ObjectiveTo compare the therapeutic efficacy of biliary tract stent placing for malignant obstruction of biliary tract by percutaneous transhepatic cholangiography (PTC) or endoscopic retrograde cholangiography (ERC). MethodsPTC approach: choosing the expansion intrahepatic bile duct which had a large angle traveling with common bile duct at the ultrasound-guided, we performed bile duct puncture and inserted the drainage pipe into it, then stent was placed with 68 cases (2 cases among the total were failure of ERC approach) after a week drainage. ERC approach: inserting drainage tube into the common bile duct by duodenal endoscopic retrogradely, the angiography showed obstruction site, the guide wire inserted through the obstruction site, then stent was placed along the guide wire with 53 cases. ResultsThe achievement ratio of stent placing by PTC was 100%(68/68), and which by ERC was 96.2%（51/53）. The complications (bleeding, bile leakage) didn’t happen in two groups. 1-18 months (average 12.4 months) of follow-up, the died cases of PTC group and ERC group were 7 and 5 cases within 6 months, respectively; the survive cases of which were 17 and 9 cases after 18 months of treatment, respectively. ConclusionsThe biliary tract stent placing is a safe and effective method to the malignant obstruction of biliary tract patients who can not drainage tube be treated by operation. It can relieve biliary obstruction efficiency, and can increase live time and life quality for patients. We can choose the stent placing method by ERC for cases whose obstruction site is at the inferior of common bile duct or duodenal ampulla, and the cases whose obstruction site is at the above of hepatic porta should be chosen by PTC.
Objective To discuss the value of biliary stent in treatment of malignant biliary obstruction with different pathways of bile duct stent insertion. Methods Fourty-two cases of malignant biliary obstruction whose biliary stent insertions were through operation (n=18), PTCD (n=17) and ERCP (n=7) respectively were reviewed retrospectively. Results The bile duct stents were successfully inserted in all patients through the malignant obstruction and achieved internal biliary drainage. Compared with the level of the bilirubin before operation, it decreased about 100 μmol/L one week after the stent insertion in all patients. Compared with the levels of glutamic oxalacetic transaminase, glutamic pyruvic transaminase, alkaline phosphatase and glutamyltranspeptidase before operation, they decreased 1 week after the stent insertion （Plt;0.05). The median survival time was 22 weeks. The average survival time was (32.89±33.87) weeks. Two patients died in hospital after PTCD, and the mortality was 4.76%. Complications included 8 cases of cholangitis, 3 cases of bile duct hemorrhage and 2 cases of hepatic failure. Conclusion The bile duct stent insertions through operation, PTCD and ERCP are all effective in relieving the bile duct construction with malignant biliary obstruction. Each method should be chosed according to the systemic and local condition for every patient so as to improve the safety and efficiency, and to decrease the occurrence of complications.
ObjectiveTo analyze the cause of complications for patients with advanced malignant biliary obstruc-tion treated with percutaneous transhepatic implantation of biliary stent (PTBS) and summarize the experiences of comp-lications of the treatment. MethodThe complications of 59 patients firstly treated with percutaneous transhepatic cholangial drainage (PTCD) then with PTBS in 156 cases of advanced malignant biliary obstruction from January 2010 to January 2013 in this hospital were analyzed retrospectively. ResultsFifty-nine cases of complications were occurred in 156 cases of advanced malignant biliary obstruction, the incidence was 37.8%, including biliary infection in 26 cases, bile duct bleeding in 17 cases, liver failure in 5 cases, renal failure in 4 cases, acute pancreatitis in 4 cases, stent displa-cement in 2 cases, bile duct perforation in 1 case.Three cases died in 59 patients with complications, 56 cases were improved after symptomatic treatment. ConclusionPTCD combined with PTBS is a safe and effective treatment of advanced malignant biliary obstruction, the reasonable perioperative management is very important to reduce the occurrence of complications.