The Analysis Of The Impact Of The Bilirubin Level On Pancreaticoduodenectomy And The Application Value Of The Preoperative Biliary Drainage

Objective:To understand the impact of the bilirubin level on pancreaticoduodenectomy, and investigate the risk factors of postoperative complications and mortality, and analyse the effect of preoperative biliary drainage(PBD) on the morbidity and mortality of pancreaticoduodeneetomy in patients of malignant obstructive jaundice in the lower bile duct, provide the basis for clinical treatment.Dates and Methods:The impact of the bilirubin level on pancreaticoduodenectomy:Clinical data of 54 cases undergoing pancreaticoduodenectomy were collected and analyzed. Patients were divided into four groups according to preoperative jaundice. Comparison was made of blood loss, postoperative complications and mortality in four groups to investigate the impact of the bilirubin level on pancreaticoduodenectomy. Univariate analysis and Logistic analysis were used to assess the influence of other factors.The effect of preoperative biliary drainage(PBD) on the morbidity and mortality of pancreaticoduodeneetomy in patients of malignant obstructive jaundice in the lower bile duct:Clinical data of 74 cases undergoing pancreaticoduodenectomy whose preoperative total bilirubin level was over 85μmol/L were collected and analyzed. Comparison was made of PBD versus no PBD in malignancy jaundiced patients undergoing resection of a tumor. Outcome measures were perioperative situation, in-hospital death rate, overall complications resulting from the treatment modality.Statistical analysis:Statistical analysis was performed by SPSS software version16.0. Continuous variables were expressed as mean士SD. T test and one-way ANOVA were used for means comparision. Count datas were compared by chi-square test, multivariate Logistic regression was used for multivariate analysis. A two-side P value of less than 0.05 was considered statistically significant.Results:The impact of the bilirubin level on pancreaticoduodenectomy:Prothrombin time between groups was statistically significant in group B and group C, group C and group D(P<0.05), but group A and group B(P=0.078). With the level of jaundice increased, there was an increasing trend in blood loss and postoperative complications. Blood loss> 600ml and postoperative complications between the two groups adjacent showed no significant difference (P<0.05), but increased significantly in patients with moderate and severe Jaundice(P=0.057,0.011, P=0.053,0.033). Logistic analysis showed preoperative high bilirubin and blood loss over 600ml were important risk factors for postoperative complications, P= 0.047, P= 0.041, P= 0.032.The effect of preoperative biliary drainage(PBD) on the morbidity and mortality of pancreaticoduodeneetomy in patients of malignant obstructive jaundice in the lower bile duct:Forty (40/74) cases received PBD procedure and the mean drainage duration was 9 days. The total bilirubin was significantly reduced from (338.1±88.38)μmol/L to (228.5±82.24)μmol/L and was significantly lower than 328.6±93.02μmol/L of non-PBD group. TB1L, DBIL, AST, ALP, GGT but ALT decreased significantly after the jaundice. Operation time, blood loss were significantly lower and total hospital stay were significantly higher in PTBD group than that in non-PTBD group (P<0.05). while intraoperative transfusion of plasma volume RBC transfusions, postoperative hospital stay were no different. The overall postoperative morbidity was 52.7%(39/74). The morbidity in PBD group was 47.5% (19/40) and 52%(20/34) in non-PBD group and there was no significance between the two groups, and so did in the single complication.Conclusion:High preoperative total bilirubin can cause liver damage, blood clotting disorders and a series of injury, which is an important factor of high complications and mortality in patients after pancreaticoduodenectomy. PBD procedure can reduce the total bilirubin level and improve the hepatic function of the patients. However, PBD does not help to reduce postoperative complications and mortality. Jaundice could be considered in patients with high preoperative bilirubin, poor nutritional status and bad coagulation to enhance the tolerance of surgery.