The choice of preoperative biliary drainage for malignant obstructive jaundice of distal bile duct / 中华肝胆外科杂志

ABSTRACT

Objective:In order to optimize the mode of biliary drainage, we compared the different drainage methods of preoperative biliary drainage in the treatment of malignant obstructive jaundice of distal bile duct.Methods:From January 2015 to December 2018, 166 cases of distal biliary malignant obstructive jaundice treated by operation in the First Medical Center of PLA General Hospital were collected. According to the preoperative biliary drainage mode, 85 cases were divided into non drainage group, 56 cases in PTBD group and 25 cases in ERBD group; according to the operation mode, 116 cases were divided into radical pancreatoduodenectomy group and 50 cases were divided into palliative cholangiojejunostomy group, each group was divided into three groups according to the drainage mode. Chi square test and ANOVA were used to compare the results of bile bacterial culture and perioperative conditions of each group.Results:The positive rate of bile bacteria culture in non drainage group, PTBD group and ERBD group is 22.4% (19/85), 28.6% (16/56) and 100% (25/25). The positive rate in ERBD group is higher than that in PTBD group and non drainage group, the difference is statistically significant ( P<0.05). The proportion of multiple bacteria in ERBD group is higher than that in PTBD group and non drainage Group [64.0% (16/25) vs. 12.5% (2/16) vs. 5.3% (1/19)], the difference is statistically significant ( P<0.05). The proportion of common pathogens in ERBD group is higher than that in PTBD group and non drainage Group [97.8% (45/46) vs. 89.5% (17/19) vs. 66.7% (14/21)], the difference is statistically significant ( P<0.05). In pancreatoduodenectomy group, the operation time of ERBD group is significantly longer than that of PTBD group and non drainage group [(334.5±48.3) min vs. (289.4±39.5) min vs. (303.9±57.1) min], the difference is statistically significant ( P<0.05). The amount of bleeding in PTBD group is less than that in ERBD group and non drainage group [(268.8±128.4) ml vs. (388.2±181.6) ml vs. (366.1±220.4) ml], the difference is statistically significant ( P<0.05). There is no significant difference in the incidence of complications after pancreatoduodenectomy among three ways of drainage ( P>0.05). The incidence of clinically relevant postoperative pancreatic fistula is 6.8% (4/59), 10.0%(4/40) and 29.4%(5/17) in non drainage group, PTBD group and ERBD group. ERBD group is higher than non drainage group, the difference is statistically significant ( P<0.05). In palliative cholangiojejunostomy, there is no significant difference in operation time, amount of bleeding, postoperative hospital stay and complications among all groups ( P>0.05). Conclusion:Compared with ERBD, PTBD is a more suitable choice for patients who need preoperative biliary drainage before pancreatoduodenectomy.