摘要目的 评价术前减黄对中度梗阻性黄疸(术前血清总胆红素水平171 ～ 342 mmol/L)患者的临床价值.方法 采用前瞻性非随机对照的方法,对2012年9月至2014年9月中国医学科学院肿瘤医院胰胃外科收治的273例恶性梗阻性黄疸患者中度梗阻性黄疸105例患者,分为减黄组和未减黄组,通过对比两组患者的术中、术后各项临床指标,进行统计分析.结果 共入组患者105例,包括术前减黄组58例,未减黄组47例;减黄组术前总胆红素水平为(264±76) mmol/L,减黄后总胆红素下降为(183±44) mmol/L,减黄前后的差异有统计学意义(P＜0.001).减黄组与未减黄组在手术时间、术中出血量、总住院时间、术后住院时间等指标上的差异无统计学意义(P＞0.05).减黄组无围手术期死亡,未减黄组围手术期死亡2例,两组围手术期死亡率差异无统计学意义(P=0.423).减黄组并发症共发生16例(27.59％),与未减黄组14例(29.79％)相比略低,但差异无统计学意义(P=0.471).分层分析显示,减黄组和未减黄组在单一并发症(伤口感染、出血、胰瘘、胆瘘、胃排空障碍、腹腔感染、肺部感染、心血管并发症等)的发生上均无显著性差异(P＞0.05).结论 术前减黄对于中度梗阻性黄疸患者的价值有限,患者术前可不行减黄治疗,明确诊断后应尽早手术.

abstractsObjective To evaluate the preoperative necessity of reducing moderate icterus index (preoperative serum total bilirubin of 171 to 342 mmol/L) in obstructive jaundice patients.Methods A prospective non-randomized control method was used to divide 105 patients into jaundice-reducing (n =58) and non-reducing (n =47) group.And the intraoperative and postoperative parameters were compared between two groups.Results In jaundice-reducing group,the level of total bilirubin decreased from (264 ± 76) mmol/L to (183 ±44) mmol/L after biliary drainage (P ＜ 0.001).There were no significant intergroup differences in operative duration,blood loss,inpatient days or postoperative inpatient days (P ＞ 0.05).There was no perioperative mortality in jaundice-reducing group while two perioperative mortalities occurred in another group.There was no significant inter-group difference in perioperative mortality rate (P =0.423).The postoperative complication rate of jaundice-reducing group (n =16,27.59％) was slightly lower than that of non-reducing group (n =14,29.79％).However,the difference was insignificant (P =0.471).Stratified analysis showed that there was no significant inter-group difference in single complication (wound infection,postoperative hemorrhage,pancreatic fistula,biliary fistula,delayed gastric emptying,abdominal infection,lung infection or cardiovascular complications,etc.) (all P ＞ 0.05).Conclusions The preoperative necessity is limited for reducing moderate icterus index in obstructive jaundice patients.They should be operated as soon as possible once there is a definite diagnosis.