Comparative Analysis Of Three Kinds Of Different Preoperative Biliary Drainage In The Bismuth-Corlett ?-? Hilar Cholangiocarcinoma

Objective Hilar cholangiocarcinoma(HCA)is the most common types of extrahepatic biliary tract malignancies,and many patients need to undergo preoperative biliary drainage in order to get a better prognosis.The means of preoperative biliary drainage mainly include percutaneous transhepatic cholangial drainage(PTCD),endoscopic retrograde biliary drainage(ERBD)and endoscopic nasobiliary drainage(ENBD),each of the preoperative biliary drainage ways has its own advantages and disadvantages.To explore which preoperative biliary drainage is the best choice for Bismuth-corlett ?-? HCA,we compared the effect of biliary drainage and the incidence of complications during the period of biliary drainage,and we also compared the related circumstances of patients who finally underwent surgical treatment.Methods From June 2012 to October 2016,70 patients with Bismuth-corlett ?-? HCA were treated with preoperative biliary drainage.According to the method of preoperative biliary drainage,patients were divided into PTCD group,ERBD group and ENBD group.The levels of TBIL ? AST,ALT,Alb,ALP,GGT and PT were observed before and after preoperative biliary drainage.The complications such as cholangitis,pancreatitis,electrolyte disturbance and abdominal pain were observed during the period of preoperative biliary drainage.If anyone's TBIL falls more than50% in 2 weeks and can get further surgical treatment after preoperative evaluation,this patient will be considered further surgical treatment.The operation time,bleeding amount,liver duodenal ligament edema and hospital days were observed in the patients who got surgical treatment.Then we carry out systematic analysis for the above data.Results The levels of TBIL?AST?ALT?ALP and GGT decreased significantly in all groups,there were significant differences before and after preoperative biliary drainage(P<0.05),but there were no significant differences in the levels of Alb andPT before and after preoperative biliary drainage(P > 0.05).The incidence of complications in PTCD group,ERBD group and ENBD group were35%(7/20),33.3%(8/24)and 26.9%(7/26)during the period of preoperative biliary drainage,and no significant difference was observed(P=0.850).The incidence of cholangitis in PTCD group,ERBD group and ENBD group were5%(1/20),16.7%(4/24)and 7.7%(2/26)during the period of preoperative biliary drainage,there was no significant difference in the incidence of cholangitis(P=0.481).The incidence of electrolyte disturbance in PTCD group,ERBD group and ENBD group were 25%(5/20),4.2%(1/24)and 15.4%(4/26)during the period of preoperative biliary drainage,PTCD group had 2 patients with serious electrolyte disturbance,but no significant difference was observed(P=0.143).The incidence of abdominal pain in PTCD group,ERBD group and ENBD group were 15%(3/20),8.3%(2/24)and3.8%(1/26)during the period of preoperative biliary drainage,no significant difference in the incidence of abdominal pain was observed(P=0.426).The complication of pancreatitis occurred in ERBD group and ENBD group,but the PTCD group didn,t occurre pancreatitis,there was no significant difference in the incidence of pancreatitis(P=0.630).There were 14 cases in PTCD group,17 cases in ERBD group and 17 cases in ENBD group can get further surgical treatment after biliary drainage treatment,there was no significant difference in the ratio of patients who can get further surgical treatment(P=0.906).The average operation time and bleeding amount in the ERBD group and ENBD group were higher than the PTCD group,but there were no significant differences among three groups(P>0.05).During the operation of surgery,we found that 2 cases in in the ERBD group and 1 case in in the ENBD group occured liver duodenal ligament edema.The liver duodenal ligament edema increased the difficulty of the operation.The average hospital days of the three groups were similar,and there was no significant difference among three groups(P> 0.05).Conclusions All of these three kinds of preoperative biliary drainage can get satisfactory results,PTCD may be the first choice for patients of Bismuth-corlett ?-? HCA who get preoperative biliary drainage.However,ERBD should be considered in order to avoid further aggravation of electrolyte imbalance in patients of Bismuth-corlett ?-? HCA with electrolyte imbalance.