Effects Of Preoperative Biliary Drainage On Pancreaticoduodenectomy In Patients With Malignant Obstructive Jaundice In The Lower Bile Duct

Objective: For patients with malignant obstructive jaundice(MOJ)undergoing pancreaticoduodenectomy(PD),we compare and analyze the effects that preoperative biliary drainage(PBD)has produced in the perioperative period to summarize the advantages and disadvantages of PBD,so as to discuss the appropriate indications and length of PBDMethods: We have retrospectivly analyzed 95 patients with MOJ undergoing pancreticoduoden-denectomy in the second affiliated hospital of nanchang university from June 2016 to June 2019.According to whether the patients received PTCD,they were divided into PBD group(40 cases)and the non-PBD group(55cases),whether the serum total bilirubin(TBIL)is less than 250 mol/L,they were divided into group A(TBIL < 250 mol/L)and group B(TBIL? 250 mol/L).According to the length of PBD,the PBD group was divided : PBD ?14days group and < 14 days group,PBD ?10days group and < 10 days group.The changes of preoperative and postoperative biochemical indexes as well as the differences of intraoperative general conditions and postoperative complication rates were observed in each group.Results:(1)The total bilirubin at admission in PBD group was significantly higher than that in non-PBD group,the former group's preoperative bilirubin level,preoperative ALT and AST were significantly lower than latter's,the results were statistically significant(P<0.05).(2)Either in total sample or group A or group B,there were no significant difference in operative time,intraoperative blood loss,major postoperative complications and hospital mortality between the PBD group and the non-PBD group(P>0.05).On the contrary,in terms of incision infection rate,the PBD group were significantly higher than the non-PBD group,the results were statistically significant(P < 0.05).(3)There were no significant difference between longer length of PBD than shorter's in terms of preoperative biochemical indicators,operative time,intraoperative blood loss,intraoperative blood transfusion,major complications and hospital mortality(P > 0.05),except inpreoperative albumin(P<0.05).Conclusion:(1)PBD can significantly improve the liver function of patients with pancreatic and periampullary carcinoma complicated with MOJ,but the benefit of this improvement is limited on on the intraoperative situation,postoperative complications and hospital mortality,even will increase the risk of incision infection and the total hospital stays and expenses.(2)For patients with TBIL less than 250mol/L and well physical condition,they could receive Surgical treatment as soon as possible,rather than PBD.(3)It is recommended to do PBD for a short period of time within 10 days for patients needed PBD,as to those with poor general conditions,the length of PBD could be appropriately extended.