[Effect of preoperative biliary drainage on liver function changes in patients with malignant obstructive jaundice in the low bile duct before and after pancreaticoduodenectomy]

Abstract

Background & objective: Pancreaticoduodenectomy can cause a high morbidity of postoperative complications. Preoperative biliary drainage can improve liver function. However, the effect of preoperative biliary drainage on preoperative liver function of the patients underwent pancreaticoduodenectomy for malignant obstructive jaundice in the low bile duct has seldom been reported. This study was to investigate the perioperative liver function changes and prognosis of the patients.

Methods: Data of 98 patients, with total serum bilirubin level of over 85 mumol/L and underwent pancreaticoduodenectomy for malignant obstructive jaundice in the low bile duct, were collected. The correlation of liver function to serum bilirubin level, perioperative liver function changes, the impacts of preoperative biliary drainage and postoperative complications on postoperative liver function, and prognosis were investigated.

Results: The index of gamma-glutamyltransferase (GGT) was positively correlated to total bilirubin (TB) (r=0.368, P<0.001), but alkaline phosphatase (ALP) was not. Preoperative biliary drainage significantly reduced TB from (266+/-119) micromol/L to (184+/-115) micromol/L, DB from (160+/-75) micromol/L to (112+/-67) micromol/L, ALP from (161+/-88) U/L to (99+/-90) U/L, alanine aminotransferase (ALT) from (508+/-276) U/L to (319+/-145) U/L, and GGT from (537+/-417) U/L to (203+/-176) U/L (all P<0.05), but did not reduce aspartate aminotransferase (AST) significantly. ALT, AST, GGT, ALP decreased to the lowest values on Day 7 after operation, but increased slightly on Day 14. On Day 7 after operation, TB and DB were significantly higher and albumin (ALB) was significantly lower in the patients with postoperative complications than in those without complications [(152+/-68) micromol/L vs. (101+/-77) micromol/L, (80+/-57) micromol/L vs. (58+/-45) micromol/L, and (36.2+/-4.7) g/L vs. (38.6+/-5.2) g/L, all P<0.05]. The median survival time was 19.2 months in the patients underwent preoperative biliary drainage and 16.4 months in the patients did not undergo preoperative biliary drainage (P=0.458).

Conclusions: GGT can sensitively reflect the extent of malignant obstruction in the low bile duct. Preoperative biliary drainage can improve liver function effectively. Postoperative complications has adverse effects on the improvement of postoperative jaundice and liver function in a short time after operation. Biliary decompression has no effects on the prognosis.