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

• 研究论文 • 上一篇    下一篇

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,赵邦博,周星彤,王苑阳,李天浩,秦骋,王维斌   

  1. 北京协和医院
  • 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: 王维斌 E-mail:wwb_xh@163.com

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

  • Received:2021-03-29 Revised:2021-05-18 Online:2021-07-05 Published:2021-06-17
  • Contact: Weibin Wang E-mail:wwb_xh@163.com

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为:经内镜逆行性胰胆管造影放置支胆管架引流组(ERCP组),纳入80例患者;经皮肝穿刺胆道引流组(PTCD组),纳入48例患者。分别在减黄前及手术前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TB减黄后、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%]。胆总管下段腺癌中,ERCP组TB减黄后、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, 内镜逆行性胰胆管造影术, 胰十二指肠切除术

Abstract: Objective To investigate the efficacy of different methods in 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 with stent placement (ERCP) 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 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 The post jaundice reduction TB(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, 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 ampullary carcinoma or distal cholangiocarcinoma.

Key words: Obstructive jaundice, Percutaneous transhepatic cholangial drainage, Endoscopic retrograde cholangiopancreatography, Pancreatico-duodenectomy

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