关键词: 经皮肝穿刺胆道引流术, 胆汁回输, 恶性梗阻性黄疸, 胰十二指肠切除术, 并发症

Abstract: To explore the clinical efficacy of percutaneous transhepatic cholangial drainage (PTCD) combined with bile reinfusion during the perioperative period of patients with malignant obstructive jaundice (MOJ). Methods    The clinical data of 180 patients with MOJ (TBil＞170 μmol/L) who underwent PD at the Department of General Surgery, the First Affiliated Hospital of Harbin Medical University between January 2018 and December 2021 were retrospectively analyzed. According to whether preoperative PTCD or bile reinfusion was performed, they were divided into PTCD combined with bile reinfusion group, PTCD without bile reinfusion group, and the group without PTCD, with 60 cases in each group. Compare the clinical indicators of the three groups of patients during the perioperative period and analyze the clinical efficacy of PTCD combined with bile reinfusion in the perioperative recovery of patients with moderate and severe lower MOJ. Results    There was no significant difference in the level of retinol-binding protein, the intraoperative conditions and the incidence of overall complications between patients from 3 groups (P>0.05). For patients from PTCD combined with bile reinfusion group, the largest decrease in the C-reactive protein level occurred on the 10th day after surgery (P<0.05), the increase in prealbumin was significantly higher than patients from PTCD without bile reinfusion group and the group without PTCD (P<0.05), and the decrease in alanine aminotransferase and total bilirubin was significantly larger than patients from PTCD without bile reinfusion group and the group without PTCD (P<0.05). The preoperative infusion volume, postoperative hospital stay, postoperative exhaust time and central venous extubation time in patients from PTCD without bile reinfusion group and the group without PTCD were significantly longer than patients from PTCD combined with bile reinfusion group (P<0.05). The incidences of diarrhea, ion disturbance and delayed gastric emptying in patients from PTCD combined with bile reinfusion group were lower than patients from PTCD reduction without bile reinfusion group and the group without PTCD (diarrhea: 1.7% vs. 11.7% vs. 10.0%; ion disturbance: 3.3% vs. 8.3% vs. 13.3%; delayed gastric emptying: 3.3% vs. 15.0% vs. 11.7%). Conclusion    During the perioperative treatment for patients(TBil＞171 μmol/L) with MOJ, PTCD combined with bile reinfusion is a safe and effective adjuvant therapy, which can promote the recovery of liver, gastrointestinal tract and other organs, inhibit inflammation, improve nutritional status, speed up postoperative exhaust, and shorten postoperative hospital stay, and thus it is worthy of clinical application.

Key words: percutaneous transhepatic cholangiography and drainage, bile reinfusion, moderate to severe lower malignant obstructive jaundice, pancreaticoduodenectomy, complications