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目的对恶性梗阻性黄疸伴急性化脓性胆管炎一期行胰十二指肠切除术进行可行性分析。方法回顾分析我院1999年至2004年施行PD手术治疗恶性梗阻性黄疸病人128例,其中,PD手术治疗恶性梗阻性黄疸伴ASC24例(A组),PD手术治疗不伴有ASC病例104例(B组)。术前按Knaus法计算每例APACHEⅢ评分,对比分析两组术后并发症的发生率和死亡率,以及APACHEⅢ不同计分段下死亡率的差异。结果A组术后并发症发生率为45．8％,死亡率8．3％;B组术后并发症发生率为34．6％,死亡率7．7％。两组术后并发症发生率有显著性差异(P<0．05),死亡率无显著性差异(P>0．05)。APACHEⅢ计分段分别为40分以下、41～70分、71分以上统计死亡率,两组死亡率差异无显著性(P>0．05),组内比较,不同计分段死亡率有显著性差异(P<0．05)。结论恶性梗阻性黄疸伴ASC病例术前全面和客观的评估、及时的手术探查和决断、术中的精细操作和围手术期的综合处理是保证一期PD术良好预后的决定因素。
Objective To analyze the feasibility of pancreaticoduodenectomy in patients with malignant obstructive jaundice and acute suppurative cholangitis. Methods A retrospective analysis of 128 cases of malignant obstructive jaundice treated with PD in our hospital from 1999 to 2004 was performed. Of these, 128 cases were treated with PD with malignant obstructive jaundice (group A), PD was not associated with ASC (104 cases) Group B). Preoperative Knaus method was used to calculate each APACHE III score, comparative analysis of the incidence of postoperative complications and mortality rates, as well as APACHE Ⅲ different sub-section of the mortality difference. Results The incidence of postoperative complications in group A was 45.8% and the mortality rate was 8.3%. The incidence of postoperative complications in group B was 34.6% and the mortality rate was 7.7%. The incidence of postoperative complications was significantly different between the two groups (P <0.05), with no significant difference in mortality (P> 0.05). APACHE Ⅲ section were 40 points or less, 41 to 70 points, 71 points or more statistical mortality, no significant difference between the two groups of mortality (P> 0.05), intra-group comparison, different sections of the mortality was significant Sex differences (P <0.05). Conclusions The preoperative comprehensive and objective assessment of malignant obstructive jaundice with ASC, timely surgical exploration and decision, fine operation in operation and comprehensive treatment of perioperative period are the determinants to ensure a good prognosis of primary PD.