术前减黄对胰十二指肠切除术后患者的效果评价

发布时间：2018-04-22 02:21

本文选题：胰十二指肠切除术 + 术前减黄　；参考：《青海大学》2015年硕士论文

【摘要】：目的:通过临床回顾性对照研究,对比观察“术前减黄+胰十二指肠切除术”在手术相关并发症、手术时间、术中出血量、术中术后总输血量、胆红素水平以及患者的住院时间、医疗费用等方面与“仅进行胰十二指肠切除术”有无改善,科学评价术前减黄的临床应用价值,为其规范化的开展提供科学依据。方法:回顾性分析青海大学附属医院普通外科2005年1月至2015年3月间行胰十二指肠切除术的胰头癌、壶腹周围癌患者87例,符合纳入标准的共57例,依据患者术前是否行减黄处理,分成减黄组(31例)和对照组(26例)。对比观察采取术前减黄(PTCD减黄)后,患者手术相关并发症、手术时间、术中出血量、术中术后总输血量、入院及术前总胆红素水平、住院时间、医疗费用等与仅进行胰十二指肠切除术患者比较有无差异。结果:(1)减黄组手术时间、术中出血量、术中术后总输血量与未减黄组上述指标比较差异有统计学意义(P0.05);减黄组患者术后死亡4例,死亡率为12.9%;未减黄组患者术后死亡3例,死亡率为11.5%,两组比较差异无统计学意义(P0.05)。(2)57例所选患者中,有24例(42.1%)术后发生了并发症。其中以肝肾衰竭、胰瘘发生例数最多,其次为胃排空障碍、腹腔感染、胆瘘、肺部感染等。减黄组术后并发症总发生率为41.9%,未减黄组术后并发症总发生率为42.3%,两组上述指标比较差异均无统计学意义(P0.05)。(3)减黄组术前平均总胆红素与减黄组入院平均总胆红素比较差异有统计学意义(P0.001);减黄组术前平均总胆红素与未减黄组术前平均总胆红素比较差异有统计学意义(P0.001)。结论:对于入院总胆红素水平大于250ummol/L的恶性梗阻性黄疸患者,术前减黄虽可缩短手术时间,减少术中出血量及术中术后总输血量,但并不能降低术后并发症的发生率和死亡率,还会延长住院时间,增加医疗费用。术前减黄不应作为恶性梗阻性黄疸患者治疗的常规措施,应对患者的年龄、经济状况、手术风险等情况综合评价后选择性行术前减黄治疗。
[Abstract]:Objective: to compare the operative complications, operative time, intraoperative bleeding volume and total blood transfusion in patients with "preoperative reduced yellow pancreaticoduodenectomy" by clinical retrospective controlled study. Bilirubin level, hospitalization time, medical cost and "pancreaticoduodenectomy only" were improved or not. The clinical application value of preoperative yellow reduction was evaluated scientifically, which provided scientific basis for its standardized development. Methods: from January 2005 to March 2015, 87 patients with carcinoma of the head of pancreas and periampullary carcinoma were retrospectively analyzed in the general surgery department of the affiliated Hospital of Qinghai University from January 2005 to March 2015. According to whether the patients were treated before operation, they were divided into two groups (31 cases) and the control group (26 cases). The postoperative complications, operative time, blood loss during operation, total blood transfusion during and after operation, total bilirubin level before and before admission, and hospitalization time were observed. There was no difference in medical expenses between patients undergoing pancreaticoduodenectomy and those who underwent pancreaticoduodenectomy alone. Results there were significant differences in the operation time, the amount of intraoperative blood loss and the total blood transfusion volume between the two groups (P < 0.05), 4 patients in the yellow reduction group died after operation, the mortality rate was 12.9 and 3 patients died after operation in the unreduced yellow group. The mortality rate was 11.50.There was no significant difference between the two groups (P 0.05, P 0.05). Of the 57 selected patients, 24 had postoperative complications (42.1%). Among them, liver and kidney failure, pancreatic fistula occurred the most, followed by gastric emptying disorder, abdominal cavity infection, biliary fistula, lung infection and so on. The total incidence of postoperative complications was 41.9 in the yellow reduction group and 42.3 in the unreduced yellow group. There was no significant difference in the above indexes between the two groups (P < 0.05) the mean total bilirubin before operation in the yellow reduction group and the admission average total bilirubin in the yellow reduction group were not significantly different. There was significant difference in the mean total bilirubin before operation between the yellow reducing group and the non-reducing yellow group (P 0.001). Conclusion: for patients with malignant obstructive jaundice whose total bilirubin level is higher than that of 250ummol/L, preoperative yellow reduction can shorten the operation time, decrease the amount of intraoperative blood loss and total blood transfusion, but it can not reduce the incidence and mortality of postoperative complications. It will also extend hospital stay and increase medical costs. Preoperative yellow reduction should not be used as a routine measure for the treatment of malignant obstructive jaundice.
【学位授予单位】：青海大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R656

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