The Comparision Of The Clinical Effects About Whipple’s Operation Of The Patients With MOJ After Preoperative Biliary Drainage By PTBO And ENBD

Objective: At present, for patients with malignant obstructivejaundice before radical surgery, the chose of way to reduce obstruction isstill the focus of controversy. This article is a retrospective study aboutWhipple’s operation of the patients with MOJ after preoperative biliarydrainage by PTBD and ENBD. Comparing the clinical effects of both,hope to be able to pick more suitable means, and to play a enlightenmentrole for future clinical work.Method: We selected all of the23patients with a clear diagnosis ofMOJ (bile duct carcinoma, pancreatic carcinoma, and vater ampullacarcinoma) from Hepatopancreatobiliary Surgery Department in the firsthospital of Jilin university from2008to2012, who were applied PTBDor ENBD for preoperative biliary drainage, and finally finishedpancreaticoduodenectomy. There are12cases (52.2%) in the group ofPTBD, and11cases (47.8%) patients with ENBD. Through observationof reducing obstruction time, hepatic enzyme and bilirubin index beforereducing obstruction, before PD and postoperative3days, leukocytevalues after biliary drainage within one week, intraoperative blood loss of PD, operative time, postoperative complications, postoperative lengthof hospital stay, total hospitalization expenses, prognosis, we can get acomprehensive evaluation of both the effect after biliary drainage,condition of liver function, severe complications and prognosis after PD.Results: Reducing obstruction time: PTBD group5.5±2.39days,ENBD group8±2.61days, p＜0.05, there is statistical significance；Postoperative leukocyte: PTBD group9.58±2.59×109/L, ENBD group12.69±1.55×109/L, p＜0.05, there is statistical significance; hepaticfunction and bilirubin difference before and after biliary drainage: PTBDgroup AST110±101.69U/L, ALT123.42±129.97U/L, ALP182.33±191.57U/L, gamma GT279.08±273.96U/L, TBil191.56±117.83umol/L, DBil121.4±78.15umol/L, ENBD group AST194.63±158.25U/L, ALT66.27±199.02U/L, ALP234.82±265.98U/L,gamma GT247.72±593.77U/L, TBil177.23±151.15umol/L, DBil97.03±82.02umol/L, p＞0.05, no statistical significance; Intraoperativeblood loss: PTBD group341.67±167.65ml, ENBD group340.91±146.32ml, operation time: PTBD group of315.83±55.67min, ENBDgroup311.82±58.83min, p＞0.05, no statistical significance;3dayspostoperative hepatic function: PTBD group AST45±27.8U/L and ALT51.2±34.5U/L, ALP181.8±80.4U/L, gamma GT163.2±147.0U/L,ENBD group AST26.4±5.1U/L, ALT45.6±19.5U/L, the ALP177.9±61.4U/L, gamma GT181.1±86.6U/L, the AST, ALT difference of postoperative and preoperative: PTBD group is lower, p＜0.05, thereis statistical significance, the rest of the ALP, gamma GT withoutstatistical significance. Postoperative hospital stay PTBD group of17.33±4.64days, ENBD group of19.49±10.16days, total hospitalizationexpenses PTBD group116486.11±59235.32RMB, ENBD group of130206.7±45297.42RMB, p＞0.05, no statistical significance. PTBDgroup1case of bilirubin increased short-term, caused by drainage tubeobstruction after PTBD, and turned better after cleaning the tube;1caseof abdominal bleeding caused by pancreatic fistula and died finally; thedigestive tract bleeding occurred in1case, applied secondary laparotomysurgery caused by uncontrolled hemorrhagic shock;3cases of biliaryfistula;4cases occurred postoperative infection. ENBD group3cases ofAcute Obstructive Suppurative Cholangitis (ASOC) applied emergencyENBD;2cases after ERBD blood amylase increased, but not clearlydiagnosed of acute pancreatitis;1cases of postoperative stress ulceroccurred gastrointestinal anastomotic bleeding and died finally;3cases ofpancreatic fistula, and1secondary surgical removal of peritoneal effusion;5cases of biliary fistula;1case occurred postoperative infection.Conclusion: Preoperative biliary drainage of patients with MOJ,PTBD and ENBD can significantly reduce the serum bilirubin andhepatic function index, PTBD drainage effect is better, with bilirubinreducing in a shorter time,lower infection rate, lower hospitalization expense, and severe complications and mortality after PD compared withENBD group no difference. Therefore, conventional preoperative biliarydrainage should be applied by PTBD, but the patients with AOSC, ENBDis more suitable.