Jichu yixue yu linchuang (Jul 2021)
Comparison of different preoperative decompression of biliary tract methods for patients with periampullary carcinoma complicated with obstructive jaundice
Abstract
Objective To investigate the efficacy of different methods in decompression of biliary tract(jaundice reduction) for patients with periampullary carcinoma combined with obstructive jaundice. Methods The clinical data of 128 patients with malignant jaundice treated by preoperative biliary decompression before pancreaticoduodenectomy were retrospectively analyzed in Peking Union Medical College Hospital from January 2015 to September 2020. Patients were divided into endoscopic retrograde cholangiopancreatography (ERCP) with stent placement group including 80 cases and percutaneous transhepatic cholangial drainage (PTCD) group including 48 cases according to different methods of jaundice reduction. Serological indicators including total bilirubin (TB) were monitored before jaundice reduction(TBpre) and surgery within one week respectively. The efficacy of jaundice reduction in two groups was compared and further categories were carried out according to the histological types. Results TB after jaundice reduction(TBpost), TB reduction rate and the reduction adequacy rate (the percentage of postoperative TB≤100 μmol/L) in ERCP group were significantly better than those in PTCD group [(68±45)μmol/L vs (114±69)μmol/L; 73.9%±16.9% vs 64.2%±21.2%;83.8% vs 56.3%]. In patients with duodenal ampullary carcinoma,TBpost, TB reduction rate and the reduction adequacy rate in ERCP group were better than those in PTCD group [(51±20)μmol/L vs (103±49)μmol/L;78.6%±10.9% vs 67.2%±14.8%;100% vs 58.3%]. In patients with distal cholangiocarcinoma with TBpost, TB reduction rate and the reduction adequacy rate of ERCP group were better than those of PTCD group [(76±52)μmol/L vs (161±51)μmol/L;70.6%±18.5% vs 56.5%±10.4%;82.1% vs 11.1%]. Conclusions For patients with malignant obstructive jaundice, stent placement by ERCP is recommended as the first choice for preoperative jaundice reduction, especially for those with ampler carcinoma or distal cholangiocarcinoma.
