Analysis Of The Curative Effect For Ddifferent Preoperative Biliary Drainage Methods In Patients With Low Malignant Obstructive Jaundice And Undergoing Pancreaticoduodenectomy

Objective:To summarize the advantages and disadvantages of ERBD(endoscopic retrograde biliary drainage)or PTCD(percutaneous transhepatic cholangial drainage)to reduce yellowing in patients with malignant obstructive jaundice of low biliary tract,and to explore the best method to reduce yellowing in patients with malignant obstructive jaundice of low biliary tract and its influence on long-term survival.WE observe the changes of perioperative physiological and biochemical indexes in patients with malignant obstructive jaundice of low biliary tract undergoing pancreaticoduodenectomy by ERBD or PTCD.Methods:A retrospective analysis was performed on the clinicopathological data of patients admitted to the Department of Hepatobiliary Surgery of The Affiliated Hospital of Guizhou Medical University from January 2014 to June 2020 who were considered to have low malignant obstructive jaundice before surgery and confirmed to have pancreatic cancer,ampuller cancer,duodenal cancer or lower common bile duct cancer after postoperative pathological examination.Patients were devide into PTCD group and ERBD gourp accordding to PBD methods.Using SPSS propensity matching module propensity score matching(PSM)analysis.Compare two groups of patients with age,sex,basic diseases(hypertension,diabetes),biochemical index,PBD time and postoperative related complications.Then,the patients were divided into pancreatic cancer group and non-pancreatic cancer group(including ampullary carcinoma,duodenal carcinoma and lower common bile duct carcinoma)by tumor type,compare the effect of two groups of patients receiving different PBD methods.Results:Participants included 84 patients,58(69.0%)of patients with PTCD.26(31.0%)of patients with ERBD.After PBD the serum alanine aminotransferase(ALT),aspartate aminotransferase(AST),total bilirubin(TBil),direct bilirubin.(DBil)、 γ-glutamyl transferase(γ-GT),alkaline phosphatase(ALP)of PTCD and ERBD group patients are lower than before(p < 0.05),The difference is statistically significant.Reducing bilirary drainage time of ERBD group were shorter than PTCD group,the difference statistically(p<0.05).Incidence of PBD related complications in ERBD were higher than PTCD group(cholangitis,pancreatitis were 8.7%vs0%)the difference statistically(p > 0.05).But PTCD group with a higher incidence of hemorrhage(17.4% vs0%),and the difference was statistically significant.In patients with pancreatic cancer group,PBD time of patients recepted ERBD were lower than PTCD difference was statistically significant.In the non-pancreatic cancer group,ERBD in time on the length of hospital stay and PBD were shorter than PTCD group,the difference was statistically significant.62 patients received postoperative visit 1 to 6 years,the patients of non-pancreatic cancer group,ERBD and PT-CD group patients the median survival time were respective 20 and 15 months,the difference was statistically significant.Conclusions:ERBD can shorten the waiting time for operation and length of hospital stay time,postoper-ative median survival time is longer than PTCD,which is the first selection for PBD.