Study On The Effect Of Preoperative Biliary Drainage On Postoperative Complications After Pancreaticoduodenectomy For Periampullary Cancer

Objective: To investigate the effect of preoperative biliary drainage on complications after pancreaticoduodenectomy for periampullary cancer.Methods: Retrospective analysis of84 patients with pathologically confirmed periampullary cancer after pancreaticoduodenectomy(PD)for low-grade obstructive jaundice seen in our hospital from January 2015 to December 2021,of whom 36 did not receive preoperative biliary drainage(PBD)defined as the non-PBD group and 48 received PBD defined as the PBD group,of whom 24 patients underwent ERCP to place bile duct stents for internal The other 24 patients underwent external drainage with PTCD placement.To compare the general information,preoperative liver function and preoperative biliary drainage on postoperative complications of PD in the two groups.Results: No significant differences were seen in the comparison of patients’ general baseline information,and the information between the two groups was comparable.TBIL was 174.9(137.6,235.4)mol/L before biliary drainage and decreased to147.9(115.9,219.0)mol/L after biliary drainage;DBIL was 153.0(19.7,210.4)mol/L before biliary drainage and decreased to 54.7(19.1,94.5)mol/L;ALT was 177.7(86.4,331.2)IU/L before biliary drainage and decreased to 92.6(74.5,127.9)IU/L after biliary drainage;AST was 145.4(66.7,219.7)IU/L before biliary drainage and decreased to 74.5(55.6,92.1)IU/L after biliary drainage.(92.1)IU/L;preoperative TBIL,preoperative DBIL,preoperative ALT and preoperative AST all decreased significantly after biliary drainage,with statistically significant differences in comparison(all P< 0.01).Intraoperative bleeding was 400.0(212.5,575.0)ml in the PBD group and 500.0(225.0,800.0)ml in the non-PBD group,with a statistically significant difference between the two groups(P<0.05),and intraoperative bleeding was less in the PBD group than in the non-PBD group.There was no statistically significant difference between the two groups in the overall postoperative complication rate and mortality rate(all P>0.05),and no statistically significant differences were found in the individual complication rates of pancreatic fistula,delayed gastric emptying,gastrointestinal bleeding,bile leak,gastrointestinal anastomotic fistula,intra-abdominal infection,incisional infection,sepsis and secondary surgery(all P>0.05).In the clinical data of 84 cases in this group,the study analysis revealed no significant correlation between the incidence of postoperative complications in PD and patient gender,preoperative combined hypertension,combined diabetes mellitus and hypoproteinemia,and preoperative ALT > 2 times the normal value or more(all P>0.05),while there was a trend of significant increase in the incidence of postoperative complications at age > 60 years and preoperative TBIL > 250 mol/L(P<0.05).Conclusions : The PBD group could significantly reduce high bilirubin and high transaminases on admission,improve preoperative liver function,and reduce intraoperative bleeding.By studying the clinical data of this group,it was found that there was a trend of significant increase in the incidence of postoperative complications with PD at age >60 years and preoperative TBIL >250μ mol/L.Thus,we suggest that PBD should be performed for patients aged >60 years with preoperative TBIL >250μ mol/L to alleviate the preoperative adverse effects of hyperbilirubinemia and reduce the trend of postoperative complication rate.