The Explorations Of Preoperative Endoscopic Biliary Drainage For Low Malignant Obstructive Jaundice

BackgroundSevere malignant obstructive jaundice can usually result in liver and kidney dysfunctions,gastriciintestinal mucosal injury,coagulation dysfunction,immune dysfunction and severe malnutrition And pancreatoduodenectomy is one of the most complex operation in abdominal surgery operation,with high mortality andpostoperative complications,such as biliary and pancreatic fistula,anastomotic hemorrhage,sepsis,abdominal abscess,pulmonary infection and other complications.Many of them lead to poor operation and postoperative recover,even result in death.To improve the operating quality,reduce the postoperative complications and the mortality.the doctors of gastroenterology has always attached great attention to the issue.The topics of whether PBD or not and how to make a choice between advantages and disadvantages of biliary drainage jaundice are controversies in recent thirty years.Routine preoperative biliary drainage is not need in mild to moderate low malignant obstructive jaundice.But for severe jaundice,whether preoperate or not,duration and modality are still big disputes.The researchs aboat preoperative biliary drainage(mixed with percutaneous transhepatic biliary drainage and endoscopic palliation) have done, but only endoscopic biliary drainage is rare and there is no consensus for the method of preoperative endoscopic drainage.This study focuses on effection of preoperative endoscopic biliary drainage before pancreatoduodenectomy.And explore indication, duration and modality of preoperative endoscopic biliary drainage on low severe malignant obstructive jaundice.ObjectiveTo investigate the effect of preoperative endoscopic biliary drainage,including endoscopic..nasobiliary..drainage.(ERBD).and.endoscopic.retrograde.biliary..drainage (ERBD)on early postoperative complications after pancreatoduodenectomy on low malignant obstructive jaundice patients.And probe into indication,duration and modality of preoperative endoscopic biliary drainage on low severe malignant obstructive jaundice.Methods78patients with low severe malignant obstructive referred to the Second Affiliated Hospital of Zhejiang University from January2007to May2012were included in this study. Preoperative endoscopic biliary drainage (including ENBD or the ERBD) was performed.on.30.patients.before.pancreatoduodenectomy.Their.preoperative total bilirubin level were over256umol/L. The other48patients without preoperative biliary drainage before pancreatoduodenectomy were retrospectively analyzed and compared.Measurement datas were compared by T test, Count datas were compared by Fisher exact probability test and chi-square test, and P<0.05has statistical significance.ResultsThe morbidity of postoperative complications of endoscopic biliary drainage was13.1%(4/30).All of complications is mionor.The total bilirubin, liver transaminases and PT.were.significantly.reduced,.after.endoscopic.biliary.drainage.before.pancreatoduode- nectomy.significantly lower than the non-biliary drainage group. Meanwhile ALB was significantly rised after endoscopic biliary drainage before pancreatoduodenectomy, significantly higher than the non-biliary drainage group.The mortality was3.3%(1/30)in preoperative biliary drainage group and18.8%(9/48) in non-biliary drainage group (P＞0.05).The total complications of early postoperative complications is47.4%(37/78), of which33.3%(10/30) in biliary drainage group, and56.3%(27/48) in non-biliary drainage group (P＜0.05). Between the two groups, the incidence rate of a single early complications such as wound infection,sepsis,anastomotic hemorrhage were statistically significantly differences (P＜0.05).There were no significant differences between the two groups in the length of total hospital stay and cost. The postoperative hospital stay in biliary drainage group was significantly shorter than non-biliary drainage group, showing a significant difference between two groups (P＜0.05).ConclusionsPreoperative endoscopic biliary drainage can effectively reduce serum bilirubin levels,improve liver function and general condition,While total bilirubin more than256μmol/L,especially older age and poor general condition,aboat2-6weeks endoscopic preoperative biliary drainage can effectively reduce parts complications of early postope-rative complications after pancreatoduodenectomy,improve the pancreatoduodenectomy prognosis and shorten the postoperative hospital stay.ENBD maybe the most suitable preoperative biliary drainage method, ERBD can be choosed if drainage duration is expectantly long.