Clinical Observation Of Endoscopic Retrograde Biliary In The Treatment Of Benign And Malignant Biliary Obstruction

Objective:To investigate the efficacy of endoscopic retrograde biliary drainage in treatment of benign and malignant biliary obstruction, providing more theoretical and practical evidence for clinical work.Methods:A retrospective analysis of 69 patients with biliary obstruction who underwent endoscopic biliary stent drainagethe in First Affiliated Hospital of Guangxi Medical University from February 2012 to February 2015. these patients had crried out ERBD 126 times in total. Symptoms, biochemical parameters and the data of ERBD procedure in the preoperative and postoperative was Collected, the stent patency and survival time was Record during the follow-up period after discharge, these will contribute to evaluate the efficacy of ERBD.Results:A total of 69 patients, mean age was 61.4 ± 13.6 years,39 men(56.5%),30 women(43.5%); the symptoms of abdominal pain (51.2%) and jaundice (59.5%) are more common, followed by fever (27.0%) and pruritus (14.3%); postoperative serum levels of bilirubin, alanine aminotransferase (ALT), gamma-glutamyltransferase (GGT), Serum bile acid decreased were significantly compared with preoperative (P<0.05), blood AMY and neutrophil percentage increased were significantly compared with preoperative (P<0.05), however, alanine transaminase (ALT) and white blood cell (WBC) there was no significant difference before and after ERBD (P>0.05); post-operative complications include infection (7.2%), hyperamylasemia (4.8%), pancreatitis (3.2%), no cases of perforation happened; Biliary obstruction from primary disease of benign obstruction (56.5%) malignant obstruction (43.5%), cholelithiasis (61.5%) is a major cause of biliary obstruction in all benign diseases,Cholangiocarcinoma is the first etiology of malignant biliary obstruction (56.7%); biliary sludge(54%) is the most common cause of biliary stent occlusion, followed by massive stones(25.4%) and tumor invasion(12.7%); the distal third (57.1%) of the CBD was the most frequent common location for the obstruction, the middle and proximal biliary obstruction, liver transplantation anastomotic stricture were and hilar stricture were 23%,17.5% and 2.4%, respectively; 69 patients has a total of 128 times ERBD,186 stents were implanted, including plastic stent 176 and metal stent 8, which placed single stent 69%, double stent 23.8%, placed three stents and above accounted for 7.2%; The overall median duration of stent patency of biliary obstruction was168 days(5.6 months);The median duration of stent patency in benign obstruction group was 197 days, The median duration of stent patency in malignant obstruction group is 73 days, There were significant differences between benign and malignant obstruction group (P<0.05); The median duration of liver transplantation biliary gruop stent patency was 178 days is similar to non-liver transplant gruop(225 days) (P> 0.05). The median survival in Malignant biliary stent obstruction was 337 days.Conclusions:Endoscopic retrograde biliary drainage effectively relieve biliary obstruction and improve liver function; biliary sludge, Cholelithiasis and tumor invasion are a major cause of biliary stent obstruction, The median duration of stent patency in benign obstruction is longger than malignant obstruction.