Drainage Effect Of A New Plastic Biliary Stent In Hilar Cholangiocarcinoma

Objectives: Hilar cholangiocarcinoma refers to malignant tumors from the left and right hepatic ducts,hepatic duct and confluence.The incidence is increasing year by yeart.Most patients are diagnosed with obstructive jaundice when they are primitively found,and and most cannot be operated,so palliative biliary drainage can be the only chosen to alleviate the symptoms of patients,and only in this way,can improve the quality of patients’ life.Endoscopic retrograde biliary drainage has become a common drainage scheme due to its advantages of less postoperative injure,reducing bilirubin rapidly and wide range of adaptation.Endoscopic biliary drainage includes internal and external drainage,and external drainage is generally used for short-term drainage.Internal drainage materials include metal stents and plastic stents.Metal stents have large diameter and good drainage effect,but they are difficult to operate and expensive.Therefore,plastic stents are more widely used in clinical.The common plastic stent may cause duodenal reflux,in order to avoid postoperative cholangitis and stent blockage caused by duodenal reflux,our center process and modifiy the pigtail nasobiliary duct in an attempt to reduce the duodenal reflux and reduce occurrence of postoperative cholangitis and increase the drainage time of the stent.In the palliative endoscopic retrograde cholangio-pancreatography’s treatment of hilar cholangiocarcinoma,the incidence of postoperative cholangitis,the effect of reducing jaundice and the patency of the stent were compared between the application of the new type of plastic biliary stent and the common plastic stent,so as to verdict the differences between the new type of stent and the common plastic stent,and provide a new idea for the better treatment of hilar biliary obstruction.Methods:A retrospective analysis consists of 46 cases who received palliative endoscopic retrograde cholangio-pancreatography’s treatment due to obstructive jaundice caused by hilar cholangiocarcinoma in our clinical department.Datas of biliary infection,liver function decline level and trend,stent patency of patients in the two groups after biliary stent implantation were collated and analyzed by SPSS25.0software.Results:1.Comparison of technical success rate,duration of operation and length of hospital stay between the two groups All the 46 patients were successfully completed ERCP with a technical success rate of 100%.There was no significant difference between the two groups in the duration of operation(19.07±10.83 minutes vs.21.65±14.27 minutes)and the length of hospital stay(11.48±5.26 days vs.10.60±3.71 days)(P>0.05).2.Comparison of preoperative and postoperative blood routine and liver function indexes between the two groups.In both groups,the symptoms,C-reactive protein and blood routine of postoperative patients with acute cholangitis decreased.Postoperative liver function indexes in 2 groups were significantly decreased(P<0.05),and the decrease of bilirubin in the new stent group was more significant,with statistical difference(P<0.05).3.Comparison of the incidence of short-term and long-term postoperative cholangitis and postoperative pancreatitis between the two groups New stent group compared with the ordinary stent group,recently the incidence of cholangitis(during hospitalization)respectively were 9.5% and 12.0%,the forward cholangitis rate respectively were 14.3% and 21.7%,the incidence of postoperative pancreatitis respectively were 9.5% and 8%,postoperative incidence of hyperamylasemie respectively were 9.5% and 12%,while the foward biliary infection rate of new stent is lower than the ordinary stent,there is no statistical difference(P >0.05).4.Stent patency time of the two groups The stent patency time of the new plastic bile duct stent group and the common plastic bile duct stent group respectively were 110.10±50.60 days and 84.76±28.68 days.The drainage time of the new plastic bile duct stent was longer than that of the common bile duct stent,and the difference was statistically significant(P < 0.05).Conclusion:In the palliative treatment of hilar cholangiocarcinoma,the new plastic bile duct stent modified with pigtail nasobiliary duct can significantly reduce bilirubin,improve liver function of patients and increase the drainage time of the biliary stent.