The Prognostic Analysis Of Malignant Obstructive Jaundice Which Were Treated With Different Biliary Drainage

Objective:To discuss the effect,complication,patency,prognosis and survival analysis of different biliary drainage of malignant obstructive jaundice.To analyze and evaluate the survival prognosis and quality of life among part of patients with malignant obstructive jaundice.To analyze the characteristic of biliary drainage among patients with malignant obstructive jaundice who were applied with intraductal ultrasonography.Methods:Between December 2008 year and October 2014 year,to choose 152 patients with malignant obstructive jaundice who were giving percutaneous transhepatic biliary drainage or endoscopic biliary drainage,which were divided into four groups:percutaneous transhepatic biliary drainage(PTBD),endoscopic plastic biliary stent(EPBS),endoscopic metal biliary stent(EMBS),and endoscopic metal biliary stent combined with plastic stent(EPBS+EMBS).To collect patients' clinical data and analyze the influence factors of survival prognosis.To choose 41 patients with malignant obstructive jaundice,which were giving endoscopic nasal biliary drainage,endoscopic biliary stent insertion,and endoscopic retrograde cholangiopancreatography combined with radiotherapy or chemotherapy.To apply SF-36 questionnaire and QLQ-MOJ11 specific questionnaire of malignant obstructive jaundice for quality of life evaluation and statistical analysis.To choose 108 patients who were suspected malignant bile duct strictures,which were all giving endoscopic retrograde cholangiopancreatography and intraductal ultrasonography.To collect clinical data for statistical analysis.Results:1.The successful drainage rate of PTBD group,EPBS group,EMBS group,and EPBS+EMBS group was 54.2%,59.1%,70.8%,and 80.6%.The complication rate of PTBD group,EPBS group,EMBS group,and EPBS+EMBS group was 62.5%,27.2%,31.3%,and 16.7%.The mean drainage patency of PTBD group,EPBS group,EMBS group,and EPBS+EMBS group was 46 days,82 days,142 days,and 164 days.The mean survival time was 191 days in PTBD group,266 days in EPBS group,284 days in EMBS group,and 436 days in EPBS+EMBS group.Through cox proportional hazards regression,the childpugh class,age,infection,and TNM stage contributed to a higher probability of death,while the drainage method and gender contributed to a lower probability of death.2.The risk factors of quality of life in malignant obstructive jaundice patients included bilirubin,CA199,CEA,ALP,and GGT.TBIL of ? 100umol/L,CA199 of?200U/ml,ALP of ?200U/L,and GGT of ?200U/L predicted a poor quality of life duration hospitalization.After ERCP,the score of role emotional(RE)significantly increased in ERCP combined with radiotherapy/chemotherapy group.The survival curve showed the median survival time was 10.2 months.The median survival time following ERCP with nasal biliary drainge,ERCP with endoscopic stent insertion and ERCP combined with radiotherapy/chemotherapy was 8.2 months,8.2 months,and 18.3 months,respectively.3.Through the ERCP and IDUS procedures,the diagnostic specificity,sensitivity,and accuracy of IDUS was 67%,97%,99%,respectively.The obstruction level of bile duct was as follows:Bismuth ?(n=5,4.6%),Bismuth ?(n=27,25%),Bismuth?(n=7,6.5%),upper and middle section of common bile duct(n=35,32.4%),lower and middle section of hepatic duct(n=5,4.6%),pancreas head region(n=29,26.9%).The mean bile duct stricture length of all patients was 3.4±1.3cm.The length of plastic stents ranges from 5cm to 15cm,and metal stents ranges from 1cm to 10cm.Conclusion:The EPBS+EMBS drainage method may improve the successful biliary drainage,have lower complications,longer patency,and longer survival time.ERCP combined with radiotherapy/chemotherapy may be more effective in improving quality of life and prolonging survival time.The IDUS performed during ERCP may contribute to distinguish between benign and malignant bile duct strictures judge the obstruction level of bile duct,and show the length of bile duct strictures.It may be helpful to choose the type and length of biliary stents for biliary drainage of malignant bile duct strictures.