The Analysis Of The Impact Of Preoperative Obstructive Jaundice On Pancreaticoduodenectomy

Pancreaticoduodenectomy(PD) often called the Whipple procedure, afterthe American surgeon Allen Whipple who devised an improved version of thesurgery in1935，marked a new epoch in the operative treatment of pancreaticsurgery. It consists of removal of the head of the pancreas, the distal half of thestomach, duodenum, proximal jejunum, the gall bladder and its cystic duct, thedistal bile duct, and regional lymph nodes. The reconstruction consists ofpancreaticojejunostomy and hepaticojejunostomy to allow digestive juices andbile respectively to flow into the gastrointestinal tract and gastrojejunostomy toallow food to pass through. PD is one of the most complex surgery in generalsurgery.At present, with the use of advanced medical and the unceasingenhancement of surgical technology, PD has become a conventional operativemethod of the treatment of carcinoma of ampulla, carcinoma of head ofpancreas, bile duct subordinate period of cancer, limitations of chronicpancreatitis, pancreatic trauma and some other related diseases[1,2].Thepostoperative complications of PD, such as hemorrhage, pancreatic fistula,biliary fistula, delayed gastric emptying, infection, are indeed familiar. With thecontinuous development and the improvement of technology, PD postoperativemortality can be decreased to around5%, generally can be controlled at about 15%in some domestic experienced medical center[7]. The incidence of earlypostoperative complications reaches up to20%~60%[8]. The foreign materialgenerally is3%~8%, but the early postoperative is still as high as20%~70%[9].There is no clear and unified clinical guidance about the preoperativeassessment of the risk of postoperative complications now. The correlation,between preoperative bilirubin level and the incidence of postoperativecomplications, is still controversial in academic circles. In this article, theclinical data of167patients who received pancreaticoduodenectomy in recent5years were collected, sorted and analyzed retrospectively. We summarized thepostoperative complications, pathology result, general hospital information andexplored the relationship with the preoperative bilirubin level. These providereferences for clinical implementation of the operation to reduce the occurrenceof postoperative complications and mortality.Objective: To analyze the influence of preoperative bilirubin level on PDprocedure, postoperative complications and the general situation of duringhospitalization.Methods: The clinical data of167patients undergoing PD in recent5years were collected, sorted and analyzed retrospectively. All the patients weredevided into non severe jaundice group(TBIL≤171umol/L) and severejaundice group(TBIL＞171umol/L). By means of the statistical analysisbetween these two groups of patients with their preoperative, intraoperative andpostoperative data, we summarized the effects of preoperative bilirubin level inpatients with PD surgery.Results: The insevere jaundice group compared with the severe jaundicegroup of gender, there is no statistically significant difference between the two groups（P=0.180）; The insevere jaundice group compared with the severejaundice group of age distribution,there is no statistically significant differencesbetween the two group（sP＞0.05）; The insevere jaundice group compared withthe severe jaundice group of preoperative TBIL level,there is a statisticallysignificant difference between the two groups（P<0.05）; The insevere jaundicegroup compared with the severe jaundice group of the intraoperative bloodloss、intraoperative blood transfusion volume and the time of operation, thereare no statistically significant differences between the two groups（P＞0.05）;The insevere jaundice group compared with the severe jaundice group of thepostoperative infection occurrence,there is a statistically significant differencebetween the two group（sP=0.035）; The insevere jaundice group compared withthe severe jaundice group of the postoperative hemorrhage occurrence,there isno statistically significant difference between the two groups（P=0.345）; Theinsevere jaundice group compared with the severe jaundice group of thepostoperative pancreatic fistula occurrence,there is no statistically significantdifference between the two groups（P=0.904）; The insevere jaundice groupcompared with the severe jaundice group of the postoperative biliary fistulaoccurrence,there is no statistically significant difference between the twogroups（P=0.257）; The insevere jaundice group compared with the severejaundice group of the postoperative gastric emptying disorder happening,thereis no statistically significant difference between the two groups（P=0.838）; Theinsevere jaundice group compared with the severe jaundice group of the time ofpostoperative hospital stay、hospitalization cost and day average cost, there areno statistically significant differences between the two groups（P＞0.05）; The insevere jaundice group compared with the severe jaundice group of thepostoperative deaths, there is no statistically significant difference between thetwo groups（P=0.268）; The insevere jaundice group compared with the severejaundice group of the postoperative pathological diagnosis, there is astatistically significant difference between the two groups（P=0.011）.Conclusion:1. There is a higher risk of postoperative infection in PDpatients with severe jaundice. And their possibility of getting aggressive tumorsis significantly higher than the non severe ones. Differences are statisticallysignificant.2.In statistical analysis, blood transfusion amount during operationsand the complications, such as pancreatic fistula, biliary fistula and so on, hadno significant difference, although they are higher in the PD patients withsevere jaundice than the non severe ones.3.The operation time, blood loss,hospitalization days and cost and perioperative mortality had no significantstatistical difference.