The Value Of Preoperative Jaundice Reduction On Pancreatoduodenectomy In Patients With Low Level Malignant Biliary Obstrution

Objective:In this study,by comparing and analyzing the effects of preoperative bilirubin level,preoperative jaundice reduction and methods of preoperative jaundice reduction on pancreaticoduodenectomy for low level malignant biliary obstrution,the value of preoperative jaundice reduction and the appropriate biliary drainage methods were discussed.Methods:Clinical data of patients who underwent pancreaticoduodenectomy with obstructive jaundice before operation in the Second Hospital of Shanxi Medical University from January2016 to December 2022 were collected and analyzed retrospectively.The patients were divided into non-PBD group and PBD group according to whether biliary drainage was performed before surgery.According to preoperative bilirubin levels,patients in the nonPBD group were divided into group A(34.2-171μmol/L)and group B(>171μmol/L);According to different biliary drainage methods,the PBD group was divided into PTCD group and ERCP group.The differences among the general data,biochemical data,operation time,intraoperative blood loss,intraoperative blood transfusion,postoperative hospital stay,total hospital stay,hospital cost and postoperative complications(including pancreatic fistula,biliary fistula,gastric empty-obstruction,bleeding and abdominal infection)of each group were statistically analyzed,to explore the effects of preoperative bilirubin levels,preoperative jaundice reduction,and different methods of jaundice reduction on patients with low malignant obstructive jaundice undergoing PD surgery.Results:1.There was no statistically significant difference between group A and group B in general information(P> 0.05).There were no significant differences inoperation time,intraoperative blood loss,intraoperative blood transfusion andpostoperative hospital stay(P> 0.05).The total length of stay,hospitalizationcost and postoperative complication rate of group B were significantly higher thanthose of group A,and the differences were statistically significant(P<0.05).2.There were no significant differences in general information,operation time,intraoperative blood loss,intraoperative blood transfusion,postoperative hospital stay and incidence of complications between the PBD group and the non-PBD group(P> 0.05).There were significant differences in admitted bilirubin level,preoperative ALT and preoperative AST between the two groups(P<0.05).The total length of hospital stay and hospitalization cost of the PBD group were higher than those of the non-PBD group,and the differences were statistically significant(P<0.05).The levels of TBIL,DBIL,ALT and AST in PBD group were significantly decreased after biliary drainage(P<0.05).3.Except preoperative TBIL and DBIL,there was no significant difference between PTCD and ERCP group in other general information and biochemical indices(P > 0.05).The preoperative TBIL and DBIL of the ERCP group were lower than those of the PTCD group(P<0.05).There were no significant differences between the two groups in operation time,intraoperative blood loss,intraoperative blood transfusion,postoperative hospital stay,total hospital stay,hospitalization cost,incidence of complications and biliary drainage complications(P> 0.05).Conclusion:Preoperative high bilirubin levels increased the total length of hospital stay,hospitalization costs and postoperative complications.Preoperative biliary drainage can significantly reduce bilirubin levels and improve liver function,but has no significant benefit on postoperative outcome of PD.Patients undergoing PD surgery do not need to undergo routine jaundice reduction before surgery,and various factors should be taken into consideration to decide whether to reduce jaundice before surgery.Priority should be given to ERCP for biliary drainage in patients with low malignant obstructive jaundice who plan to undergo preoperative biliary drainage.