术前选择性肝内胆道引流减黄治疗对肝门部胆管癌手术患者预后的影响

摘要

目的 探讨肝门部胆管癌(HCCA)患者行术前选择性肝内胆道引流减黄治疗对预后的影响.方法 选取在东莞东华医院2014年6月至2016年12月期间接受手术治疗的HCCA患者108例,采用随机数表法分为减黄组和非减黄组,每组54例.减黄组术前行选择性肝内胆道引流减黄治疗后进行根治性手术切除,非减黄组直接进行根治性手术切除.比较减黄组引流前、后肝功能指标变化以及两组患者术中出血量、术中红细胞和血浆输注量、住院时间,并统计两组术后并发症以及死亡率情况.结果 减黄组患者经引流减黄治疗后,血浆总胆红素(TB)、丙氨酸转移酶(ALT)、碱性磷酸酶(ALP)、γ-谷氨酰转肽酶(γ-GT)水平分别为(156.28±67.02)μmol/L、(104.36±31.81)U/L、(399.25±30.38)U/L和(201.39±53.87)U/L,较引流前均显著降低,差异均有统计学意义(P<0.05);减黄组患者术中出血量、红细胞和血浆输注量分别为(987.37±159.28)mL、(579.24±121.33)mL和(584.12±127.34)mL,非减黄组分别为(935.20±130.37)mL、(573.26±116.18)mL和(581.62±120.32)mL,两组比较差异均无统计学意义(P>0.05);减黄组患者住院时间为(38.81±11.67)d,明显长于非减黄组的(32.08±12.82)d,差异有统计学意义(P<0.05);住院期间减黄组并发症总发病率和死亡率分别为57.41％和9.26％,非减黄组分别为50.00％和11.11％,两组比较差异均无统计学意义(P>0.05).结论 术前选择性肝内胆道引流减黄治疗可降低HCCA手术患者血浆TB水平并改善术前肝功能,但不能降低术后并发症风险和死亡率.%Objective To investigate the effect of preoperative selective transhepatic cholangiodrainage for re-lieving jaundice on the prognosis of patients with hilarcholangiocarcinoma (HCCA). Methods A total of 108 patients with HCCA who underwent operation in our hospital from June 2014 to December 2016 were divided into the relieving jaundice group and the non-relieving jaundice group by random number table, with 54 patients in each group. The reliev-ing jaundice group was treated with radical resection after selective transhepatic cholangiodrainage, while the non-reliev-ing jaundice group was treated with radical resection directly. The changes of liver function indexes before and after drain-age, intraoperative blood loss, intraoperative red blood cell, plasma transfusion, hospitalization time were compared be-tween the two groups. The postoperative complications and mortality rates in the two groups were statistically analyzed. Results After treatment, the levels of plasma total bilirubin (TB), alanine aminotransferase (ALT), alkaline phospha-tase (ALP) and γ-glutamyltranspeptidase (γ-GT) in the relieving jaundice group were (156.28±67.02) μmol/L, (104.36± 31.81) U/L, (399.25±30.38) U/L and (201.39±53.87) U/L, which were significantly lower than those before drainage (P<0.05). The levels of intraoperative blood loss, red blood cell, and plasma transfusion were (987.37±159.28) mL, (579.24± 121.33) mL, (584.12±127.34) mL in the relieving jaundice group versus (935.20±130.37) mL, (573.26±116.18) mL, (581.62±120.32) mL in the non-relieving jaundice group (P>0.05). The hospitalization time of relieving jaundice group was significantly longer than that of non-relieving jaundice group, (38.81±11.67) d vs (32.08±12.82) d, P<0.05. During the hospitalization, the total incidence rate of complications and the mortality rate were 57.41％, 9.26％ in the relieving jaundice group versus 50.00％, 11.11％ in the non-relieving jaundice group (P>0.05). Conclusion Preoperative selec-tive transhepatic cholangiodrainage for relieving jaundice can reduce the plasma TB level and improve the preoperative liver function in patients with HCCA. However, it cannot reduce the risk of postoperative complications and mortality.