| Background and objective: High malignant biliary obstruction refers to high obstructive jaundice of the biliary duct caused by malignant tumors.The obstruction includes direct invasion and compression or transfer to the hilar lymph nodes for indirect compression,resulting in biliary stenosis and cholestasis in the liver,further damaging the liver function.Common causes of diseases mainly include hilar cholangiocarcinoma,gallbladder carcinoma,hepatocellular carcinoma and other malignant tumors directly infiltrate,invade or metastasize to compress the bile duct,while a few causes are found in gastrointestinal tumors and lung cancer metastasizing to hilar lymph nodes and then indirectly compress the bile duct.This kind of disease develops insidiently and is often found at an advanced stage.Therefore,no radical operation can be carried out,and palliative surgery can only be used to alleviate jaundice,improve liver function and prolong survival time and improve life quality.This study was to evaluate the efficacy of endoscopic stent placement in the treatment of high-grade malignant biliary obstruction.Methods: A retrospective study was conducted to select 34 patients with high-grade malignant biliary obstruction admitted to the Second Affiliated Hospital of Guangzhou Medical University from March 2017 to March 2020,including 18 males and 16 females,aged 39-86 years old,with an average age of 65.42±12.73 years old.Among them,there were 17 cases of hilar cholangiocarcinoma,8 cases of hilar hepatocellular carcinoma,7cases of hilar gallbladder carcinoma,2 cases of hilar lymph node metastasis of colon cancer and lung cancer.According to the stent placement method,they were divided into double plastic stent drainage group and single metal stent drainage group.The effect of drainage,improvement of liver function,postoperative complications and hospitalization were compared between the two groups.Results: There was no statistical significance in preoperative general clinical data between the double plastic stent group and the single metal stent group(P >0.05),which showed comparability.Both groups had yellow-back effect,and the serum total bilirubin decreased significantly on the 3rd day,which was statistically significant compared with the preoperative serum total bilirubin(P <0.05).On the 7th day after surgery,the serum total bilirubin in the double plastic stent group was significantly lower than that in the single metal stent group,which was statistically significant(P <0.05).Both groups had the effect of improving liver function,and the serum ALT and AST decreased significantly on the 7th day,which had statistical significance compared with the ALT and AST before surgery(P<0.05),and the serum ALT and AST of the double plastic stent group were lower than those of the single metal stent group on the 7th day after surgery(P <0.05).Postoperative complications were not statistically significant between the two groups(P >0.05).The total hospitalization cost of the double plastic stent group was 38,715.75 ±2766.19 yuan,and the total hospitalization cost of the single metal stent group was 56894.33±2268.78 yuan,with statistical significance(P <0.05).;After 6 months of follow-up,the patency rates of the double plastic stent group and the single metal stent group were 27.3%(3/11)and66.7%(8/12),respectively,and the difference between the two groups was statistically significant(P <0.05).After 9 months of follow-up,the patency rates of the double plastic stent group and the single metal stent group were 11.1%(1/9)and 54.5%(6/11),respectively,and the difference between the two groups was statistically significant(P <0.05).KaplanMeier survival analysis showed that the median survival time in the double plastic stent group was 271.0d(95%CI: 157.3 ～ 384.7d),and that in the single metal stent group was285.0d(95%CI: 251.05 ～ 300.9d).The median survival time in the single metal stent group was higher than that in the double plastic stent group,but the difference between the two groups was not statistically significant(P >0.05).Conclusion :(1)For patients with resectable hilar cholangiocarcinoma,preoperative placement of double plastic stents has better drainage effect and improved liver function,and can reduce the incidence of intraoperative and postoperative complications.(2)For patients with advanced high-grade malignant biliary obstruction,compared with the expensive metal stent,the placement of the relatively cheap double-plastic biliary stent still has a significant yellowing effect and liver function recovery in a short period of time,but the patency time of the stent is still a problem to be solved.(3)ERCP is one of the feasible and safe means for palliative treatment of high-grade malignant biliary obstruction. |
PDF Full Text Request