A Clinical Study About The Poor Jaundice Resolution After Radical Pancreaticoduodenectomy In Patients With Malignant Obstructive Jaundice

Objective:By contrasting the changes of total bilirubin after radical pancreaticoduodenectomy in patients with malignant obstructive jaundice,find the change rule of the of jaundice,study the influencing factors combine with the physical condition of patients.Methods:The retrospective case-control study was conducted.The clinicopathologic data of one hundred and twenty-one patients with malignant obstructive jaundice who were admitted to the Affiliated Changzhou No.2 People’s Hospital of Nanjing Medical University between March 2013 to June 2018 were collected.There were 70 males and 51 females,aged(69±9)years,with a range from 39 to 85 years.Of 121 patients,112 underwent open radical pancreaticoduodenectomy,and 9 underwent totally laparoscopic radical pancreaticoduodenectomy.The digestive tract was reconstructed by conventional Child method.And Blumgart anastomosis was used in pancreaticojejunostomy.Two drainage tubes were placed around the anastomotic site after the operation.All of the biliary obstruction were caused by malignant tumor.The blood samples were collected in preoperative 1 day and postoperative several days.The work was finished in six o’clock when the patients haven’t done any treatment.The total bilirubin was measured to observe the situations of jaundice resolution.By combining the different conditions of patients,such as gender,age,the tumor originated from the pancreatic head cancer,the tumor originated from the periampullary cancer,the tumor originated from the lower bile duct cancer,the tumor originated from duodenal the papillary carcinoma,preoperative serum total bilirubin lever,preoperative serum gamma-glutamyl transpeptidase lever,preoperative serum alanine aminotransferase level,serum albumin level at admission,preoperative jaundice duration,diabetes mellitus,hypertensive disease,chronic lung disease,preoperative NRS2002 nutrition score,the duration of the operation,the operative method,the amount of peroperative bleeding,the volume of peroperative blood transfusion,postoperative pancreatic fistula,postoperative biliary fistula,postoperative gastrointestinal hemorrhage,postoperative intra-abdominal hemorrhage,postoperative intra-abdominal infection and postoperative delayed gastric emptying,univariate and multivariate analyses were performed to study the influencing factors for poor jaundice resolution after radical pancreaticoduodenectomy.Results:Of 121 patients,97 whose serum total bilirubin level decreased by 50% or more had good jaundice resolution after radical pancreaticoduodenectomy,and 24 whose serum total bilirubin level decreased less than 50% had poor jaundice resolution after radical pancreaticoduodenectomy.There were 30 patients coexisted with diabetes mellitus,among whom 12 had poor jaundice resolution.Postoperative pancreatic fistula was occurred in 7 patients,including 4 patients with poor jaundice resolution.Preoperative level of serum total bilirubin,comorbidity with diabetes mellitus and postoperative pancreatic fistula were influencing factors for poor jaundice resolution after radical pancreaticoduodenectomy(P<0.05).Comorbidity with diabetes mellitus and postoperative pancreatic fistula were independent risk factors for poor jaundice resolution after radical pancreaticoduodenectomy(P<0.05).Conclusion:After pancreatoduodenectomy in patients with malignant obstructive jaundice,the situation of jaundice resolution is not always a simple declining linear relationship.It could be occurred that the postoperative level of serum total bilirubin might decline slowly,and even go up instead of down.