| Among the clinical works on liver and biliary surgery, malignant obstructive jaundice by tumor is one of the common diseases.This research is aimed at the patients of malignant obstructive jaundice. On one hand, for the patients who still have the chance of the operation, we apply the HB-H-6 resin plasma perfusion to reduce the jaundice before radical operation in order to ensure the safety and favoring healing;on the other hand, when the patients have lost the operative chance, we applied PTCD and posting of biliary metallic stents to alleviate hyperbilirubinemia so as to improve life quality and prolong survival time.1 Clinical study of bilirubin absorption with HB-H-6 resin plasma perfusion in preoperative for severe malignant obstructive jaundice. Objective To investigate the efficacy and safety of bilirubin absorption with HB-H-6 resin plasma perfusion in alleviating hyperbilirubinemia in patients with malignant obstructive jaundice before the radical surgery, and the operative and postoperative influence. Datas and Methods From Jan to Dec at 2003, 36 patients withmalignant obstructive jaundice accepted radical operation, 10 cases alleviated hyperbilirubinemia by HB-H-6 resin plasma perfusion before operation(A team), 16cases by drainage(B team), 10 cases didn't alleviated hyperbilirubinemia(C team). A team included 4 cases of pancreatic carcinoma, 3 cases of bile duct carcinoma, 2 cases of hilar cholangiocarcinoma, 1 case of gallbladder carcinoma, plasma was perfused to absorb bilirubin for preparation of the second day's surgical treatment, the operations were performed in the next days, including 7 cases of pancreaticduodenectomy, 2 cases of hilar cholangiocarcinoma resection combined with hepaticojejunostomy;one case of radical resection of gallbladder carcinoma combined with pancreatioduodenectomy and hepaticojejunostomy. B team included 5 cases of pancreatic carcinoma, 8 cases of bile duct carcinoma, 2 cases of hilar cholangiocarcinoma, 1 case of gallbladder carcinoma, PTCD was implemented in 15 patients and ENBD in one patient. C team included 2 cases of pancreatic carcinoma, 8 cases of bile duct carcinoma. The conglutinative degree during operations and the recuperation state around operation were observed. Result The main signs were not abnormal during perfusion. The absorption rate of bilirubin was 27.6%(P<0.05) after perfusion. The counts of erythrocytes, leukocytes and hemoblasts did not obviously change. The concentration of electrolyte in blood were not abnormal. The concentration of protein descended lightly. A team, the conglutination was light and bile duct holded the bulgy status so as to depress operative difficulty. All operations performed satisfied and without hemorrhage in three team. Bile duct anastomotic leakage in A team occurred in one patient, in B team two, in C team one, which was all healed through drainage. Plasma bilirubin reduced rapidly after operation in allpatients, average lower than 60umol/L within 10 days after operation, with no significant difference between A team and C team. Other aspects was also no significant difference among three teams. Conclusions The plasma perfusion with HB-H-6 resin can effectively and safely reduce bilirubin as a new method to relieve icterus before radical surgery in patients with severe malignant obstructive jaundice, avoiding the complications of PTCD and ENBD, holding bile duct's dilation and no cholangitis, enhancing the safety and exercisable degree of operations. But it cannot relive biliary obstruction fundamentally and permanently, so it can only be used as preoperative preparation.2 Clinical investigation on palliative management of malignant obstructive jaundice with PTCD and biliary metallic stents for patients without operation. Objective To investigate the clinical value on the treatment of malignant obstructive jaundice with PTCD and posting of biliary metallic stents for patients without operation. Data and Methods From Jan to Dec in 2005, 76 patients with malignant biliary obstruction were treated by the percutaneous transhepatic cholangiographic drainage(PTCD) guided by ultrasound, average age is 63.5 years old. A total of 45 biliary metallic stents were placed in 40 patients in the third day after PTCD. Results Plasma bilirubin reduced markedly in 39 patients, whose reduced to lower than 20nmol/L within 3 weeks;reduced in some degree in 33 patients;increased in 3 patients. Degree of skin pruritis, anorexia, jaundice and colour of urine alleviated in a degree in most patients, otherwise, 3 patients became worse (P<0.05). Complicationsoccurred in 12 patients, the incidence is 15.8%, two or more complications occurred in 6 patients. 54 patients died before April,2006, except for one patient died because of sereve complications sooner after treatment, total average survival time is 7.6 months, the group of PTCD only is 5.8 months, the group of combined with biliary stent is 9.5 months. The longest survivor lived 14 months after displaced biliary stent. Conclusions PTCD combined with biliary stent is an safe and effective method to relive malignant biliary obstruction, it can improve life quality, prolong survival time, so it is a good method to treat the patients with malignant biliary obstruction and without operation. For coming into being intestinal drainage, PTCD combined with biliary stent is better than only PTCD.
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