Retrospective Study On Biliary Drainage In Patients With Malignant Obstructive Jaundice

Objective:According to study the relationship between the level of bilirubin and the effect of biliary drainage and the correlation between the location of obstruction and the patterns of biliary drainage,provide references for the optimized model in the diagnosis and treatment of the patients with malignant obstructive jaundice.Methods:A total of 114 patients with malignant obstructive jaundice were included in this retrospective analysis during the period from May 2015 to November 2019.Patients were divided into four groups according to the level of total bilirubin(TBIL)before biliary drainage and then divided into intrahepatic and extrahepatic subgroups based on the location of obstruction and percutaneous transhepatic cholangial drainage(PTCD)and endoscopic retrograde cholangiopancreatography(ERCP)subgroups based on the patterns of biliary drainage.Statistical analysis was performed using SPSS software(version 25).Wilcoxon signed-rank test,Mann-Whitney U test,and binary logistic regression analysis were used to investigate the distinctions of TBIL,direct bilirubin(DBIL)between after and before biliary drainage,the contrast of the decrease of TBIL and DBIL in the four groups between before biliary drainage,3-,7-and 14-day after biliary drainage;the correlation between liver function indexes,patterns of biliary drainage and the location of obstruction.Results:TBIL was(227.3± 130.0)pmol/L and DBIL was(186.6±110.2)μmol/L before biliary drainage.In Group A,TBILs were(59.4±45.2)μmol/L,(66.2±72.2)μmol/L and(63.3±51.0)μmol/L and DBILs were(50.2±41.5)μmol/L,(58.6±73.0)μmol/L and(61.6±54.1)μmol/L 3-,7-,and 14-day after biliary drainage respectively,and the distinctions had no statistical significance compared with that before biliary drainage(P>0.05).In Group B,Compared TBIL of 3-,7-,and 14-day after biliary drainage with that before biliary drainage,P values were all less than 0.05,while P values were greater than 0.05 when compared DBIL of 7-and 14-day after biliary drainage with that before biliary drainage.In Group C,P values were all less than 0.05 when compared TBIL and DBIL after biliary drainage with that before.In Group D,Compared TBIL of 3-,7-,and 14-day after biliary drainage and DBIL of 7-,and 14-day after biliary drainage with that before biliary drainage,P values were all less than 0.05.P values of group A compared with group B in the decrease of TBIL on the 7-and 14-day after biliary drainage compared with that before biliary drainage were 0.127,0.214 respectively(both of them were more than 0.05).P values of group A compared with group B in the decrease of DBIL after biliary drainage compared with that before biliary drainage were 0.065,0.306,0.125 respectively(all of them were more than 0.05),P values of group C compared with group A and group B in the decrease of TBIL on the 7-and 14-day after biliary drainage compared with that before biliary drainage were all less than 0.05.P values of group C compared with group B in the decrease of DBIL after biliary drainage compared with that before biliary drainage were all less than 0.05.P values of group D compared with group A and B in the decrease of TBIL and DBIL on the 3-,7-and 14day after biliary drainage compared with that before biliary drainage were all less than 0.05.P values of group D compared with group C in the decrease of TBIL on the 7-and 14-day after biliary drainage compared with that before biliary drainage were 0.616,0.250 respectively(both of them were more than 0.05).P values of group D compared with group C in the decrease DBIL on the3-,7-and 14-day after biliary drainage compared with that before biliary drainage c were 0.577,0.800,0.362 respectively(all of them were more than>0.05).There was a significant distinction of the location of obstruction in pattern subgroups,P value was 0.000<0.05and EXP(B)was 0.117(95%confidence intervals(CI)0.038-0.361).P values of AKP and TBA between ERCP and PTCD Subgroups were less than 0.05.The Exp(B)of AKP was 1.002(95%confidence intervals(CI)1.001-1.004)and the Exp(B)of TBA was 0.994(95%confidence intervals(CI)0.989-0.999).Conclusion:For patients with malignant obstructive jaundice,whether to biliary drainage depends on multiple considrerable factors such as the location of the obstruction,whether accompanied by cholangitis,surgery,liver function indexes,general conditions,and other factors.However,biliary drainage is not recommended when TBIL is lower than 200μmol/L.The location of obstruction is an independent factor of the selection of biliary drainage patterns.Extrahepatic biliary drainage in PTCD is 0.117 times of that in ERCP.When AKP increases by one unit,the probability of PTCD increases by 0.2%;when TBA increases by one unit,the probability of PTCD decreases by 0.6%.