MEDLINE/PubMed Journal Browser Search

Pubmed for Handhelds

PUBMED FOR HANDHELDS

Search MEDLINE/PubMed

Title: [Effects of preoperative percutaneous transhepatic biliary drainage on surgical treatment of type Ⅲ and Ⅳ hilar cholangiocarcinoma].
Author: Wang DD, Xu JZ, Fu Q, Fu XJ, Chen FF, Lu Z, Guo J, Ma X, Sun WL, Zhang DY.
Journal: Zhonghua Wai Ke Za Zhi; 2019 Apr 01; 57(4):288-292. PubMed ID: 30929375.
Abstract:
Objective: To investigate the effects of preoperative percutaneous transhepatic biliary drainage on surgical treatment of type Ⅲ and Ⅳ hilar cholangiocarcinoma. Methods: Clinical data of 72 patients with hilar cholangiocarcinoma of the Bismuth-Corlette type Ⅲ and Ⅳ treated at Department of General Surgery,First Affiliated Hospital of Bengbu Medical College from January 2010 to December 2017 were analyzed retrospectively.Patients were divided into two groups based on whether PTBD was performed:a drained group and an undrained group.In the drained group,there were 31 patients,20 males and 11 females,aged (59.9±9.7)years (range: 39-73 years).Among them,14 patients underwent hepatectomy with half or more than half of the liver removed (extended hepatectomy)and 17 patients underwent non-anatomical hepatectomy in the hilar region (limited hepatectomy).In the undrained group,there were 41 patients, 26 males and 15 females, aged (60.8±7.8)years(range: 45-75 years).Among them, 17 patients underwent hepatectomy with half or more than half of the liver removed (extended hepatectomy)and 24 patients underwent non-anatomical hepatectomy in the hilar region (limited hepatectomy).Percutaneous transhepatic biliary drainage(PTBD)was used in the drained group.Under the guidance of ultrasound,one or more hepatobiliary ducts could be sufficiently drained,which had good effect and was not restricted by the obstruction location of hilar cholangiocarcinoma.The analysis of the measurement data was performed using t test,and the analysis of the count data was performed using χ(2) test,and the survival curve was plotted using Kaplan-meier method. Results: In total, 72 jaundiced patients with hilar cholangiocarcinoma underwent surgical treatment: 31 had PTBD prior to operation while 41 did not had PTBD.There were significant differences in ALT((93.2±21.4)U/L vs.(207.4±65.1)U/L),AST((87.6±18.1)U/L vs.(188.9±56.6)U/L)and total bilirubin((68.8±12.6)μmol/L vs.(227.5±87.7)μmol/L)between the patients after treatment and those before treatment(t=10.958, P=0.000; t=10.845, P=0.000; t=10.386, P=0.000).Compared with those in the undrained group, the operation time was shorter, the amount of intraoperative bleeding and the incidence of complications were lower in the drained group(t=-2.840, P=0.006; t=-3.698, P=0.000; χ(2)=4.108, P=0.043).There were no perioperative death cases in drained group and 2 perioperative death cases in undrained group.There was no significant difference in R0 resection rate between the two groups(χ(2)=0.778,P=0.378).The 1-,3-,5-year survival rate of patients in the drained group and the undrained group was 72.7%,34.2%, 13.7% and 72.8%, 31.5%, 11.8%, respectively.The difference was not statistically significant(all P>0.05). Conclusions: The preoperative percutaneous transhepatic biliary drainage in patients with hilar cholangiocarcinoma of Bismuth-Corlette type Ⅲ and Ⅳ could effectively shorten operative time, reduce amount of intraoperative bleeding and incidence of postoperative complications,but have no significant effect on the R0 resection rate and survival rate. 目的： 探讨术前减黄对Bismuth-Corlette Ⅲ、Ⅳ型肝门部胆管癌手术治疗的影响。 方法： 回顾性分析2010年1月至2017年12月蚌埠医学院第一附属医院普通外科收治的72例行手术治疗的Bismuth-Corlette Ⅲ、Ⅳ型肝门部胆管癌患者的临床资料。根据术前是否减黄治疗分为减黄组和未减黄组。减黄组31例患者，男性20例，女性11例，年龄（59.9±9.7）岁（范围：39~73岁），其中半肝及以上肝切除患者（扩大肝切除）14例，肝门区肝组织非解剖性切除术（局限肝切除）17例。未减黄组41例患者，男性26例，女性15例，年龄（60.8±7.8）岁（范围：45~75岁），其中半肝及以上肝切除（扩大肝切除术）17例，肝门区肝组织非解剖性切除（局限肝切除术）24例。术前减黄组均采用经皮经肝胆管引流术，在超声引导下可以对一个或多个肝胆管进行胆汁充分引流，具有较好的减黄效果，且不受制于肝门部胆管癌梗阻位置的高低。计量资料的分析使用t检验，计数资料的分析使用χ(2)检验；使用Kaplan-Meier方法绘制生存曲线。 结果： 72例患者中，术前行减黄治疗31例，术前未行减黄治疗41例。减黄治疗后患者的ALT[（93.2±21.4）U/L]、AST[（87.6±18.1）U/L]、总胆红素[（68.8±12.6）μmol/L]分别与减黄治疗前[（207.4±65.1）U/L、（188.9±56.6）U/L、（227.5±87.7）μmol/L]比较，差异有统计学意义（t=10.958，P=0.000；t=10.845，P=0.000；t=10.386，P=0.000）。减黄组患者相比未减黄组患者手术时间短、术中出血量少和并发症发生率低，差异有统计学意义（t=-2.840，P=0.006；t=-3.698，P=0.000；χ(2)=4.108，P=0.043）。减黄组无围手术期死亡病例，未减黄组有2例围手术期死亡患者。减黄组患者R0切除率与未减黄组患者比较，差异无统计学意义（χ(2)=0.778，P=0.378）。减黄组患者1、3、5年总体生存率分别为72.7%、34.2%、13.7%，未减黄组患者分别为72.8%、31.5%、11.8%，差异无统计学意义（P值均>0.05）。 结论： Bismuth-Corlette Ⅲ、Ⅳ型肝门部胆管癌患者术前减黄治疗可以缩短手术时间、减少术中出血量和术后并发症的发生率，但对患者的R0切除率和生存率无明显影响。.

[Abstract] [Full Text] [Related] [New Search]