Analysis Of Endoscopic Biliary Drainage For Malignant Biliary Obstruction

Objective To investigate the clinical value, therapeutic effect and the survival time and its influencing factors of the patients with inoperable malignant biliary obstruction who underwent endoscopic biliary drainage.Methods A total of136patients with inoperable malignant biliary obstruction underwent palliative treatment via endoscopic retrograde cholangiopancreatography(ERCP) were identified from1/2010to2/2012at the Second Hospital of Lanzhou University and their clinical histories were retrospectively reviewed.They were divided into there groups,endoscopic nasobiliary drainage(ENBD) group,endoscopic retrograde biliary drainage(ERBD) group and endoscopic metal biliary endoprosthesis(EMBE) group respectively.The therapeutic effect of there groups were analyzed, the univariate survival analysis method(Kaplan-Meier method and log.rank test) was used to analyze the patency duration and survivial time of ERBD and EMBE group, COX regression model was established to analyze the influence factors on the survival time.Results The successful rate of procedure was95.4%. Within a week after endoscopic procedure,the patient’s liver function and clinical symptoms were significantly improved and drainage satisfaction rate was91.0%.Post-drainage complication rate was5.4%.The mean patency duration of ERBD group and EMBE group was88.0±21.9days and200.6±46.6days respectively,there was significant difference between them.The mean survivial time of ERBD group and EMBE group was215.4±111.3days and271.8±100.8days respectively, there was no significant difference between them. COX regression showed that stents implantation(B=-0.725, P=0.007) which was the protective factor,had the opportunity to prolong the survival time.The position of obstruction (B=0.573, P=0.040)and clinical stage of carcinoma (B=0.704, P=0.001) were risk factors, had the hazard to decrease the survival time.Conclusions1. ENBD, ERBD, EMBE in treatmen malignant biliary obstruction can effectively alleviate the obstruction of biliary tract,decrease the jaundice and improve liver function.2. The patency duration of biliary metallic stent is significantly longer than the plastic stent,with a significant difference.But there is no difference between the survival time about the two kinds of stents. 3. Stent insertion is a safe and effective palliative treatment for malignant biliary obstruction.The clinical stage of carcinoma is an curcial risk factor,the later clinical stage,the worse the prognosis.The prognosis is poorer with malignant hilar obstruction,compared with malignant distal bile duct obstruction.