| pancreaticoduodenectomy(PD) is still the effective procedure so far to treat the carcinoma of the head of pancreas, distal duct bile carcinoma ,periampullary carcinoma.It is well known that the malignant obstructive jaundice is often seen as the major manifestation presented in patients with carcinoma involving the conjunction of pancreas and bile duct. Whether to perform preoperative biliary drainage is still confusing the general surgeons, and has become the hot topic of considerable interest of the experts over the half-century. Advocators hold the opinion that preoperative biliary drainage can improve the outcome of surgical procedure, diminish the postoperative complications, enhance the toleration of the patients for surgery; while the opponents claim that the preoperative biliary drainage isn't concerned with the postoperative mortality, instead it can delay the treatment, even possibly lead to severe complications .At present, percutaneous transhepatic choleductus drainage (PTCD ) and Endoscopic naso-biliary drainage (ENBD) has become prevalent for the advantages of microinvasiveness and relatively simple manipulation, however clinically, it isn't reach the consensus whether to perform the preoperative biliary drainage. This paper retrospected and review the 32 clinical information of the patients undergoing the PD to explore the measures to diminish the postoperative complications and mortality .Objective: To examine the effect of preoperative biliary drainage on the PD procedure of the patients with malignant obstructive jaundice.Methods: A retrospective review of 32 patients undergoing pancreaticoduodenectomy because of malignant obstructive jaundice at the Second affiliated hospital of Hebei Medical University between January 2010 and January 2011 was performed. Collect and analyze the clinical information of the patients. There was a total of 18 men and 14 women, the ratio of male to female is 1:0.78, the age range is 39—77.Primary diseases: 10 patients have the carcinoma of the head of pancreas, 17 ,carcinoma of middle and distal common bile duct, 15,ampullary carcinoma, all diagnosed by the pathological assay. 9 patients have the comorbity of diabetes mellitus, 3 , cholelithiasis ,11, hypertension.10 patients underwent the percutaneous transhepatic choleductus drainage (PTCD()31.25%)before the PD,3 patients underwent the Endoscopic naso-biliary drainage (ENBD) , a total of 13 patients underwent the preoperative biliary drainage(40.63%). The standard PD is performed Pancreaticojejunostomy: 24 patients underwent end-to-end Invagination Pancreaticojejunostomy, 3,pancreaticogastric anastomosis, 5,binding Pancreaticojejunostom. Divide the patients into two groups, one underwent biliary drainage (13 patients )and one didn't(19 patients), compare the postoperativecomplications and mortality. The statistically analysis was carried out using SPSS13.0.The univariate comparisons were carried out using Fisher test andχ2 test, A P value of <0.05 was considered statistically significant. A Logistic regression test was performed for the factors with statistically significance to identify the independent risk factors.Results: General measures: average surgery duration:5.7hours, average blood loss in process 310ml.of these 32 patients, there was one death around Perioperative , the deathrate was 3.1%(1/32) , the incidence in non-biliary drainage group was 5.2% ( 1/19 ) , in biliary drainage group was 0(0/13).postoperative complications were observed in 13 patients, the total incidence was 40.6%(13/32). among which 1 was refractory ascites(observed in non-biliary drainage group), the total incidence was 3.1%(1/32), the incidence in non-biliary drainage group was 5.2%(1/19), in biliary drainage group was 0(0/13)。3 Fat liquefaction were observed , the total incidence was9.3%(3/32). the incidence in non-biliary drainage group was 5.2%(1/19), in biliary drainage group was 15.3%(2/13). 4 pancreatic fistula were observed, the total incidence was 12.5%(4/32), the incidence in non-biliary drainage group was 15.7%(3/19), in biliary drainage group was 7.6%(1/13). 1 renal failure was observed, the total incidence was 3.1%(1/32), the incidence in non-biliary drainage group was 5.2%(1/19), in biliary drainage group was 0(0/13). 2 postoperative blood loss. the total incidence was 6.2 %(2/32), the incidence in non-biliary drainage group was 5.2%(1/19), in biliary drainage group was7.6%(1/13). 2 gastric paralysis were observed. the total incidence was 6.2 %(2/32), the incidence in non-biliary drainage group was 5.2%(1/19), in biliary drainage group was7.6%(1/13).There is no statistically significant difference of the level of bilirubin between preoperative biliary drainage group and non-biliary drainage group ( P >0.05) before PD, there is no statistically significant difference of average surgical duration, blood loss in procedure, perioperative mortality between preoperative biliary drainage group and non-PBD group( P >0.05); There is statistically significant difference of bilirubin level before the PD and after.(P < 0.05)。There is statistically significance difference of the complication rate between the preoperative biliary drainage group and non-PBD group (P < 0.05).Conclusion: Obstructive jaundice is one of the risk factors for the procedure of PD, according to the comparison, it was found that for the patients whose jaundice is severe and the liver function is seriously damaged , it is necessary for the patients to undergo the preoperative biliary drainage and untile the liver function is ameliorated and the jaundice is greatly lessened, then the PD could be performed, which would make the surgery more beneficial, diminish the postoperative complication rate, improve the living quality of the patients. |
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