌手术治疗的影响[J]. 中华外科杂志, 2019, 57: 288-292.
[10]Wiggers JK, Groot KB, Coelen RJ, et al. Preoperative biliary drainage in perihilar cholangiocarcinoma: identifying patients who require percutaneous drainage after failed endoscopic drainage[J]. Endoscopy, 2015, 47: 1124-1131.
[11]Inamdar S, Slattery E, Bhalla R, et al. Comparison of adverse events for endoscopic vs. percutaneous biliary drainage in the treatment of malignant biliary tract obstruction in an inpatient national cohort[J]. JAMA Oncol, 2016, 2: 112-117.
[12]马海燕. 经内镜逆行胰胆管造影支架置入对老年恶性梗阻性黄疸患者的临床疗效和对肝功能及免疫功能的影响[J]. 中国内镜杂志, 2017,23: 55-60.
[13]Sun B, Moon JH, Cai Q, et al. Review article: Asia-Pacific consensus recommendations on endoscopic tissue acquisition for biliary strictures[J]. Aliment Pharmacol Ther, 2018, 48: 138-151.