Clinical Analysis Of Palliative Operation Therapeutic Effect On Advanced Pancreatic Cancer With Obstructive Jaundice

Objective: To explore the selection of palliative operation for patientswith advanced pancreatic cancer, through the retrospective analysis ofpalliative operation therapeutic effect on adanced pancreatic cancer withobstructive jaundice patients.Methods: This retrospective analysis was performed on67advancedpancreatic cancer patients with obstructive jaundice, all of them had completemedical records and accepted palliative operation between January2007andJanuary2012in Department of Hepatobiliary Surgery, the Fourth Hospital ofHebei Medical University. All patients should conform with severalconditions as follows: Pantients with obstructive jaundice; CT or MRI showedintrahepatic bile duct dilatated and pancreatic space-occupying; CA-199elevated for two times at least; Preoperativ examination or intraoperativeexploration revealed that pancreatic tumor invaded portal vein or superiormesenteric vessels or there was liver metastasis or widespread intraabdominallymph nodes metastasis.According to the operative modes, the patients weredivided into four operation groups:①Nineteen cases underwentcholecystoenterostomy. The operation steps: When ti was found that cysticduct was unobstructed there were no stones or tumors in gallbladder, andpancreatic tumor was small through intraoperative exploration, cut offjejunum from Treitz ligament15cm, closed the distal end, and made side toside anastomosis between the distal jejunum and gallbladder on front oftransverse colon. At last, made a side to side anastomosis between theproximal jejunum ande the distal jejunum which was away from the firstanastomosis45～50cm.②T weenty-six cases underwentcholedochoenterostomy. The operation steps: Removed gallbladder from the body first,then transected the common bile duct, and ligated the diatal end.Cut off jejunum from the Treitz ligament15cm, closed the distal end, andmade end to side anastomosis between the distal jejunum and the commonbile duct behind transverse colon.At last, made a side to side anastomosisbetween the proximal jejunum and the distal jejunum which was away fromthe first anastomosis45～50cm.③Five cases underwentcholecystoenterostomy combined with preventive gastrojejunostomy. Theoperation steps: Did gastrojejunostomy in addition on the basis ofcholecystoenterostomy. But there were differences between the two kinds ofoperation, it was that cut off jejunum from the Treitz ligament35cm and didgastrojejunostomy from the Treitz ligament15~20cm.④Seventeen casesunderwent choledochoenterostomy combined with prophylacticgastrojejunostomy. The operation method: Did gastrojejunostomy in additionon the basis of choledochoenterostomy. The method of anastomosis was as thesame to above.Through readed complete clinical cases, observed change of bilirubin,postoperative length of time, postoperative complications and mortality ratewhich were used to establish an Excel database. The statistical analyses weresubjected to t test for measurement data and Fisher’s exact test forenumeration data using SPSS13.0statistical software. We compared ofadvantages and disadvantages of different palliative operations according tothe results of statistical analysis.Results:1The jaundice subsided rate one week after operation (preoperative TBILminus TBIL one week after operation account for preoperative TBILpercentage) in cholecystoenterostomy group and choledochoenterostomygroup were68.4%,65.6%, the mean postoperative length of stay were11days,11.4days, the incidence of complications were15.8%,3.8%, the differenceswere nonsignificant between groups(p>0.05). Cholecystoenterostomycombined with preventive gastrojejunostomy group’s mean postoperativelength of stay was13.8days, the incidence of postoperative complications was40%. Compared with cholecystoenterostomy group, there was nostatistical differences(p>0.05). The mean postoperative length of stay incholedochoenterostomy combined with preventive gastrojejunostomy groupwas12.9days, the incidence of postoperative complication was17.6%.Compared with choledochoenterostomy group, there was no statisticaldifferences (p>0.05).2There were no hospitalized death cases. Patients with gastrointestinalbleeding were cured through active hemostasis, blood transfusion, fluidinfusion, acid suppression, maintenance of electrolyte and acid-base balanceand nutritional support therapy; Patients with pulmonary infection were curedthrough active resistance to infection, oxygen inhalation, antipyretic treatment,maintenance of electrolyte and acid-base balance and nutritional supporttreatment; Patients with delayed emptying of the stomach were cured throughgastrointestinal decompression, promoting gastrointestinal peristalsis andnutrition support treatment.Conclusion:1Cholecystoenterostomy is simple, effective and feasible, on the basis ofavoiding its shortcomings.2Cholangiojejunostomy doesn’t increase length of stay and postoperativecomplications. Therefore, This kind of operation should be selected first ifconditions are permitted.3Cholangiojejunostomy combined with prophylactic gastrojejunostomydoesn’t increase incidence of complications, mortality rat and the length ofstay. Therefore, patients should undergo prophylactic gastrojejunostomy at thesame time.