Influence Of Malignant Obstructive Jaundice Levels In Pre-operation On Postoperative Complications Of Pancreaticodenectomy

Objective:Pancreaticoduodenectomy is a very dangerous and complex surgery.A retrospective study was carried out on patients who were treated for Pancreaticoduodenectomy in Dalian Medical University.To analyze the influence of malignant obstructive jaundice levels in pre-operation on Postoperative complications of pancreaticodenectomy.To investigate the clinical value of preoperative biliary drainage.Methods:Aretrospective study was carried out on 85 patients who were treated for pancreaticoduodenectomy in Dalian Medical University from May 1,2012 to October 31,2016.The patients were divided into four groups according to the level of preoperative total bilirubin(TB):A group,TB≤34.2umol/L(n=12);B group,34.2umol/L<TB≤171.0uom/L(n=31);C group,the patients who had not biliary drainage,171.0umol/L<TB≤342.0umol/L(n=19);D group,the patients who had biliary drainage,171.0umol/L<TB≤342.0umol/L(n=23)。We collected the patients clinical data,including gender,age,tumor sizes,the level of preoperative total bilirubin and postoperative complication.To study analysis.To analyze the influence of malignant obstructive jaundice levels in pre-operation on postoperative complications of pancreaticodenectomy.To investigate the clinical value of preoperative biliary drainage.Results: Four groups` general information have no significant difference(P>0.05).In the aspect of the postoperative complication rate,postoperative hemorrhage and intra-abdominal infection.The A、B、C third groups have significant difference(P<0.05).With the increase of preoperative bilirubin level,the data in group C was higher than that in groups B and A,the data in group B was higher than that in group A in the aspect of the postoperative complication rate,postoperative hemorrhage and intra-abdominal infection.But In the aspect of the pancreatic fistula,biliary fistula,incision infection and delayed gastric emptying.The three groups of A,B,C have no significant difference(P>0.05).To study whether preoperative drainage was benefit for PD,group C(the patients who had not biliary drainage)and D(the patients who had biliary drainage)have no significant difference in the aspect of postoperative complication rate and six complications(P>0.05).Conclusions:The degree of obstructive jaundice increase the risk of postoperative complication rate for the patients with malignant obstructive jaundice.With the increase of preoperative bilirubin level,there has been a marked increase in the aspect of the postoperative complication rate,postoperative hemorrhage and intra-abdominal infection.For the patients who had severe jaundice(171.0umol/L<TB≤342.0umol/L),there was no significant benefit from biliary drainage.Although preoperative biliary drainage decreased the total bilirubin levels,the effect of treatment was not obvious on partly by invasive operation,but also by risk of infection.Therefore,we need to deliberate over the decision that patients need biliary drainage according to state of patients.