| Objective1.To investigate the efficacy of different jaundice reduction methods for patients diagnosed of periampullary adenocarcinoma complicated with obstructive jaundice.2.To explore the impact and quantitative relationship of obstructive jaundice on carbohydrate antigen 19-9(CA19-9)in patients with periampullary adenocarcinoma.Methods1.The clinical data of 128 patients with pancreatic adenocarcinoma,ampullary adenocarcinoma or distal cholangiocarcinoma,who received preoperative biliary decompression followed by pancreaticoduodenectomy in Peking Union Medical College Hospital from January 2015 to September 2020,were retrospectively collected and analyzed.The patients were divided into endoscopic retrograde cholangiopancreatography(ERCP)with stent placement group(referred to as ERCP group)and percutaneous transhepatic cholangial drainage(PTCD)group according to different methods of j aundice reduction.A total of 80 patients were enrolled in ERCP group,while 48 patients were enrolled in PTCD group.2.Total bilirubin(TB),albumin,alanine aminotransferase,hemoglobin,white blood cell,percentage of neutrophil and CA19-9 were monitored in 72 hours before jaundice reduction and surgery respectively.3.TB before pancreaticoduodenectomy(referred to as TBpost),rate of TB decline(referred to as RD)and proportion of reduction sufficiency(the percentage of patients with TBpost≤100μmol/L,referred to as PRS)were selected as indicators for evaluating the efficacy of jaundice reduction.Firstly,we performed a comparative analysis by grouping the method of jaundice reduction,in order to exclude the effect of high bilirubin levels,patients with severe obstructive jaundice TBpre>340 μmol/L were compared and analyzed;then comparative analysis was performed according to different tumor pathological types.Finally,patients with CA19-9pre≥500 U/mL were selected,and comparative analysis was performed in two groups according to the occasion that whether CA19-9 could be reduced lower than 500U/mL after jaundice reduction,the influencing factors of CA19-9 are screened out according to the difference between groups,and the binary linearity between CA19-9post,CA19-9pre and TBpre.Results1.The TBpost,RD and PRS in ERCP group were significantly better than those indicators in PTCD group[(68.0±44.7)μmol/L vs.(114.0±68.8)μmol/L;(73.9±16.9)%vs.(64.2±21.2)%;83.8%vs.56.3%],while the severe obstructive jaundice patients share the consistent outcomes.In patients with ampullary carcinoma,TBpost,RD and PRS in ERCP group was significantly better than those in PTCD group[(50.6±20.2)μmol/L vs.(102.8±48.7)μmol/L;(78.6±10.9)%vs.(67.2±14.8)%;100%vs.58.3%].In patients with distal cholangiocarcinoma,TBpost,RD and PRS of ERCP group were better than those of PTCD group[(76.1±51.6)μmol/L vs.(161.2±51.1)μmol/L;(70.6±18.5)%vs.(56.5±10.4)%;82.1%vs.11.1%].There was no statistical difference in the above indicators of jaundice reduction between ERCP group and PTCD group in pancreatic cancer patients.2.There are significant differences in CA19-9post,rate of CA19-9 decline,TBpre and RD between the two groups.A binary linear regression curve was fitted:1gCA19-9post=0.8221gCA19-9pre-1.5971gTBpre+3.858Conclusions1.For patients diagnosed of periampullary adenocarcinoma complicated with obstructive jaundice,stent placement by ERCP is recommended as the first choice for preoperative jaundice reduction,especially for those with ampullary carcinoma or distal cholangiocarcinoma.2.Obstructive jaundice can cause an over increase of CA19-9.There is a significant positive correlation between the total bilirubin level before jaundice reduction and the CA19-9 bias. |
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