Application Of Minimally Invasive Biliary Drainage In Hepatic Hydatid Complicated With Obstructive Jaundice

Objective:Hepatocystis hepatica patients caused by various reasons of obstructive jaundice,hyperbilirubinemia will affect the patient's liver function and multiple organ functions,for the patients with high bilirubin,liver damage,overall malnutrition through preoperative biliary drainage to improve liver function levels and improve surgical tolerance.This paper deals with the effect and safety of biliary drainage as preoperative yellow reduction on patients with hepatic hydatid disease and obstructive jaundice.Method:The clinical data of 108 patients with hepatic hydatid disease with obstructive jaundice in Sichuan People's Hospital in 2011.08-2017 were analyzed retrospectively.(1)According to whether or not the preoperative reduction was performed,there were two groups: yellow reduction and non-yellow reduction.Among them,72 cases were preoperative and 36 cases were non-preoperative.The general data(age,BMI),disease type,liver function,Child-Pugh rating,bile duct drainage,and preoperative BMI,and liver function Child-Pugh rating were compared.The incidence and mortality of postoperative complications(including postoperative biliary fistula,liver failure,hemorrhage,hypoproteinemia,incision infection,ascites)were observed,and the necessity of preoperative biliary drainage was evaluated.(2)According to the TBIL level,the patients were classified as mild bilirubin(serum total bilirubin less than 171umol/L),moderate bilirubin(serum total bilirubin between 171 umol / L-342 umol/L),severe jaundice(serum total bilirubin greater than 342 umol/L),compared with general data at admission(including age,BMI),liver function rating,bile duct drainage reduced to Huangdanzu,liver function,and liver function.To observe the incidence and mortality ofsurgical time,intraoperative bleeding,postoperative complications(including postoperative biliary fistula,liver failure,hemorrhage,hypoproteinemia,incision infection,ascites)in two groups of patients,and to evaluate the necessity of bilirubin drainage.(3)The incidence and mortality rates of TBIL and drainage complications(including biliary tract infection,drainage tube shedding,water electrolyte disorder,biliary tract bleeding,amylase rise or PEP)were compared betweenthe two groups of 72 patients with mild and minimally invasive biliary drainage(ERCP),including ERBD and ENBD,and PTCD;To evaluate the safety of microbiliary drainage and its advantages and disadvantages.(4)To compare the results of TBIL,ALB,ALT,AST,ALP,GGT in 72 patients with minimally invasive biliary drainage at the time of admission,1 week after drainage and 6 weeks after drainage,and to evaluate the relationship between liver function recovery and time in microbiliary drainage,so as to provide reference for the time limit for preoperative reduction of liver hydatid disease with obstructive jaundice.(5)Multifactorial analysis of patients 'age,course,TBIL,Alb,intraoperative bleeding and postoperative complication rate,and evaluation of postoperative complication risk factors.Data analysis using SPSS17.0 software.Counting data were compared by the card-square test or Fisher's exact probability method,and the measurement data were compared by the card-square test or the Mann-Whitney U test.The least significant difference(LSD)method was used to compare the multiple factors correlation analysis with Logistic regression analysis.The statistical results were confirmed as bilateral tests.Results:1.There were significant differences in the preoperative composition of patients(P=0.025),BMI(P=0.045),and liver function child grade(P=0.036)between the anti-yellow group and the non-anti-yellow group,with vesicular echinococcosis in the majority.There was no significant difference between BMI(P=1.000)and liver function child(P=0.896)after preoperative reduction,and 32 patients with C liver function were downgraded to A and B.There was no significant difference between the two groups in the amount of intraoperative bleeding,operative time,mean hospital day,3 days after operation and 1 week after operation.The overall reduction rate of postoperative complications was better than that of the non-reduction group(P=0.003).There were statistically significant differences in postoperative mortality(P=0.037),and the reduction of yellow was better than the non-reduction of yellow.During admission,38 patients with C-class liver function were admitted,and 32 patients with C-class liver function were downgraded to A and B after minimally invasive biliary drainage.2.Human rights There was no significant difference in age,BMI and BMI before admission between mild jaundice and mild jaundice.There was no significant differencein liver function rating between admission and preoperative stage.There was no significant difference in blood loss,operative time and postoperative complication rate,and the mortality rate was 0.(2)In moderate patients with Huangdanzu,the BMI was better than that in Huangyazu(P = 0.038),and there were 7 patients with C-level liver function and 0 cases with Huangyazu.After 7 patients were reduced toalevel A or B before operation,no C-level liver function was found.The BMI and C-level liver function was significantly better than before.The blood loss was higher than that of Huangyazu(P=0.025)in the suboperative group.There was no significant difference in postoperative complications(P=0.562).The mortality rate was 0.(3)Huangdanzu was superior to Huangyazu group(P=0.042)in BMI,1 patient with C-grade liver function,In27 patient.In 26 patients,the number of BMI and C liver function was significantly better than that before the reduction of yellow in the subgroup.There were significant differences in postoperative complications(P=0.008).There were no patients who died after radical operation,and there were no significant differences in 2 patients who died from postoperative hemorrhage and postoperative liver failure(P=0.008).3.There was no significant difference between PTCD group and ERCP group in 6weeks after drainage.The incidence of biliary tract infection in ERCP group was higher than that in PTCD group(P = 0.025).There was no significant difference between the two groups in the number of cases of drainage tube clogging,drainage tube shedding,biliary bleeding,electrolyte disorder,amylase rise or PEP.The number of deaths during drainage was 0.4.Human rights In 72 cases,TBIL,Alb,AST,ALT,GTT and ALP were significantly improved 6 weeks after drainage.In one case,PTCD was performed successfully after June.After 6 weeks of drainage,the serum Alb,ascites and BMI were not up to standard in 6 patients,and the liver performance of Child-Pugh was rated C,without radical surgery and continued drainage.5.Human rights The risk factors of postoperative complications were analyzed and compared by single factors.The incidence of postoperative complications was more than one month(P=0.042),TBIL 171 umol/L(P=0.021),TBIL342umol/L(P=0.037),and the intraoperative hemorrhage was more than 600ml(P=0.041).Line Logistic regression gets OR values(4.125,3.854,3.976,4.444).Conclusion:1.Preoperative yellowing of patients with hepatic hydatid disease is safe and effective,has certain clinical value,advocated liver hydatid with obstructive jaundice bilirubin levels greater than 342 umol L patients with preoperative yellowing treatment,for the serum TBIL in 171 umol/L-342 umol L patients,based on the overall body nutrition,obstructive time and other comprehensive assessment of the need for yellowing.After bilirubin level was reduced to below 100 umol L,albumin level and coagulation function were normal,the second stage surgery was performed.2.All kinds of minimally invasive yellow reduction methods have their advantages and disadvantages.According to patients obstruction level different choice of different minimally invasive yellow reduction methods,according to biliary yellow reduction drainage methods to deal with complications,can achieve safe and effective yellow reduction,first recommended PTCD.3.Serum bilirubin 171 mmol/L limit is not absolute value,need to combine patient liver excision range,obstructive jaundice time,blood coagulation function,serum albumin level and other indicators of liver function,systemic nutritional status,whether combined with cholangitis comprehensive assessment of the need to reduce yellow.4.The biliary drainage can not only be used to reduce yellowing before operation,but also can guide the identification of biliary tract,reduce the time of operation,reduce the probability of biliary injury,and can be used as a long-term treatment for hepatic hydatid disease patients with obstructive jaundice.