Clinical Research To Biliary Stent Implantation And Biliary Pathogen Culture Of MEOJ

ObjectiveThis paper is to analyze the data of preoperation and postoperation for MBOJ (malignant biliary obstructive jaundice) who biliary stent were performed and to evaluate the efficacy of biliary stent implantation and to compare the advantages of PTBS (percutaneous transhepatic biliary stent) and ERBD (endoscopic retrograde biliary drainage). In addition, it discusses the causes and the treatment of restenosis after biliary stent implantation.It analyzes their type and clinical meaning by observing the biliary pathogen and drug sensitivity in patients with MBOJ.MethodsThe clinical data of106patients with MBOJ of treatment by ERBD (60patients) and PTBS (46patients) in digestive disease center from May2009to May2010were analysized. The data of BIL and hepatic function and complications after PTBS and ERBD were compared. Cholangio-pancreatography and pathological diagnosis of the patients with biliary restenosis were performed. At the same time extra treatment was taken to deal with the biliary restenosis. The bile of106patients with MBOJ of treatment by biliary stent implantation in this hospital were detected and cultured and the pathogenic bacteria causing biliary infection were analyzed respectively.ResultsEffective biliary stent implantation was achieved in42out of46patients (91.3%) treated with PTBS and in57out of60patients (95.0%) treated with ERBD. And jaundice reduction rate was36%(third day) and68%(seventh day) in PTBS, and was35%(third day) and67%(seventh day) in ERBD. ALT ALP and γ-GGT after biliary stent implantation decreased and hepatic function was improved. The hospitalization was (12.5±2.4) days in ERBD and (20.2±3.2) days in PTBS.The complication rate of PTBS was19.0%, and the complication rate of ERBD was14.0%(P<0.05). There was no significant difference between ERBD and PTBS in total complications.Pancreatitis occured in4patients (7.0%) of ERBD and no occurred in patients of PTBS. There was significant difference between ERBD and PTBS. Biliary infection occurred in4patients (7.0%) of ERBD and occurred in4patients (9.5%) of PTBS. There was no significant difference between ERBD and PTBS. But biliary infection occurred in6patients (10.5%) of low order obstruction and occurred in2patients (4.7%) of high order obstruction. There was significant difference between low order obstruction and high order obstruction.Among18patients of restenosis with the pathological diagnosis,10restensis were caused by tumor growth,5were caused by bile sand and3were due to chronic inflammation.The bile of64patients from106patients with MBOJ had bacteria and the positive rate was60.3%. In all the72strains,52strains (72.2%) were Gram-negative bacilli and Gram-positive cocci accounted for20.8%and fungi accounted for6.9%.Gram-negative bacilli were sensitive to etimicin sulfate, imipenem and cefoperazone/sulbactam and Gram-positive cocci were sensitive to vancomycin. Linezolid and teicoplanin. Both Gram-negative bacilli and Gram-positive cocci was resistant to carbostyril and third generation cephems.ConclusionBoth ERBD and PTBS are palliative and efficient procedures to relieve MBOJ, which are similar in technical success rates and clinical efficacv and total complications. But ERBD is advantageous in hospital stay than PTBS, and it has high complication of pancreatitis. Biliary infection occurs more in low order obstruction than high order obstruction.Tumor growth, chronic inflammation and bile sand are main causes of the restenosis after biliary metal stent implantation.Among the pathogens of MBOJ, Gram-negative bacilli are the most common, which is most sensitive to carbapenems, aminoglycoside and cefoperazone/sulbactam, which is resistant to the carbostyril and third generation cephems that are widely clinically.