[The management of obstructive jaundice caused by pancreatic head carcinoma and periampullary carcinoma].
We had treated 115 patients with malignant obstructive jaundice, including 69 pancreatic head carcinoma and 46 periampullary carcinoma during the period between 1982 and 1991. In the 115 jaundiced patients 33 had undergone pancreaticoduodenectomy, 50 had bypass operation and the remaining 32 patients undergone percutaneous transhepatic biliary drainage (PTBD) only. No operative mortality happened for the 33 pancreaticoduodenectomies. Postoperative complications occurred in 12 patients. Leakage from the choledochojejunostomy was the most often occurred complications, it was found in 7 patients (21.2%). Intraabdominal abscesses happened in six patients (18.2%) which recovered by treating with ultrasound-guided catheteral drainage. Leakage from pancreaticojejunostomy was also found in five patients (15.2%), the complication recovered uneventfully after administration of total parenteral nutrition and good abdominal drainage. Twenty-two out 33 patients with pancreaticoduodenectomy received preoperative biliary drainage. However, despite preoperative biliary drainage, 10 of 22 patients (45.5%) still suffered postoperative complications. It implied that hyperbilirubinemia would trend to carry a high postoperative morbility. The prognosis for our patients with pancreatic head carcinoma was extremely poor. The mean survival period for all of them was not exceeding 12 months. Those who had PTBD as the sole treatment had the shortest survival period, which was 3.4 +/- 3.1 months only. On the other hand, the mean survival period for those who had periampullary cancer and had pancreaticoduodenectomy was 35.5 +/- 27.2 months, while it was 13.3 +/- 10.1 and 11.8 +/- 10.0 months for those having bypass operation and PTBD respectively.(ABSTRACT TRUNCATED AT 250 WORDS)
Lee
K T
KT
Dept. of Surgery, Kaohsiung Medical College Hospital, Taiwan, R.O.C.
Tsai
C C
CC
Ker
C G
CG
Sheen
P C
PC
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014670:Ampulla of Vater; D002779:Cholestasis / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D003138:Common Bile Duct Neoplasms / Q000401:mortality / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000601:surgery*; D015996:Survival Rate