Analysis Of The Influence Of Malignant Obstructive Jaundice And Preoperative Biliary Drainage Methods On Complications After Laparoscopic Pancreaticoduodenectomy

Background and Purpose:Pancreaticoduodenectomy（PD）was first used in 1935 by an American surgeon named Whipple to treat periampullary cancer,so it is also called Whipple surgery.This is a kind of abdominal surgery with great trauma,complicated operation and high incidence of postoperative complications.It is the standard procedure for the treatment of periampullary malignancies,precancerous lesions and some benign diseases.With the vigorous development of minimally invasive surgery,laparoscopic pancreati coduodenectomy（LPD）has sprung up at home and abroad,and the surgical skills of surgeons in each center have gradually improved.In patients undergoing LPD surgery,a large number of them were found to have clinical symptoms of jaundice caused by biliary obstruction before surgery.In our center,doctors usually use percutaneous transhepatic cholangial drainage before surgery（PTCD）or endoscopic nasobiliary drainage（ENBD）method to reduce the value of total bilirubin in the patient’s blood to a safe range before surgery.In recent years,the preoperative jaundice reduction method for patients with obstructive jaundice is still controversial internationally,and there is still no consistent guideline on the impact of the choice of jaundice reduction method on postoperative complications and recovery of LPD.This article analyzes the relationship between postoperative complications and preoperative jaundice,and finds the corresponding relationship between jaundice and LPD complications.To analyze the different effects of different preoperative biliary drainage methods on complications after LPD.This research will help to increase the correct selection rate of preoperative treatment for patients in clinic,reduce the risk of postoperative complications and speed up recovery,greatly minify pain and economic burden,and improve their quality of life in the later period.Methods:This study investigated 426 patients who underwent standard laparoscopic pancreati coduodenectomy（LPD）in the Hepatobiliary and Pancreatic Surgery Ward of the First Hospital of Jilin University from October 2019 to October 2021.Statistical retrospective analysis of clinical data.First,the patients were divided into four groups according to the value of total bilirubin in liver function at admission:normal value group（≤21μmol/L）,mild jaundice group（>21,≤171μmol/L）,moderate jaundice group（>171μmol/L）,≤342μmol/L)and severe jaundice group（>342μmol/L）,to investigate the effect of preoperative jaundice severity on pancreatic fistula（PF）,biliary fistula（BF）,intestinal fistula（IF）,bleeding,infection,gastroparesis,and drainage tube indwelling time after operation and differences in length of hospital stay.Then,according to the methods of reducing jaundice taken by the part of the patients who received jaundice drainage before operation,they were divided into PTCD group and ENBD group.The differences in postoperative pancreatic fistula,biliary fistula,intestinal fistula,hemorrhage,infection,gastroparesis,drainage tube indwelling time and hospitalization days were statistically analyzed.Results:The clinical data of the included studies were analyzed using SPSS 26.0 software.The measurement data that did not conform to the normal distribution was represented by M(P₂₅-P₇₅),the grade data was represented by the number of cases（n）,the Wilcoxon rank sum test was used for comparison between different operation groups,and the Kruskal-Wallis test was used for independent samples grouped by different jaundice degrees;The data were expressed as n（%）,and the chi-square（c~2）test or Fisher’s exact test was used for comparison between groups.P<0.05 indicates statistical significance.The results showed that the incidence of postoperative complications with different degrees of jaundice was significantly different in infection,gastroparesis and pancreatic fistula（P<0.05）.There was no significant difference in the incidence of postoperative complications with different degrees of jaundice,bleeding,biliary fistula and intestinal fistula（P>0.05）.There were statistically significant differences in the grades of pancreatic fistula between groups with different jaundice degrees（P<0.05）.There was no significant difference in the indwelling time of the drainage tube and the length of hospitalization between groups with different jaundice degrees（P>0.05）.There was no significant difference in the incidence of complications such as bleeding,infection,biliary fistula,intestinal fistula and gastroparesis among different surgical groups（P>0.05）.There was no statistically significant difference in the grade of pancreatic fistula between groups of different surgical methods（P>0.05）.There were significant differences in the indwelling time of the drainage tube and the length of hospital stay in the comparison of each index in different surgical methods（P<0.05）.Conclusion:1.With the aggravation of jaundice,the risk of pancreatic fistula,infection and gastroparesis after LPD surgery is greatly increased;and the severity of postoperative pancreatic fistula is closely related to the degree of preoperative obstructive jaundice.The more severe the jaundice,the higher the risk of severe postoperative pancreatic fistula.The degree of jaundice does not affect the occurrence of postoperative bleeding,biliary fistula and intestinal fistula.2.Preoperative jaundice reduction using PTCD or ENBD has no effect on postoperative bleeding,infection,biliary fistula,intestinal fistula,gastroparesis pancreatic fistula and grade of pancreatic fistula,so both methods are effective and feasible.However,the ENBD method has the advantages of less drainage tube indwelling time and shorter hospitalization days.