| Objective:Malignant obstructive jaundice(MOJ)refers to a group of clinical diseases caused by the elevation of serum bilirubin due to the direct invasion or compression of the extrahepatic biliary tract caused by the malignant tumors and the obstruction of bile drainage.Biliary obstruction results in dilated bile ducts,increase bile duct pressure and capillary permeability,and the return of bile components to the blood and lymph fluid,leading to severe hyperbilirubinemia.Common diseases associated with MOJ include pancreatic cancer,bile duct cancer,gallbladder cancer,duodenal ampullary cancer,etc.The main manifestation of MOJ is progressive yellow staining of the skin and sclera of the whole body.At present,the principle of radical surgery is supplemented by comprehensive treatments such as radiotherapy,chemotherapy and biological therapy.After surgical removal of biliary obstruction,bile drainage was smooth,bile duct pressure gradually decreased,and the patient's bilirubin level and liver function gradually returned to normal after surgery.However,in clinical practice,the author found that even in the case of smooth bile duct drainage after surgery,bilirubin first decreased and then increased,and the postoperative complications of these patients were significantly higher than patients that bilirubin decreased.This study retrospectively analyzed the clinical case data of MOJ in our hospital,explored the independent risk factors for bilirubin rebound after surgery,and used statistical methods to further explain the main complication rate of patients with bilirubin rebound,deepened the understanding of MOJ.Methods:This study retrospectively analyzed the clinical data of patients who received surgical treatment in our hospital from June 1,2014 to June 1,2019 and whose pathological diagnosis was malignant tumor with MOJ.A total of 121 patient cases were included according to the inclusion and exclusion criteria.Combined with the postoperative bilirubin changes,patients were divided into the rebound group(n=63 cases)and the decreasing group(n=58 cases).Analyze the age,gender,abdominal pain,itching of the skin,yellow skin sclera,liver cirrhosis,history of hypertension,history of coronary heart disease,history of diabetes,history of hepatitis B,drinking and smoking,BMI,white blood cell level(WBC),neutral Granulocyte ratio(NEUT),hemoglobin(HGB),platelets(PLT),aspartate aminotransferase(AST),alanine aminotransferase(ALT),AST/ALT value,total bilirubin(TBIL),Alkaline phosphatase(ALP),?-glutamyl transferase(GGT),albumin(ALB),white ball ratio(A/G),carcinoembryonic antigen(CEA),carbohydrate antigen 199(CA199),coagulation Enzyme time(PT),operation time,surgical method,intraoperative blood loss,intraoperative and postoperative blood transfusion,tumor size,and postoperative complications.Among them,c~2 test was used for count data,t-test was used for measurement data,and statistically significant(P<0.05)related factors were analyzed by Logistic regression model to screen for independent risk factors.The differences in postoperative complications between the two groups were further compared using thec~2 test and analyzed.Result:In this study,there were 63 patients in the bilirubin rebound group and 58patients in the decreasing group,of which the rebound group accounted for 52%of the entire study group.The preoperative mean serum bilirubin level in the rebound group was 231.96±107.70?mol/L,and the decreasing was 171.23±102.88?mol/L.A univariate analysis of postoperative bilirubin rebound showed that the history of liver cirrhosis,blood transfusion during and after surgery,CA199>150 mmol/L,bleeding>400ml,total bilirubin,ALP,GGT,operation time,and tumor diameter Statistical significance.The multivariate logistic regression analysis was performed for the risk factors with significant statistical significance in the patient's various indicators.The results showed that the preoperative liver cirrhosis history,CA199>150 mmol/L,preoperative total bilirubin,GGT,and operation time were postoperative bilirubin.Independent risk factors for resurgence.Analysis of postoperative complications in the two groups showed that the incidence of postoperative pancreatic fistula,biliary fistula,infection complications(intra-abdominal infection,pulmonary infection),and postoperative bleeding complications were higher than those in the declining group,and were statistically significant.Conclusion:The history of cirrhosis,CA199>150 mmol/L,preoperative bilirubin level,GGT,and operation time are independent risk factors for bilirubin recovery after MOJ.Bilirubin levels after MOJ were positively correlated with complications such as postoperative pancreatic fistula,biliary fistula,intra-abdominal infection,pulmonary infection,and postoperative bleeding... |
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