| The obstructive jaundice has extensive adverse effects on the organism, can cause the physiological change of a series of pathology of organism, and then do harm to muti system organ, accelerate the condition to worsen, a series of consequences caused that its key question is continuation of the biliary tract,going on to obstruct. Most of obstructive jaundice needs the operation to treat, but its operation is relatively risky, the incidence and death rate of the complication are relatively high after the operation. A large number of materials indicate the serum bilirubin level had close relations with emergence of the complication after the skill before obstructive jaundice patient's skill, when the serum bilirubin level rises, the rising thereupon too of incidence of some complications. This text plan through treat and handle skill therapeutical obstructive jaundice analysis of cases not to find out about serum bilirubin competence and skill in hospital to Jilin university Union-Japanese friendship ties hospital basic surgery And then the relation that the complication happens,In order to define whether the serum bilirubin level has relations with emergence of the complication after the skill. Methods: University Union-Japanese friendship ties hospital basic surgery handle 312 obstructive jaundice patient that skill treat divide into four groups in hospital in Jilin January to will it be August 2004,2000,serum bilirubin≤171μmol/L is set as group A before the skill,serum bilirubin 171～200μmol/L is set as group B, serum bilirubin 200～342μmol/L is set as group C, ≥of serum bilirubin 342μmol/L set as D group (serum total bilirubin 34 patient among 200～450μmol/L go ahead of the rest PTCD among them, about serum total bilirubin competent operation treat when dropping 171μmol/L to one week), use method, case of comparative study compare and analyse to all group patient, relation of levels of serum bilirubin before the complication, death and skill after comparative skill. Statistics method: The single factor is analysed and examined withχ2. Results:Serum bilirubin ≤171μmol/L before the skill, the incidence of the patients of 171～200μmol/L, 200～342μmol/L and ≥342μmol/L gallbladder Lou after skill is 8.2%,11.1%,10.6%,12.7% respectively; The incidence of pancreas Lou is 1.0%,5.6%,2.1%, 4.9% respectively; Identical mouthfuls of incidence of Lou are 2.0%, 5.6%,9.6%,13.7% respectively; The incidence that the lung infects is 5.1%,5.6%,9.6%,20.6% respectively; The whole incidence of liver function is 2.0%,11.1%,8.5%,19.6% respectively;The whole incidence of kidney function is 6.1%,11.1%,12.8%,28.4% respectively; The incidence that the notch delays healing is 14.3%,16.7%,20.2%, 44.1% respectively; The incidence of abdominal cavity's abscess is 3.1%, 0%, 5.3%, 10.8% respectively; Incidence that the abdominal cavity bleeds is 3.1%,5.6%,4.3%,5.9% respectively The disorderly incidence of water and electrolyte is 20.4%,22.2%,22.3%,28.4% respectively; The incidence in heart failure is 6.1%, 5.6%, 7.4%,7.8% respectively; The incidence of thesepticaemia is 1.0%,0%,1.1%,7.8% respectively; The incidence of DIC is 0%, 0%,2.1%,5.9% respectively; The total incidence of the complication is 23.5%, 27.8%, 31.9%, 45.1% respectively after the skill; Death rate is 1.0%, 0%, 2.1%,8.8% respectively. Have not had significance difference (P>0.05) without reducing the incidence of the complication after the yellow patient's skill to reduce yellow patient and 278 before 34 skills among 200 ～450μmol/L of total bilirubin of serum. Discussion: Find after analysing to the complication taking place after 312 skills of handling the obstructive jaundice patient with therapeutical skill, serum bilirubin ≤171μmol/L before the skill, the total incidence of the complication is 23.5%,27.8%,31.9%, 45.1% respectively after the skills of the patients of 171～200μmol/L,200 ～342μmol/L and ≥342μmol/L,the two have significance difference(P<0.05 ),the death rate of every group is 1.0%, 0%, 2.1%,8.8% respectively. The complication and death rate are higher than the slight jaundice patient notably after briefing the serious degree of obstructive jaundice patient a skill on. Gallbladder Lou in the complication under skill, pancreas Lou, abdominal cavity bleed, water electrolyte disorderly and in heart failure emergence have significance difference among every group (P> 0.05), emergence that the lung is infected, liver function is not complete, the kidney function is not complete, the notch delays healing etc. is apparent between two groups There is significance difference or the extraordinary significance difference (P<0.05 orP<0.01 ) between two groups in the emergence that the notch delays healing etc. Obstructive jaundice patient's surgery treats very high complication incidence and death rate, it is reported it is 40%～60%,15%～25% respectively. Someone finds after studying, analysing endotoxin and blood disease that the high bilirubin causes take the main factor in the factor related to case fatality rate. The persons who obviously rise of endotoxin while circulating around the obstructive jaundice patient can be up to 24%～68%; So, the endotoxin and blood disease are noteworthy on the influence that the obstructive jaundice patient produces . It has two respects factor mainly that the mechanism of the endotoxin and blood disease takes place to the obstructive jaundice patient: ⑴Because obstruct with bile duct, the gallbladder salt is scarce in the intestines, make the bacterium fungus group in the intestines change, because the emulsification of the gallbladder salt resists the forfeiture on function of endotoxin even more, the endotoxin in the large intestine is absorbed and entered portal vein endotoxin and blood disease happens in the portal vein. ⑵The obstructive jaundice makes the liver withered and denies cells and engulfs the function and is damaged. In 70-80 times , most doctors maintain that reduce the serious degree of obstructive jaundice patient yellow before carrying on the skill. Because the improvement of modern anaesthesia and operation technology and use of the effective medicine, have not...
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