Abstract:

To investigate the therapeutic effect of preoperative biliary drainage on morbidity and mortality of pancreaticoduodenectomy in patients with malignant obstructive jaundice in carcinoma of the head of the pancreas. MethodsClinical data of 91cases undergoing pancreaticoduodenectomy from January 2000 to December 2007 whose preoperative total bilirubin level was over 100?μmol／L were collected and analyzed. Results32 cases(35%) received preoperative biliary drainage, the total bilirubin level significantly decreased from 286±105?μmol／L to 115±92?μmol／L（t=20.15, P＜0.001）,　and the average blood loss was 280±59?mL. In the nonpreoperative biliary drainage group, the average preoperative total bilirubin level was 279±133?μmol／L， and the average blood loss was 490±109?mL. Overall postoperative complications were found in 10 cases (31%,10/32) in the preoperative biliary drainage group and 22 cases (37%,22/59)  in the nonpreoperative biliary drainage group, and there was no significant difference in infectious complications and other complications between the two groups. Patients whose preoperative total bilirubin level was over 340?μmol／L and indication of the liver function was twice the normal had significantly increased postoperative complications. In the preoperative biliary drainage group, blood loss in patients successfully decreased and their jaundice was lower than that in patients whose jaundice decreased slowly. ConclusionPreoperative biliary drainage in patients with carcinoma of the head of the pancreas does not help to reduce postoperative complications, but can reduce the blood loss and make operations safer. Postoperative total complications were significantly increased when preoperative total bilirubin was over 340?μmol／L.

Key words: Pancreatic neoplasms; Preoperative biliary drainage; Pancreaticoduodenectomy