Original Article
Comparative study of two biliary drainage strategies in perioperative period of cholangiojejunostomy
Chen Jiajun, Huang Jinxin, Tang Rui, Zhang Xiwen, Li Fu
Published 2022-12-15
Cite as Int J Surg, 2022, 49(12): 813-818. DOI: 10.3760/cma.j.cn115396-20221011-00325
Abstract
ObjectiveTo evaluate the clinical efficacy of PTCD and ERCP combined with T tube in the perioperative period of biliary anastomosis in patients with moderate to severe obstructive jaundice.
MethodsThe data of 93 patients with moderate obstructive jaundice who met the inclusion criteria and planned to undergo cholangiojejunostomy (including reconstruction after pancreaticoduodenectomy) in Shuguang Hospital Affiliated to Shanghai University of traditional Chinese medicine from March 2015 to December 2021 were collected. According to the perioperative drainage strategy, 54 cases were divided into PTCD group and 39 cases were divided into ERCP combined with intraoperative T-tube drainage group. Retrospective cohort method was used to analyze the bile duct diameter, postoperative hospital stay, operation cost, time of jaundice reduction, degree of jaundice reduction, average postoperative bile loss, postoperative bile leakage, abdominal infection of the two groups. The measurement data were expressed as mean ± standard deviation(
±s), and t test was used for comparison between groups. The data of skewed distribution were represented by M(Q1, Q3), and nonparametric rank sum test was used. Chi-square test was used for counting data.
ResultsThe preoperative yellowing reduction time, operation cost, mean bile loss 7 days after operation, time to remove biliary drainage tube, and postoperative hospital stay in PTCD group were (5.9±3.1) d, (59 846.3±9 129.7) yuan, 210.0(170.0, 325.0) mL/d, (18.4±5.6) d, and(10.7±4.4) d, respectively, while those in ERCP group were (9.5±4.4) d, (77 833.1±12 164.5) yuan, 285.0(225.0, 370.0) mL/d, (41.4±17.2) d and(15.3±5.6) d, respectively. The difference between the two groups was statistically significant (P<0.05). There was no significant difference between the two groups in general condition before drainage, cholangitis and hemorrhage after drainage, degree of jaundice reduction, bile leakage after surgery, abdominal infection, etc.
ConclusionsWhen performing biliary enterostomy in patients with moderate or above obstructive jaundice, PTCD and ERCP combined with intraoperative T-tube drainage are effective means to improve the safety of perioperative period. PTCD has some advantages in reducing jaundice efficiency, operation cost and rapid postoperative rehabilitation.
Key words:
Portoenterostomy, hepatic; Cholangiopancreatography, endoscopic retrograde; Perioperative care; Drainage; Percutaneous transhepatic biliary drainage
Contributor Information
Chen Jiajun
Department of Hepatobiliary and Pancreatic Surgery, Shuguang Hospital Affliated to Shanghai University of Traditional Chinese Medincine, Shanghai 201203, China
Huang Jinxin
Department of Hepatobiliary and Pancreatic Surgery, Shuguang Hospital Affliated to Shanghai University of Traditional Chinese Medincine, Shanghai 201203, China
Tang Rui
Department of Hepatobiliary and Pancreatic Surgery, Shuguang Hospital Affliated to Shanghai University of Traditional Chinese Medincine, Shanghai 201203, China
Zhang Xiwen
Department of Hepatobiliary and Pancreatic Surgery, Shuguang Hospital Affliated to Shanghai University of Traditional Chinese Medincine, Shanghai 201203, China
Li Fu
Department of Hepatobiliary and Pancreatic Surgery, Shuguang Hospital Affliated to Shanghai University of Traditional Chinese Medincine, Shanghai 201203, China
±s)表示，组间比较采用t检验，偏态分布的计量资料以M(Q1，Q3)表示，组间比较采用非参数检验；计数资料组间比较采用χ2检验。
