| Background and purpose: Obstructive jaundice caused by internal-external hepatic bile ductal stricture or occulusion is a kind of disease often seen and occurred in clinical. It can result from many diseases like biliary stone, neoplasm, inflammation or congenital deformation etc, and it is not always possible to distinguish benign from malignant biliary obstruction with imaging studies alone. Placement of a drainage tube or endoplasty can eliminate jaundice and maintain the bile duct unblocked once benign obstructive jaundice caused by biliary stone, inflammation is comfirmed with pathologic diagnosis accurately and released. But as for malignant obstructive jaundice caused by cholangiocarcinoma, pancreatic adenocarcinoma, hepatocelluar carcinoma , metastatic carcinoma etc, we can not get a long curetive effect unless these tumors are treated after obstructive jaundice were released.Malignant obstructive jaundice caused by bile ductal and periphery malignant neoplasms, especially cholangiosarcoma with no special clinical findings early, seriously threaten the health of the aged people, it is only 3 month survival with physician palliative treatment; only 7 percent patients can be excised radically with surgery and 19 percent patients can be treated with bilio-intestinal anastomoasis. It is difficult to establish a histopathologic diagnosis because most tumors are often small and could not be showed. We could only indirectly conduct the characteristic of thesetumors according to the signs of jaundice in US, CT or MRI findings; placement of a stent could not prevent early biliary restenosis because of the growth of tumors, it could be blind and bad curetive effect treating with chemotherapy, radiotherapy, continuously arterial chemotherapeutics infusion and chemotherapeutic embolization without histologic diagnosis. We could not know how and what to do when we could not differentiate benign from malignant biliary obstruction, especially with imaging and clinical ringings.To acquire a long curetive effect, maintain the stent unblocked for a long time and get the purpose of improving life quality and survival time, we must know the pathologic feature of the tumours to effect a permanent cure on primary rumors. So we could select combinded therapy sensitive to the tumor to treat these obstructive jaundice according to different type of pathology. Therefore the purpose of the study is to find and explore a feasible bile ductal biopsy approach to acquire appropriate specimen to pathologically diagnose the obstructive jaundice accurately, and help the clinical to effect a redical cure .Materials and methods: Between April 2001 and March 2003, sixty-five consecutive patients(36 men and 29 women; age range 33-88 years; mean age 54 years) with obstructive jaundice underwent foreceps biopsy or/and brushing during percutaneous transhepatic cholangiograph, percutaneous transhepatic cholangiodrai-nage or placement of stents, the technique was performed through an existing percutaneous transhepatic tract, Multiple specimens were obtained after passing the forceps biopsy or brush into a long 8-French sheath and the specimens were fixed with formalin for pathologic or cytologic diagnosis. Statistical analysis was performed with the x 2 test or Fisher exact probability; a P<0.05 was considered to indicate a significant difference.Results: The successful rate of specimen with biopsy was 98.46%. Biopsy were performed with a right-sided approach in 62 patients and with a left-sided approach in three patients. Complications occurred in 2 patients with transient local biliary extrav-astation and no other major complications occurred. The histopathologic diagnosis was acquired in 58 of 65 patients with forceps biopsy. Pathologic reports includedcholan- gioadenocarcinoma n=42, cholangiosquamocarcinoma n=l, pancreatic adeno-carcinoma n=2, hepatocelluar carcinoma n=2, metastatic carcinoma n=5, hyperplasia in fibrous connective tissue n=2, sclerosing cholangitis n=l, biliary stone n=l, zoogloea aggredation n=l, chro... |
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