Li Yilan, Pu Sicheng, Zong Kezhen, Liao Rui, Huang Zuotian, Huang Jianbo, Liu Yawen, Zhou Baoyong, Wu Zhongjun
Department of Hepatobiliary Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Department of Hepatobiliary Pancreatic Tumor Center, Chongqing University Cancer Hospital, Chongqing, China.
Front Med (Lausanne). 2025 May 14;12:1535106. doi: 10.3389/fmed.2025.1535106. eCollection 2025.
The effect of elevated preoperative serum bilirubin on complications after pancreaticoduodenectomy (PD) remains uncertain. Preoperative biliary drainage (PBD) effectively reduces serum bilirubin values; however, its impact on PD complications remains debatable.
We conducted a retrospective analysis on patients who underwent PD at the First Affiliated Hospital of Chongqing Medical University from October 2018 to July 2023. Patients were categorized into quartiles based on preoperative serum bilirubin levels. Multivariable logistic regression was used to investigate the relationship between bilirubin and the risk of PD complications. Restricted cubic spline (RCS) analysis was conducted to assess the dose-response relationship between bilirubin levels and PD complications. Furthermore, a 3-way interaction of PD complications, preoperative serum bilirubin, and PBD was examined.
A total of 326 patients participated in the study. Multivariate logistic regression analysis revealed that higher preoperative serum bilirubin levels increased the likelihood of perioperative PD complications. RCS analysis revealed a significant linear dose-response relationship between bilirubin levels and the risk of PD complications. While PBD did not independently affect PD complications, there was a significant 3-way interaction of PD complications, preoperative serum bilirubin levels, and PBD, indicating that patients with serum bilirubin values exceeding 10 times the upper limit of normal (≥ 171 μmol/L) exhibited a lower risk of complications through PBD.
Elevated preoperative serum bilirubin increases the risk of complications after PD. Patients with high preoperative serum bilirubin values (≥ 171 μmol/L) undergoing PD benefit from PBD.
术前血清胆红素升高对胰十二指肠切除术（PD）后并发症的影响仍不确定。术前胆道引流（PBD）可有效降低血清胆红素值；然而，其对PD并发症的影响仍存在争议。
我们对2018年10月至2023年7月在重庆医科大学附属第一医院接受PD的患者进行了回顾性分析。根据术前血清胆红素水平将患者分为四分位数。采用多变量逻辑回归分析胆红素与PD并发症风险之间的关系。进行限制立方样条（RCS）分析以评估胆红素水平与PD并发症之间的剂量反应关系。此外，还研究了PD并发症、术前血清胆红素和PBD之间的三方相互作用。
共有326例患者参与了本研究。多变量逻辑回归分析显示，术前血清胆红素水平越高，围手术期PD并发症的可能性越大。RCS分析显示胆红素水平与PD并发症风险之间存在显著的线性剂量反应关系。虽然PBD并未独立影响PD并发症，但PD并发症、术前血清胆红素水平和PBD之间存在显著的三方相互作用，表明血清胆红素值超过正常上限10倍（≥171μmol/L）的患者通过PBD并发症风险较低。
术前血清胆红素升高会增加PD术后并发症的风险。术前血清胆红素值高（≥171μmol/L）的患者接受PD可从PBD中获益。
