[Curative effect analysis of bile reinfusion combined with enteral nutrition support before surgery of hilar cholangiocarcinoma].

Objective: To investigate the clinical effect of bile reinfusion combined with enteral nutrition support before surgery for hilar cholangiocarcinoma. Methods: A retrospective analysis of patients with hilar cholangiocarcinoma who underwent surgical treatment at Nanjing Drum Tower Hospital Hepato-biliary-pancreatic Surgery Department from July 2010 to August 2017 was completed.A total of 52 cases were finally enrolled in our study.All the patients included, on the basis of whether they received preoperative drainage and bile reinfusion, were divided into non-drainage group(n=15) and drainage group(n=37). Differences of clinical indicators, including operation time, intraoperative bleeding and serum liver function index levels at day 1, 3, 7 postoperative, postoperative complications(liver failure, biliary fistula, pleural effusion, peritoneal effusion, abdominal cavity infection, death in hospital), tumor classification, R0 resection, postoperative hospitalization time between the 2 groups were analyzed. At the same time, in the drainage group, patients were divided into non-enteral nutrition subgroup(n=13) and enteral nutrition subgroup(n=24) according to whether they received enteral nutrition before operation. The normal distribution data of the group was statistically analyzed by independent sample t test, the non-normal distribution data of the group was statistically analyzed by rank-sum test. The count data was statistically analyzed by non-calibration and correction of the square test. Results: There was no statistically significant difference in general infomation such as age, gender, and serum liver function between non-drainage group and drainage group(P>0.05). There was no statistically significant difference in general information such as age, gender, and serum liver function between non-enteral nutrition group and enteral nutrition group(P>0.05). The rate of vascular resection and reconstruction(33.3%) and operating time(10.8(2.2)h) in drainage group were both higher than those in non-drainage group(6.7% and 8.3(3.0)h), the differences were both statistically significant(χ(2)=4.397, Z=1.595; both P<0.05). The level of AST at the 7th day after surgery in drainage group(32.8(17.3)U/L) was significantly lower than that in non-drainage group(55.0(64.7)U/L), the difference was statistically significant(Z=-2.212, P<0.05). The level of TBil at 1st day after surgery in drainage group(43.6(91.2)μmol/L) was lower than that in non-drainage group(91.2(188.4)μmol/L), the difference was statistically significant(Z=-2.150, P<0.05). The rate of pancreatoduodenectomy(25.0%) and average operating time(11.1(1.3)h) in the enteral nutrition group were both higher than those in the non-enteral nutrition group(0, 9.0(2.6)h). The differences were both statistically significant(χ(2)=3.879, Z=-2.693; P<0.05). The average level of AST at the 1st day after surgery in enteral nutrition group(396.4(268.3)U/L) was significantly lower than that in non-enteral nutrition group(642.5(341.1)U/L), the difference was statistically significant(Z=-2.483, P<0.05). The average level of TBil at the 1st, 3th day after surgery in enteral nutrition group(38.8(21.5)μmol/L and 30.0(25.6)μmol/L) were both lower than those in non-enteral nutrition group(60.9(75.2)μmol/L and 46.5(50.0)μmol/L), the differences were both statistically significant(Z=-2.416, -2.026; P<0.05). The level of CRP at 1st, 3th day after surgery((41.9±31.1)mg/L, (50.8±31.4)mg/L)in enteral nutrition subgroup was lower than that in non-enteral nutrition subgroup((64.4±33.6)mg/L, (74.1±35.3)mg/L), the differences were both statistically significant(t=1.456, 1.675; P<0.05). Conclusion: Based on the present study , there is no effective improvement on postoperative recovery using bile reinfusion combined with nutrition support before R0 resection of hilar cholangiocarcinoma.目的： 探究肝门部胆管癌患者术前引流胆汁回输联合肠内营养支持的临床疗效。 方法： 回顾性分析南京鼓楼医院肝胆外科2010年7月至2017年8月行肝门部胆管癌行手术切除的患者资料，其中52例患者符合纳入和排除标准纳入研究。依据患者术前是否行引流减黄胆汁回输治疗，分成未减黄组(n＝15)和减黄组(n＝37)。同时在减黄组中，依据是否行术前肠内营养治疗分为非肠内营养亚组(n＝13)和肠内营养亚组(n＝24)。组间正态分布数据比较采用独立样本t检验，非正态分布资料采用秩和检验；计数资料采用非校正及校正χ(2)检验进行统计学分析。 结果： 未减黄组与减黄组患者年龄、性别、入院时血清肝功能指标等一般资料比较，差异均无统计学意义(P值均>0.05)；非肠内营养亚组与肠内营养亚组患者年龄、性别、入院时血清肝功能指标等一般资料的比较，差异均无统计学意义(P值均>0.05)。减黄组患者术中合并血管切除重建率(33.3%)和手术时间[10.8(2.2)h]均高于未减黄组[6.7%和8.3(3.0)h]，差异有统计学意义(χ(2)＝4.397、Z＝1.595，P值均<0.05)。减黄组患者术后第7天AST水平[32.8(17.3)U/L]低于非减黄组[55.0(64.7)U/L]，差异有统计学意义(Z＝－2.212，P<0.05)；减黄组患者术后第1天的血清总胆红素[43.6(91.2)μmol/L]低于非减黄组[91.2(188.4)μmol/L]，差异有统计学意义(Z＝－2.150，P值<0.05)。肠内营养亚组患者手术合并胰十二指肠切除率(25.0%)和手术时间[11.1(1.3)h]均高于非肠内营养亚组[0、9.0(2.6)h]，差异均有统计学意义(χ(2)＝3.879、Z＝－2.693，P值均<0.05)；肠内营养亚组患者术后第1天AST水平[396.4(268.3)U/L]低于非肠内营养亚组[642.5(341.1)U/L]，差异有统计学意义(Z＝－2.483，P<0.05)；肠内营养亚组患者术后第1、3天的血清总胆红素[38.8(21.5)μmol/L和30.0(25.6)μmol/L]低于非肠内营养亚组[60.9(75.2)μmol/L和46.5(50.0) μmol/L]，差异有统计学意义(Z＝－2.416、－2.026，P值均<0.05)；肠内营养亚组患者术后1、3 d血清C－反应蛋白水平[(41.9±31.1)、(50.8±31.4)mg/L]明显低于非肠内营养亚组[(64.4±33.6)、(74.1±35.3)mg/L]，差异有统计学意义(t＝1.456、1.675，P值均<0.05)。 结论： 肝门部胆管癌根治性切除术前行引流胆汁回输联合肠内营养支持治疗在促进患者术后恢复方面尚未表现出优势。.