Obstructive jaundice due to the lower bile duct lesions: biliary drainage and predictive factors of postoperative complications
We studied the effect of biliary decompression and operative risk in patients with obstructive jaundice. Subjects were a consecutive series of patients (n=42) in the past 10 years excluding those with calculi. Bile was drained by means of percutaneous transhepatic, endoscopic, or cholecystostomy met...
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| Published in | Tando Vol. 10; no. 2; pp. 124 - 130 |
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| Main Authors | , , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
Japan Biliary Association
1996
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| Subjects | |
| Online Access | Get full text |
| ISSN | 0914-0077 1883-6879 |
| DOI | 10.11210/tando1987.10.2_124 |
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| Abstract | We studied the effect of biliary decompression and operative risk in patients with obstructive jaundice. Subjects were a consecutive series of patients (n=42) in the past 10 years excluding those with calculi. Bile was drained by means of percutaneous transhepatic, endoscopic, or cholecystostomy method. We statistically analyzed predictive factors of postoperative complications such that developed in nine (21%) of our patients. Comparing factors before and after biliary drainage, the levels of total bilirubin, transaminases, alkaline phosphatase, lactic dehydrogenase, and rglutamic transpeptidase were significantly decreased. A multivariate analysis revealed that predrainage platelet count and post-drainage platelet count and creatinine level correlated positively with postoperative complications. Little was described in the literature on the platelet count as a poor risk factor. In conclusion, icteric patients having an increased number of platelet or renal dysfunction would dictate less invasive procedures or close postoperative management. |
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| AbstractList | We studied the effect of biliary decompression and operative risk in patients with obstructive jaundice. Subjects were a consecutive series of patients (n=42) in the past 10 years excluding those with calculi. Bile was drained by means of percutaneous transhepatic, endoscopic, or cholecystostomy method. We statistically analyzed predictive factors of postoperative complications such that developed in nine (21%) of our patients. Comparing factors before and after biliary drainage, the levels of total bilirubin, transaminases, alkaline phosphatase, lactic dehydrogenase, and rglutamic transpeptidase were significantly decreased. A multivariate analysis revealed that predrainage platelet count and post-drainage platelet count and creatinine level correlated positively with postoperative complications. Little was described in the literature on the platelet count as a poor risk factor. In conclusion, icteric patients having an increased number of platelet or renal dysfunction would dictate less invasive procedures or close postoperative management.
閉塞性黄疸において,術前減黄の意義と手術リスク因子について検討した.対象は過去10年間の結石症を除く下部胆管病変による黄疸の全例(n=42)で,減黄は経皮経肝法・内視鏡法・胆嚢外瘻法のいずれかにて行われた.術後9例(21%)に合併症が生じ,このような合併症を予測する臨床的因子を,統計学的に単変量および多変量解析した.単変量解析では,総ビリルビン,トランスアミナーゼ,LDH,ALP,γ-GTP値が有意に減少していた. 多変量解析では, 減黄前の血小板数および減黄後の血小板数とクレアチニン値が, 合併症発生と正の関連を示した. 血小板増多が, 予後不良の一因子であるという文献は少ない. 結論として, 黄疸症例で術前に血小板数が多い場合や腎機能が低下している場合,手術侵襲の軽減あるいは術後管理に注意すべきと思われた. We studied the effect of biliary decompression and operative risk in patients with obstructive jaundice. Subjects were a consecutive series of patients (n=42) in the past 10 years excluding those with calculi. Bile was drained by means of percutaneous transhepatic, endoscopic, or cholecystostomy method. We statistically analyzed predictive factors of postoperative complications such that developed in nine (21%) of our patients. Comparing factors before and after biliary drainage, the levels of total bilirubin, transaminases, alkaline phosphatase, lactic dehydrogenase, and rglutamic transpeptidase were significantly decreased. A multivariate analysis revealed that predrainage platelet count and post-drainage platelet count and creatinine level correlated positively with postoperative complications. Little was described in the literature on the platelet count as a poor risk factor. In conclusion, icteric patients having an increased number of platelet or renal dysfunction would dictate less invasive procedures or close postoperative management. |
| Author | SATO, Hiroshi YOSHIDA, Junichi CHIJIIWA, Kazuo YAMAGUCHI, Koji SHIMURA, Hideo TANAKA, Masao KINUKAWA, Naoko |
| Author_FL | 志村 英生 絹川 直子 田中 雅夫 千々岩 一男 山口 幸二 佐藤 裕 吉田 順一 |
| Author_FL_xml | – sequence: 1 fullname: 吉田 順一 – sequence: 2 fullname: 千々岩 一男 – sequence: 3 fullname: 佐藤 裕 – sequence: 4 fullname: 山口 幸二 – sequence: 5 fullname: 志村 英生 – sequence: 6 fullname: 絹川 直子 – sequence: 7 fullname: 田中 雅夫 |
| Author_xml | – sequence: 1 fullname: CHIJIIWA, Kazuo organization: Department of Surgery I, Kyushu University Faculty of Medicine (Fukuoka) – sequence: 1 fullname: YOSHIDA, Junichi organization: Department of Surgery I, Kyushu University Faculty of Medicine (Fukuoka) – sequence: 1 fullname: SHIMURA, Hideo organization: Department of Surgery I, Kyushu University Faculty of Medicine (Fukuoka) – sequence: 1 fullname: KINUKAWA, Naoko organization: Department of Medical Informatics, Kyushu University Faculty of Medicine (Fukuoka) – sequence: 1 fullname: SATO, Hiroshi organization: Department of Surgery I, Kyushu University Faculty of Medicine (Fukuoka) – sequence: 1 fullname: YAMAGUCHI, Koji organization: Department of Surgery I, Kyushu University Faculty of Medicine (Fukuoka) – sequence: 1 fullname: TANAKA, Masao organization: Department of Surgery I, Kyushu University Faculty of Medicine (Fukuoka) |
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| References | 6) Kamiyama Y, Tokunaga Y, Aoyama H, et al: An assessment of percutaneous transhepatic bilia r y drainage in the correction of the metabolic c apacity of the jaundiced liver by hippurate-synthesiz i n g test. Surg Gynecol Obstet 17 7: 72-76, 1993 19) Smith RC, Pooley M, George CRP, et al: Preoperative percutaneous transhepatic internal d r ainage in obstructive jaundice: a randomized co n trolled trial examining renal function. Surgery 71: 371375, 1984 23) Trede M, Schwall G: The complications of pancreatectomy. Ann Surg 207: 39-41, 1988 8) Clements WDB, Halliday MI, McCaigue MD, et al: Effects of extrahepatic obstructive jaundice o n Kupffer cell clearance capacity. Arch Surg 128: 200-205, 1993 12) Earnshaw JJ, Hayter JP, Teasdale C, et al: Should endoscopic stenting be the initial treatment of malignant biliary obstruction ? Ann R Coll Surg Engl 74: 338-341, 1992 21) Sirenek KR, Levine BA: Percutaneous transhepatic cholangiography and biliary decompr e ssion. Arch Surg 124: 885-888, 1989 5) Nakayama T, Ikeda A, Okuda K: Percutaneous transhepatic drainage of the biliary tract. Technique and results in 104 cases. Gastroenterol o gy 74: 554-559, 1978 10) Pain JA, Cahill CJ, Gilbert JM, et al: Prevention of 下部胆管病変による閉塞性黄疸の減黄と術後合併症予測因子23: 129postoperative renal dysfunction in patients with obstructive jaundice: a multicentre study of b ile salts and lactulose. Br J Surg 78: 467-469, 1991 20) Rypins EB, Bitzer LG, Sarfeh IJ, et al: The role of percutaneous transhepatic drainage in preoperative patients. Am Surg 53: 562-564, 1987 14) Lai EC, Chu KM, Lo CY, et al: Surgery for malignant obstructive jaundice: analysis of mort a lity. Surgery 112: 891-896, 1992 16) Alderson D, Lavelle MI, Venables CW: Endoscopic sphincterotomy before pancreaticoduode n ectomy for ampullary carcinoma. BMJ 282: 1109-1111, 1981 22) Lygidakis NJ, Van Der Heyde MN, Lubbers MJ: Evaluation of preoperative biliary drainage in the surgical management of pancreatic head c a rcinoma. Acta Chir Scand 153: 665-668, 1987 17) Denning DA, Ellison EC, Carey LC: Preoperative percutaneous transhepatic biliary de c ompression lowers operative morbidity in p a tients with obstructive jaundice. Am J Surg 141: 61-65, 1 9 81 18) Gouma DJ, Moody FG: Preoperative percutaneous biliary drainage: use of abuse. Surg G a stroenterol 3: 74-80, 1984 1) Olen R, Pickman J, Freeark RJ: Less is better. The diagnostic workup of the patient with obstructi v e jaundice. Arch Surg 124: 791-795, 1989 3) Hatfield ARW, Tobias R, Terblanche J, et al: Preoperative external biliary drainage in obstructive jaundice. Lancet ii: 896-899, 1982 7) Engelman L: Stepwise logistic regression. BMDP Statistical Software Manual, Vol 2; ed by D ixon WJ, pp 941-970, University of California P ress, Berkeley, 1981 13) Zhou W, Chao W, Levine BA, Olson MS: Role of platelet-activating factor in hepatic responses afte r bile duct ligation in rats. Am J Physiol 263: G 5 87-G592, 1992 15) Takada T, Hanyu F, Kobayashi S, et al: Percutaneous transhepatic cholangial drainage: di r e ct approach under fluoroscopic control. J Surg O ncol 4) McPherson GAD, Benjamin IS, Hodgson HJF, et al: Pre-operative percutaneous transhepatic biliar y drainage: the results of a controlled trial. Br J Surg 71: 371-375, 1984 11) Colucci M, Altomare DF, Chetta G, et al: Impaired fibrinolysis in obstructive jaundiceevidenc e from clinical and experimental studies. Thro m b Haemost 60: 25-29, 1988 2) Pitt HA, Gomes AS, Lois JF, et al: Does preoperative percutaneous biliary drainage reduce operative risk or increase hospital cost ? Ann Surg 2 01: 545-553, 1985 9) Greve JWM, Gouma DJ, Buurman WA: Complications in obstructive jaundice: role of en d otoxins. Scand J Gastroenterol Suppl 194: 8-12, 1992 |
| References_xml | – reference: 3) Hatfield ARW, Tobias R, Terblanche J, et al: Preoperative external biliary drainage in obstructive jaundice. Lancet ii: 896-899, 1982 – reference: 11) Colucci M, Altomare DF, Chetta G, et al: Impaired fibrinolysis in obstructive jaundiceevidenc e from clinical and experimental studies. Thro m b Haemost 60: 25-29, 1988 – reference: 15) Takada T, Hanyu F, Kobayashi S, et al: Percutaneous transhepatic cholangial drainage: di r e ct approach under fluoroscopic control. J Surg O ncol – reference: 5) Nakayama T, Ikeda A, Okuda K: Percutaneous transhepatic drainage of the biliary tract. Technique and results in 104 cases. Gastroenterol o gy 74: 554-559, 1978 – reference: 23) Trede M, Schwall G: The complications of pancreatectomy. Ann Surg 207: 39-41, 1988 – reference: 6) Kamiyama Y, Tokunaga Y, Aoyama H, et al: An assessment of percutaneous transhepatic bilia r y drainage in the correction of the metabolic c apacity of the jaundiced liver by hippurate-synthesiz i n g test. Surg Gynecol Obstet 17 7: 72-76, 1993 – reference: 1) Olen R, Pickman J, Freeark RJ: Less is better. The diagnostic workup of the patient with obstructi v e jaundice. Arch Surg 124: 791-795, 1989 – reference: 8) Clements WDB, Halliday MI, McCaigue MD, et al: Effects of extrahepatic obstructive jaundice o n Kupffer cell clearance capacity. Arch Surg 128: 200-205, 1993 – reference: 7) Engelman L: Stepwise logistic regression. BMDP Statistical Software Manual, Vol 2; ed by D ixon WJ, pp 941-970, University of California P ress, Berkeley, 1981 – reference: 12) Earnshaw JJ, Hayter JP, Teasdale C, et al: Should endoscopic stenting be the initial treatment of malignant biliary obstruction ? Ann R Coll Surg Engl 74: 338-341, 1992 – reference: 16) Alderson D, Lavelle MI, Venables CW: Endoscopic sphincterotomy before pancreaticoduode n ectomy for ampullary carcinoma. BMJ 282: 1109-1111, 1981 – reference: 21) Sirenek KR, Levine BA: Percutaneous transhepatic cholangiography and biliary decompr e ssion. Arch Surg 124: 885-888, 1989 – reference: 2) Pitt HA, Gomes AS, Lois JF, et al: Does preoperative percutaneous biliary drainage reduce operative risk or increase hospital cost ? Ann Surg 2 01: 545-553, 1985 – reference: 13) Zhou W, Chao W, Levine BA, Olson MS: Role of platelet-activating factor in hepatic responses afte r bile duct ligation in rats. Am J Physiol 263: G 5 87-G592, 1992 – reference: 14) Lai EC, Chu KM, Lo CY, et al: Surgery for malignant obstructive jaundice: analysis of mort a lity. Surgery 112: 891-896, 1992 – reference: 19) Smith RC, Pooley M, George CRP, et al: Preoperative percutaneous transhepatic internal d r ainage in obstructive jaundice: a randomized co n trolled trial examining renal function. Surgery 71: 371375, 1984 – reference: 9) Greve JWM, Gouma DJ, Buurman WA: Complications in obstructive jaundice: role of en d otoxins. Scand J Gastroenterol Suppl 194: 8-12, 1992 – reference: 17) Denning DA, Ellison EC, Carey LC: Preoperative percutaneous transhepatic biliary de c ompression lowers operative morbidity in p a tients with obstructive jaundice. Am J Surg 141: 61-65, 1 9 81 – reference: 20) Rypins EB, Bitzer LG, Sarfeh IJ, et al: The role of percutaneous transhepatic drainage in preoperative patients. Am Surg 53: 562-564, 1987 – reference: 4) McPherson GAD, Benjamin IS, Hodgson HJF, et al: Pre-operative percutaneous transhepatic biliar y drainage: the results of a controlled trial. Br J Surg 71: 371-375, 1984 – reference: 18) Gouma DJ, Moody FG: Preoperative percutaneous biliary drainage: use of abuse. Surg G a stroenterol 3: 74-80, 1984 – reference: 22) Lygidakis NJ, Van Der Heyde MN, Lubbers MJ: Evaluation of preoperative biliary drainage in the surgical management of pancreatic head c a rcinoma. Acta Chir Scand 153: 665-668, 1987 – reference: 10) Pain JA, Cahill CJ, Gilbert JM, et al: Prevention of 下部胆管病変による閉塞性黄疸の減黄と術後合併症予測因子23: 129postoperative renal dysfunction in patients with obstructive jaundice: a multicentre study of b ile salts and lactulose. Br J Surg 78: 467-469, 1991 |
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| SubjectTerms | 合併症 減黄 術後合併症予測因子 閉塞性黄疸 |
| Title | Obstructive jaundice due to the lower bile duct lesions: biliary drainage and predictive factors of postoperative complications |
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