Effect of preoperative biliary drainage on perioperative period in patients with pancreatic head or periampullary carcinoma undergoing open pancreaticoduodenectomy
Objective To explore the effect of preoperative biliary drainage on perioperative period(during hospitalization or 30 days post-operation)in patients with pancreatic head or periampullary carcinoma undergoing open pancreaticoduodenectomy.Methods From October 1,2019 to October 1,2022,retrospective analysis was performed for 73 patients of pancreatic head or periampullae carcinoma undergoing pancreaticoduodenectomy including biliary drainage(n=33)and without biliary drainage(n=40).The changes of total bilirubin(TBIL),alanine transaminase(ALT),glutamic oxalacetic transaminase(GOT),albumin and creatinine before yellowing(at admission)and after yellowing(pre-operation)were compared for evaluating the effect of biliary drainage biliary drainage group.Then statistical differences were examined in postoperative complications between biliary drainage and without biliary drainage groups.Statistical software SPSS21 was used for statistical processings.Results The preoperative levels of TBIL,albumin,ALT and AST declined as compared with admission(P＜0.05).The preoperative level of creatinine had no significant change as compared with admission(P＞0.05).Biliary drainage group was more prone to have a higher incidence of tertiary complications(P＜0.05),a longer time from admission to surgery(P＜0.05)and a longer total hospitalization stay(P＜0.05).No significant differences existed in operative duration,intraoperative volume of blood loss,intraoperative unit of blood transfusion,bile leakage,gastroparesis,peritoneal infection,pancreatic leakage,hemorrhage,wound infection,mortality,incidence of complications or postoperative hospitalization stay(P＞0.05).Conclusion Preoperative biliary drainage may lower the level of bilirubin in patients with severe jaundice caused by periampullary carcinoma,improve liver function and have no effect upon the level of creatinine.Preoperative biliary drainage may cause a decline of serum albumin.Preoperative biliary drainage may not reduce operative duration,volume of intraoperative blood loss and unit of intraoperative blood transfusion.It can not reduce the incidence of biliary leakage,gastroparesis,abdominal infection,pancreatic leakage,postoperative bleeding,wound infection,death,other complications or total complications.Length of postoperative hospitalization stay is not shortened.There are higher rates of tertiary and higher complications,longer overall hospitalization stay and extended time from admission to surgery.Patients with severe jaundice(TBIL≥250 μmol/L)caused by pancreatic head or periampullary carcinoma should not be routinely treated preoperatively with biliary drainage.
Pancreatic head carcinomaPeriampullary carcinomaObstructive jaundicePreoperative biliary drainageComplications
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