Efficacy of preoperative biliary drainage for hilar cholangiocarcinoma complicated with obstructive jaundice

doi:10.3877/cma.j.issn.2095-3232.2021.01.007

Abstract

Abstract:

Objective

To evaluate the efficacy of preoperative biliary drainage (PBD) in the treatment of hilar cholangiocarcinoma complicated with obstructive jaundice.

Methods

Clinical data of 204 patients undergoing radical resection of hilar cholangiocarcinoma in Shanghai General Hospital Affiliated to Shanghai Jiao Tong University from January 2010 to December 2019 were retrospectively analyzed. Among them, 99 patients were male and 105 female, aged (63±13) years on average. The informed consents of all patients were obtained and the local ethical committee approval was received. All patients were divided into the PBD group (n=142) and control group (n=62) according to whether PBD was performed before operation. According to different drainage methods, patients in the PBD group were divided into the percutaneous transhepatic cholangio drainage (PTCD) subgroup (n=60) and endoscopic retrograde cholangiopancreatography (ERCP) subgroup (n=82). The baseline data and perioperative conditions of patients in each group were observed. The length of hospital stay between two groups were compared by t test. The incidence of postoperative complications between two groups were compared using Chi-square test.

Results

In the PBD group, the incidence of liver failure and perioperative mortality were 12.7% (18/142) and 5.6%(8/142), significantly lower than 27.4%(17/62) and 14.5% (9/62) in the control group (χ2=6.600, 4.457; P<0.05). The incidence of postoperative biliary infection in the PBD group was 31.7% (45/142), significantly higher than 17.7%(11/62) in the control group (χ2=4.216, P<0.05). In the PBD group, the length of postoperative hospital stay was (14±6) d, significantly longer than (12±5) d in the control group (t=2.367, P<0.05). The incidence of hemorrhage and biliary infection in PTCD subgroup was 3.3%(2/60) and 21.7%(13/60), significantly lower than 13.4%(11/82) and 39.0%(32/82) in ERCP subgroup (χ2=4.234, 4.822; P<0.05).

Conclusions

PBD can reduce the incidence of liver failure and perioperative mortality and improve the surgical safety. The risk of biliary infection and bleeding after PTCD is lower than thatof ERCP.

Key words: Bile duct neoplasms, Hilar cholangiocarcinoma, Jaundice, obstructive, Drainage

Haitao Gu, Jinyan Zhang, Zhaowen Wang, Guoqing Chen, Junming Xu. Efficacy of preoperative biliary drainage for hilar cholangiocarcinoma complicated with obstructive jaundice[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2021, 10(01): 29-32.

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References 18

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组别	例数	性别（例）		年龄（岁，±s）	TB(μmol/L，±s)	Bismuth-Corlette分型（例）
组别	例数	男	女	年龄（岁，±s）	TB(μmol/L，±s)	Ⅰ	Ⅱ	Ⅲa	Ⅲb	Ⅳ
PBD组	142	67	75	63±14	283±118	3	12	35	44	48
对照组	62	32	30	62±14	239±120	8	16	18	14	6
统计值		χ²=0.339		t=1.181	t=1.826	U=12.000
P值		0.560		0.171	0.071	0.944

组别	例数	性别（例）		年龄（岁，±s）	TB(μmol/L，±s)	Bismuth-Corlette分型（例）
组别	例数	男	女	年龄（岁，±s）	TB(μmol/L，±s)	Ⅰ	Ⅱ	Ⅲa	Ⅲb	Ⅳ
PBD组	142	67	75	63±14	283±118	3	12	35	44	48
对照组	62	32	30	62±14	239±120	8	16	18	14	6
统计值		χ²=0.339		t=1.181	t=1.826	U=12.000
P值		0.560		0.171	0.071	0.944

组别	例数	性别（例）		年龄（岁，±s）	TB（μmol/L，±s）	Bismuth-Corlette分型（例）
组别	例数	男	女	年龄（岁，±s）	TB（μmol/L，±s）	Ⅰ	Ⅱ	Ⅲa	Ⅲb	Ⅳ
PTCD组	60	24	36	64±14	295±108	0	5	9	21	25
ERCP组	82	43	39	62±13	270±105	3	7	26	23	23
统计值		χ²=2.151		t=0.316	t=1.282	U=12.000
P值		0.143		0.806	0.203	0.968

组别	例数	性别（例）		年龄（岁，±s）	TB（μmol/L，±s）	Bismuth-Corlette分型（例）
组别	例数	男	女	年龄（岁，±s）	TB（μmol/L，±s）	Ⅰ	Ⅱ	Ⅲa	Ⅲb	Ⅳ
PTCD组	60	24	36	64±14	295±108	0	5	9	21	25
ERCP组	82	43	39	62±13	270±105	3	7	26	23	23
统计值		χ²=2.151		t=0.316	t=1.282	U=12.000
P值		0.143		0.806	0.203	0.968

组别	例数	术中出血量[ml，M（Q_R）]	术后出血（例）	术后胆漏（例）	术后肝衰竭（例）	术后胆道感染（例）	术后住院时间（d,±s）	围手术期死亡（例）
PBD组	142	500（400）	13	22	18	45	14±6	8
对照组	62	450（300）	4	7	17	11	12±5	9
统计值		Z=192.000	χ²=0.413	χ²=0.625	χ²=6.600	χ²=4.216	t=2.367	χ²=4.457
P值		0.423	0.521	0.429	0.010	0.040	0.019	0.035

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