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Follow-up of Percutaneous Transhepatic Biliary Drainage for Malignant Obstructive Jaundice<?xml:namespace prefix = o ns = "urn:schemas-microsoft-com:office:office" />
钱晓军 翟仁友
戴定可 于平
首都医科大学附属北京朝阳医院放射科100020
Xiaojun Qian, Renyou Zhai, Dingke Dai, Ping Yu
Department of Beijing Chaoyang Hospital, affinated to Capital University of Medical Science
ABSTRACT
Objective: Retrospective analysis our experience of patients with malignant biliary obstruction whom underwent successful palliative drainage by means of metallic indwelling stents or plastic tubes.
Materials and Methods: Consecutive study of 233 patients with malignant biliary obstruction who was treated with the transhepatic placement of the metallic stents and/or plastic tubes (Male 141, female 92, age range 29~91, mean 63.6 years). The causes of jaundice were pancreatic carcinoma (n=44), cholangiocarcinoma (n=96), metastases lymphadenopathy (n=54) and hepatic carcinoma (n=39). Obstruction occurred at hilar in 127 cases, and at lower common bile duct in 106 cases. After taking percutaneous transhepatic cholangiography, puncture the dilated biliary duct. Then metallic stent or plastic external-internal catheter was released. If the guide wire can't pass the narrow segment, then detain the external drainage. Followed up with clinical and radiographic evaluation. Procedure- and device- related complication were recorded. Patients' survival rate were calculated with Kaplan-Meier survival analysis.
Results: All patients got PTBD successfully. Stent placement were done in 136 cases, 100 were treated with only a single stent, and 20 cases had two stents installed for bilateral drainage, and other 16 had two stents installed for long strictures, made stent in stent, 11 stents crossed the ampulla of Vater. Ninty-seven cases received plastic catheters this series. When obstruction occurred at hilar, 68 patients got multi-drainage, 20 patients received parallel stents, and 13 received stent in one side and catheter in other side, and 35 patients received catheters in bilateral drainages, the others received unilateral drainage. After PTBD, 49 patients treated for the local tumor in these series, 22 patients took chemotherapy, and 27 patients received radiotherapy, and 13 accepted brachytherapy. Total serum bilirubin reduced from 349.2+/-155.6mmol/l to 178.9+/-141.2mmol/l, t=17.90, p=0.000, respectively. There were 62 patients involving incorporative infection before procedure, 23 cases cured after procedure, and 29 new patients got inflammation after procedure, 3 cases had bleeding within upper gastroenteric tract, 15 cases got haematic bile drainage, 4 cases got intestinal obstruction. 9 cases present coma, and 30 cases died within one month. The survival time was 7.3 months (median), and 1, 3, 6, 12 month survival were 87.1%, 70.1%, 51.3%, 25.4%. Survive time was related with effection of drainage, style of drainage, the type of tumor, inflammation after procedure and therapy after drainage.
Conclusion: Percutaneous transhepatic bile drainage can provide good palliative drainage and is well tolerated by patients. It also improves other condition caused by biliary obstruction. Proper drainage and inflammation control and brachytherapy in stent or extra-radiation therapy or arterial infusion chemotherapy, may prolong the duration of patency of stent and the survival.
Key words: Jaundice/obstructive; PTBD; Stent; Interventional Radiology |
