Preoperative Biliary Drainage To Improve Intestinal Mucosal Barrier Function In Patients With Malignant Obstructive Jaundice

Objective : Patients with malignant obstructive jaundice(MOJ)are often associated with systemic multisystem dysfunction and have a high incidence of complications and mortality,so it is particularly important to correct the function of the patient’s organism preoperatively,and the correction of intestinal barrier function is one of the top priorities.Although preoperative biliary drainage is a commonly used treatment,the use of biliary drainage is controversial in the field.The purpose of this study was to analyze the effects of preoperative biliary drainage on the expression of ocludin and zonulin-1(ZO-1)in the intestinal mucosa of patients with malignant obstructive jaundice and the permeability of the intestinal mucosal barrier,to determine whether preoperative biliary drainage can improve the intestinal mucosal barrier function in patients with malignant obstructive jaundice and to provide a theoretical basis for preoperative yellowness reduction therapy.Methods : Patients with malignant obstructive jaundice who attended the Department of Hepatobiliary Surgery at the Affiliated Hospital of Inner Mongolia Medical University between October 2019 and October 2021 were selected,and the patients were divided into an observation group who received preoperative PTCD combined with bile transfusion therapy and a control group who received preoperative hepatoprotective therapy only,and a total of 44 patients were finally included in the study cases,including 24 patients in the observation group and 20 patients in the control group,and the patients were recorded General information.In both groups,blood samples were collected on the first day of admission and 7days after treatment to test liver function before and after treatment,and serum diamine oxidase(DAO)and serum endotoxin(ET)levels were measured before and after treatment using enzyme-linked immunosorbent assay.Intraoperative jejunal samples were taken from the patient’s bile duct jejunostomy,and the expression of ocludin and ZO-1 proteins in the patient’s intestinal mucosa was analyzed by immunohistochemical staining(SP).Results : 1.The general data of patients in both groups,including age,gender,BMI,and disease type did not show significant differences(P>0.05).2.The comparison of liver functions,including glutamic aminotransferase(ALT),glutamic aminotransferase(AST),total bilirubin(TBIL),and conjugated bilirubin(DBIL)in the first admission of patients in both groups did not show significant differences(P<0.05)and were comparable;patients in both groups After 7 days of treatment,the liver function conditions were ALT(100.17±56.22U/L),AST(66.83±24.50U/L),TBIL(183.42±58.99μmmol/L),DBIL(139.80±42.08μmmol/L)in the PTCD-treated group and ALT(162.46±62.40U/L),AST(110.88±49.68U/L),TBIL(256.73±80.94μmmol/L),DBIL(210.61±81.49μmmol/L)in the control group,the indexes of patients in the PTCD treatment group were significantly lower than those in the control group(P<0.05).3.Day 1 of admission in the PTCD treatment group The serum DAO and ET levels on day 1 of admission in the PTCD treatment group(4.341±0.493u/ml,0.158±0.012Eu/ml)and the serum DAO and ET levels on day 1 of admission in the control group(4.274±0.380u/ml,0.155±0.013Eu/ml)were not significantly different between the two groups(P>0.05).The serum DAO and ET levels after 7 days of treatment in both groups,serum DAO and ET levels in PTCD treatment group(3.872±0.471u/ml,0.136±0.014Eu/ml)and serum DAO and ET levels in control group(4.244±0.492 u/ml,0.148±0.126 Eu/ml),were significantly lower in PTCD treatment group compared to TBIL was positively correlated with DAO(r=0.832,P<0.05),TBIL was positively correlated with ET(r=0.882,P<0.05)and DAO was positively correlated with ET(r=0.694,P<0.05)in the PTCD group before treatment;TBIL was positively correlated with DAO(r=0.869,P<0.05)in the PTCD group after treatment.(r=0.869,P<0.05),TBIL was positively correlated with ET(r=0.856,P<0.05),and DAO was positively correlated with ET(r=0.825,P<0.05).TBIL was positively correlated with DAO(r=0.655,P<0.05),TBIL was positively correlated with ET(r=0.932,P<0.05),and DAO was positively correlated with ET(0.631,P<0.05)before treatment in the control group;TBIL was positively correlated with DAO(r=0.765,P<0.05)after treatment in the control group.TBIL was positively correlated with ET(r=0.882,P<0.05)and DAO was positively correlated with ET(0.772,P<0.05).4.ocludin and ZO-1 were expressed in the cytoplasm of intestinal mucosal epithelial cells in both groups,with a brownish-yellow linear distribution.ocludin protein expression in the PTCD-treated group(1.40783± 0.32117)in the PTCD treatment group was higher than that in the control group(0.82581±0.23717)(P<0.05),and the expression of ZO-1 protein in the PTCD treatment group(5.58050±2.25866)was higher than that in the control group(1.78962±0.63208)(P<0.05).Conclusions:1.PTCD combined with bile transfusion can repair the damage of liver function in patients with malignant obstructive jaundice;2.PTCD combined with bile transfusion can reduce the level of serum endotoxin,promote the improvement of endotoxemia and maintain the intestinal permeability;3.PTCD combined with bile transfusion can promote the recovery of intestinal tight junction damage caused by malignant obstructive jaundice and maintain the intestinal mucosal barrier function integrity.