| Objective: To retrospectively analyze the clinical data and postoperative recovery of ERCP and PTCD in patients with low malignant biliary obstruction undergoing pancreaticoduodenectomy,and to explore the two preoperative methods of ERCP and PTCD for low malignant biliary obstruction The effect of reducing jaundice in patients and its influence on radical pancreaticoduodenectomy.Methods: Retrospective analysis of low-level malignancies that underwent pancreaticoduodenectomy in our hospital(Shengjing Hospital,China Medical University)from January 2010 to January 2020 and performed ERCP or PTCD before surgery to reduce yellowing Clinical data of patients with biliary obstruction.Divided into ERCP group(group A)and PTCD group(group B)according to the preoperative method of reducing yellowing,of which 17 cases were in the ERCP group(16 cases with ENBD external drainage and 1 case with ERBD internal drainage),50 cases in the PTCD group;bile duct in the ERCP group 6 cases of cancer,3 cases of pancreatic cancer,3 cases of duodenal cancer,5 cases of ampullary cancer,18 cases of cholangiocarcinoma,16 cases of pancreatic cancer in the PTCD group,7 cases of duodenal cancer,and 9 cases of ampullary cancer Patients in the ERCP group underwent open pancreaticoduodenectomy after jaundice reduction.In the PTCD group,43 patients underwent open pancreaticoduodenectomy,and 7 patients underwent laparoscopic pancreaticoduodenectomy.The general data,liver function,nutritional status,inflammation,and complications of the two groups of patients before and after the reduction of jaundice and PD were compared,and the effects of different preoperative reduction methods on the operation time,hospitalization time,hospitalization expenses and patient prognosis were analyzed..Results: There was no difference in bile duct diameter(1.49±0.36 cm vs 1.46±0.41cm)and pancreatic duct diameter(0.41±0.18 cm vs 0.44±0.25cm)between group A and group B before yellowing(P>0.05).There was no difference in total bilirubin(340.21±25.44μmol/L vs 338.18±19.20μmol/L)and direct bilirubin level(169.00±49.89μmol/L vs 158.46±51.52μmol/L)between group A and group B before yellowing Statistical significance(P>0.05).The levels of total bilirubin and direct bilirubin reduced in group A were significantly lower than those in group B(141.21±78.96μmol/L vs 216.96±81.86μmol/L,71.49±39.94μmol/L vs103.31±58.35μmol/L),The difference was statistically significant(P<0.05).The interval between patients in group A and the same bilirubin level(pancreaticoduodenectomy)was significantly longer than that in group B(23.53±7.18 days vs 12.18±5.77 days),the difference was statistically significant(P<0.05).There was no significant difference in the levels of ALT(182.76±94.95U/L vs186.45±85.63U/L)and AST(161.18±90.83U/L vs 175.32±84.35U/L)between group A and group B before yellowing(P> 0.05),the difference was statistically significant after reducing yellowing(90.65±46.33 U/L vs 66.16±37.73 U/L,77.59±46.67 U/L vs52.35±24.64 U/L)(P<0.05),interventional therapy in group B The recovery of liver function was better than that of group A.There were 6 cases of postoperative complications in group A,including 1 case of bacterial infection,3 cases of fungal infection,1 case of biliary hemorrhage,1 case of pancreatic fistula,about 35.3%.There were 24 cases of postoperative complications in group B,including 7 cases of bacterial infection,4 cases of fungal infection,4cases of biliary hemorrhage,3 cases of pancreatic fistula,3 cases of gastrointestinal dysfunction,3 cases of liver and kidney dysfunction,about 48.0%.There was no significant difference in postoperative complications between group A and group B(P>0.05).Operation time(7.93±1.59 h vs 7.22±1.99h),intraoperative blood loss(297.06±113.84 ml vs 385.00±309.25ml),intraoperative blood transfusion(585.29±524.33 ml vs 532.00±449.75ml)in group A and group B)There was no statistically significant difference(P>0.05).The length of hospital stay in group A was significantly greater than that in group B(51.06±4.01 days vs 40.12±11.11 days),and the difference was statistically significant(P<0.05).There was no difference in hospitalization expenses between group A and group B(147974.49±40139.41 yuan vs127495.64±38114.20 yuan)(P>0.05).Conclusion: For patients with low malignant biliary obstruction,the jaundice reduction effect of PTCD and the recovery of liver function of patients are better than that of ERCP.At the same time,patients who have undergone PTCD yellowing treatment require less time to reach the bilirubin level for pancreaticoduodenectomy,the overall hospital stay of patients is shorter,and the recovery is faster.In addition,the two methods of reducing jaundice have similar effects on postoperative complications,electrolyte imbalance,inflammation,and nutritional status. |
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