肝门部胆管癌术前减轻黄疸对外科治疗的影响
Effects of preoperative jaundice relieving on surgical treatment of hilar cholangiocarcinoma
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摘要:目的 探讨术前彻底减轻黄疸对肝门部胆管癌半肝切除治疗的影响。方法 回顾性分析2007年1月至2012年1月华中科技大学同济医学院附属同济医院收治的18例行半肝切除术前彻底减轻黄疸的肝门部胆管癌患者(减轻黄疸组)的临床资料，与同期24例半肝切除术前未行减轻黄疸治疗的肝门部胆管癌患者(未减轻黄疸组)的临床资料进行比较。分析两组患者术前、术中情况(手术时间、出血量、输血量)和术后并发症等的差异。计量资料组间比较采用t检验，计数资料采用χ2检验。结果 减轻黄疸治疗后，患者的平均TBil、DBil、ALT分别为(27±5)μmol/L、(22±6)μmol/L、(52±42)U/L，分别与治疗前的(287±120)μmol/L、(212±86)μmol/L、(267±180)U/L比较，差异有统计学意义(t=4.33，6.61，4.19，P<0.05)。减轻黄疸组患者行左半肝切除术14例、右半肝切除术4例，R0切除率为16/18。未减轻黄疸组患者行左半肝切除术11例、右半肝切除术13例，R0切除率为83.3%(20/24)。两组患者R0切除率比较，差异无统计学意义(χ2=1.09，P>0.05)。减轻黄疸组和未减轻黄疸组患者手术时间分别为(5.0±0.8)h和(6.3±1.5)h，术中出血量分别为(562±207)ml和(815±463)ml，术中输血量分别为(430±317)ml和(750±146)ml。两组比较，差异均有统计学意义(t=4.77，7.80，4.65，P<0.05)。减轻黄疸组和未减轻黄疸组患者术后并发症发生率分别为3/18和75.0%(18/24)，其中术后出血发生率分别为1/18和33.3%(8/24)，术后肝功能衰竭发生率分别为1/18和33.3%(8/24)，两组比较，差异均有统计学意义(χ2=5.14,7.58，7.58，P<0.05)。结论 肝门部胆管癌患者行半肝切除术前有效减轻黄疸能缩短手术时间，减少术中出血量和术后并发症的发生。Abstract:Objective To investigate the effects of preoperative jaundice relieving on hemihepatectomy of hilar cholangiocarcinoma.Methods The clinical data of 18 patients who received preoperative percutaneous transhepatic cholangiography and drainage (PTCD) or endoscopic nasobiliary drainage (ENBD) before hemihepatectomy at the Tongji Hospital of Huazhong University of Science and Technology from January 2007 to January 2012 were retrospectively analyzed. The condition of the 18 patients (jaundice relieving group) was compared with that of 24 patients (non-jaundice relieving group) who did not receive PTCD or ENBD before hemihepatectomy. The differences in the pre- and postoperative blood loss, blood transfusion, operation time and postoperative incidence of complications between the 2 groups were analyzed. All data were analyzed using the t test or chi-square test.Results After PTCD or ENBD, the levels of total bilirubin (TBil), direct bilirubin (DBil), alanine aminotransferase (ALT) were (27±5)μmol/L, (22±6)μmol/L and (52±42)U/L, which were significantly lower than (287±120)μmol/L, (212±86)μmol/L, and (267±180)U/L before PTCD or ENBD in the jaundice relieving group (t=4.33, 6.61, 4.19, P<0.05). In the jaundice relieving group, left hemihepatectomy was performed on 14 patients, and right hemihepatectomy on 4 patients, and the radical resection rate was 16/18. In the non-jaundice relieving group, left hemihepatectomy was performed on 11 patients, and right hemihepatectomy on 13 patients, and the radical resection rate was 83.3%(20/24). There was no significant difference in the radical resection rate between the 2 groups (χ2=1.09, P>0.05). The operation time, volume of intraoperative blood loss, volume of blood transfusion were (5.0±0.8)hours, (562±207)ml and (430±317)ml in the jaundicerelieving group, and (6.3±1.5)hours, (815±463)ml and (750±146)ml in the nonjaundice relieving group, with significant differences between the 2 groups (t=4.77, 7.80, 4.65, P<0.05). The incidences of postoperative complications, bleeding and postoperative hepatic failure were 3/18, 1/18 and 1/18 in the jaundice relieving group, and 75.0%(18/24), 33.3%(8/24) and 33.3%(8/24) in the non-jaundice relieving group, with significant differences between the 2 groups (χ2=5.14, 7.58, 7.58, P<0.05).Conclusion Preoperative jaundice relieving could shorten the operation time and reduce the volume of intraoperative blood loss and the incidence of postoperative complications.
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