| Objective: Low biliary obstruction caused by tumors around the ampulla often causes hyperbilirubinemia.Laparoscopic pancreaticoduodenectomy(LPD)is the Radical surgery about those tumor,Preoperative biliary drainage(PBD)is used to reduce hyperbilirubinemia.However,It has not been decided whether PBD is routinely performed before the operation.Therefore,for patients with the same hyperbilirubinemia,there are two different treatment methods:surgery after PBD and directly surgery.This study analyzed the influence of PBD in the laparoscopic era on perioperative period of LPD patients,so as to further explore the necessity and adaptability of PBD.Method:A retrospective analysis of patients who were treated for Severe obstructive jaundice(TBIL>171μmol/L)and successfully performed LPD in the Hepatobiliary and Pancreatic Gland Surgery of the Second Hospital of Hebei Medical University from January 2017 to December 2019 was divided according to whether they received biliary drainage before LPD surgery.PBD group and no PBD group.The sex,age,BMI,preoperative basic disease,ASA classification,and preoperative total bilirubin;the surgical time,the amount of bleeding during the operation,the rate of conversion to open surgery,The amount of blood transfusion;the postoperative observation of patients with pancreatic fistula,biliary fistula,gastric emptying disorders,postoperative bleeding,intra-abdominal infection,unplanned reoperation,perioperative death and other complications.This all were compared between the patients in the PBD groups and no PBD groups.Statistically significant with P<0.05Result:1.The TBIL before LPD(126.0±86.4 μmol/L)in the PBD group was decreased significantly compared with the TBIL before PBD(290.7±95.4μmol/L),(P<0.05),the biliary drainage was effective;2.The intraoperative blood loss in the PBD group(473.8±435.1ml)was less than that in the no PBD group(765.00±630.97ml),(P=0.026);3.The incidence of intra-abdominal infection in the PBD group(15/59)was higher than that in the no PBD group(0/30)(P=0.018).Conclusion:1.Preoperative biliary drainage operation can reduce bleeding during laparoscopic pancreaticoduodenectomy2.Preoperative biliary drainage before surgery increases the probability of intra-abdominal infections. |
