摘要
目的 探讨梗阻性黄疸围手术期处理和死亡原因。方法 对 1991年 12月～ 2 0 0 0年 12月间的 12 0例梗阻性黄疸患者进行回顾性分析 ,将 1995年以前的 5 8例患者作为 A组 ,1995年之后的 6 2例做为 B组进行比较研究。并对围手术期处理和死亡原因的探讨进行总结。结果 (1)梗阻性黄疸患者的内毒素血症 ,高胆红素血症及肝功、肾功受损和术后死亡有密切关系。(2 ) B组并发症和术后死亡率分别为 4 0 .3% (2 5 /6 2 ) ;6 5 % (4/6 2 ) ,较 A组并发症 81% (47/5 8)和术后死亡率 2 0 .7% (12 /5 8)有显著降低 (P<0 .0 0 1)。(3)血清胆红素 >342 μmol/L 患者的病死率 (45 .8% )明显高于血清胆红素≤ 342 μm ol/l(8.6 % )患者 (P<0 .0 0 5 )。恶性病例的病死率 (38.1% )也显著高于良性病例 (4.8% ) (P<0 .0 0 5 )。结论 加强围手术期处理 ,选择适当的手术方式可减少梗阻性黄疸患者的手术。
Objective To explore the effect of preoperative management to reduce the postoperative mortality in pa- tients with obstructive jaundice.Methods Retrospective analysis was used on12 0 patients with obstructive jaundice admitted from Dec.1991to Dec.2 0 0 0 in order to evaluate the reason of postoperative death and perioperative m anagem ent.12 0 patients were divided into two groups.5 8patients treated before1995 were divided into Group A.and6 2 patients after1995 into Group B.The results from the two groups were compared.Results (1) Hyperbilirubinemia,renal failure and liver dysfunction were the risk factors related to the higher postoperative mortality. (2 ) The complications and m ortality in Group A were 81% (47/ 5 8) ,2 0 .7% (12 / 5 8) ;and the same targets in Group B4 0 .3% (2 5 / 6 2 ) ,6 .5 % (4/ 6 2 ) .There were significant differences be- tween the two groups(P<0 .0 1) .(3) Postoperative mortality in patients with total bilirubin>342μm ol/ L (45 .8% ) was signifi- cantly higher than in that≤ 342 μmol/ L(8.6 % ) (P<0 .0 0 5 )Postoperative m ortality in patients with m alignant illness(38.1% ) was significantly higher than that with benign illness(4. 8% ) (P<0 .0 0 5 ) .Conclusion It can be decreasing the operative and postoperative mortality for the patients with obstructive jaundice by intensifying the perioperative m anagem ent and selection a proper operative type.
出处
《肝胆外科杂志》
2002年第6期432-434,共3页
Journal of Hepatobiliary Surgery
