To evaluate the effect of preoperative biliary drainage on the prognosis of patients with low biliary obstruction undergoing pancreaticoduodenectomy (PD).

Clinical data of 183 patients with low obstructive jaundice admitted to Xinqiao Hospital Affiliated to Army Medical University from January 2013 to January 2017 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 113 patients were male and 70 female, aged (63±12) years on average. All patients received biliary drainage before PD. The patients were divided into 2 groups: better drainage group and poorer drainage group, and another 15 cases with pancreatic head carcinoma without jaundice were enrolled as control group. The expression of T lymphocytes subset in patients with abdominal infection in poorer drainage group and control group were compard. TB and DB before and after jaundice reduction were compared by t test, and the correlation with surgical complications was analyzed by Chi-square test.

At 3 d after biliary drainage, the TB and DB levels were (149±26) and (107±16) μmol/L, significantly lower than the preoperative (243±37) and (177±24) μmol/L (t=-3.255, -1.836; P<0.05). The risk of bile leakage and abdominal infection was significantly higher in poorer drainage group after PD (χ2=4.936, 7.617; P<0.05). The percentage of CD4⁺CD25⁺Foxp3⁺ Tregs in patients with abdominal infection was (5.89±0.28)%, significantly higher compared with (4.28±0.19)% in control group (t=4.765, P<0.05).

Preoperative biliary drainage can rapidly reduce the bilirubin level in patients with low biliary obstruction, and decrease the incidence of abdominal infection probably by improving the immune function.