Value of preoperative biliary drainage in pancreatic head cancer patients with severe obstructive jaundice: A multicenter retrospective study.

IF 16.4 1区化学 Q1 CHEMISTRY, MULTIDISCIPLINARY

Accounts of Chemical Research Pub Date : 2024-05-01 Epub Date: 2023-11-18 DOI:10.4103/sjg.sjg_296_23

Bin Lu, Yao Chen, Songyuan Qin, Jiansheng Chen

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引用次数: 0

Abstract

Background: Pancreatic head cancer accompanied by obstructive jaundice is a common clinical situation. The aim of this study was to assess the impact of preoperative biliary drainage (PBD) on clinical outcomes in patients with severe obstructive jaundice.

Methods: Patients with a bilirubin level of ≥250 μmol/L at diagnosis who underwent PBD were included. The primary endpoints and secondary endpoints were the postoperative severe complications rates. Secondary endpoints were the degree of improvement in general condition, predictors of severe postoperative complications, and the impact of PBD on patients with bilirubin levels >300 μmol/L.

Results: In total, 289 patients were included, and 188 patients (65.1%) underwent PBD. The patients who met the American Society of Anesthesiologists (ASA) classification II-III stages decreased from 119 to 100 ( P = 0.047) after PBD. The overall severe complications were significantly more frequent in the direct surgery (DS) group than in the PBD group (34.7% vs. 22.9%, P = 0.031), especially the postoperative hemorrhage (6/43 [14.0%] vs. 9/35 [25.7%], P = 0.038) and intra-abdominal infection (6/43 [14.0%] vs. 10/35 [28.6%], P = 0.018). The ASA classifications II-III (odds ratio [OR]=2.89, 95% confidence interval [CI]: 1.38-4.31), P = 0.01) and DS (OR = 3.65, 95% CI: 1.45-7.08; P = 0.003) were independently associated with severe postoperative complications. The occurrence rate of severe postoperative complications in patients with a bilirubin level >300 μmol/L who underwent PBD was significantly lower than in patients who underwent DS (25.6% vs. 40.6%, P = 0.028), but the benefit of PBD was not observed in patients who had a bilirubin level between 250 and 300 μmol/L.

Conclusion: PBD is useful in reducing severe postoperative complications, especially in patients with bilirubin levels >300 μmol/L.

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胰头癌合并重度梗阻性黄疸患者术前胆道引流的价值:一项多中心回顾性研究。

背景:胰头癌伴梗阻性黄疸是一种常见的临床情况。本研究的目的是评估术前胆道引流(PBD)对严重阻塞性黄疸患者临床结局的影响。方法:纳入诊断时胆红素水平≥250 mmol/L的PBD患者。主要终点和次要终点是术后严重并发症发生率。次要终点是一般情况的改善程度，严重术后并发症的预测因素，以及PBD对胆红素水平为bb0 300 mmol/L的患者的影响。结果:共纳入289例患者，其中188例(65.1%)行PBD。PBD后符合美国麻醉师学会(ASA) II-III级的患者从119例减少到100例(P = 0.047)。直接手术组(DS)总严重并发症发生率明显高于PBD组(34.7%比22.9%，P = 0.031)，尤其是术后出血(6/43[14.0%]比9/35 [25.7%]，P = 0.038)和腹腔感染(6/43[14.0%]比10/35 [28.6%]，P = 0.018)。ASA分类II-III(优势比[OR]=2.89, 95%可信区间[CI]: 1.38 ~ 4.31)， P = 0.01)和DS (OR = 3.65, 95% CI: 1.45 ~ 7.08;P = 0.003)与严重的术后并发症独立相关。胆红素水平为bbb300 mmol/L的患者行PBD的严重术后并发症发生率显著低于DS (25.6% vs. 40.6%， P = 0.028)，但胆红素水平为250 ~ 300 mmol/L的患者未观察到PBD的益处。结论:PBD可有效减少严重的术后并发症，特别是胆红素水平为bb0 300 mmol/L的患者。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Accounts of Chemical Research 化学-化学综合

CiteScore

31.40

自引率

1.10%

发文量

312

审稿时长

2 months

期刊介绍： Accounts of Chemical Research presents short, concise and critical articles offering easy-to-read overviews of basic research and applications in all areas of chemistry and biochemistry. These short reviews focus on research from the author’s own laboratory and are designed to teach the reader about a research project. In addition, Accounts of Chemical Research publishes commentaries that give an informed opinion on a current research problem. Special Issues online are devoted to a single topic of unusual activity and significance. Accounts of Chemical Research replaces the traditional article abstract with an article "Conspectus." These entries synopsize the research affording the reader a closer look at the content and significance of an article. Through this provision of a more detailed description of the article contents, the Conspectus enhances the article's discoverability by search engines and the exposure for the research.