A Clinical Study Of Malignant Obstructive Jaundice Treated By PTCD

Objective: to evaluate the technique of PTCD under the guidence of ultrasound with DSA;to compare the complications,short-term and long-term clinical efficacy of plastic drainage catheters with metalic stents;to analyse the risk factors of early mortality.Materials and Methods:210 cases of malignant obstructive jaundice,of which 161 cases of plastic drainage catheters placement and 49 cases of metalic stents implantation,included 32 patients with clinical diagnosis of hepatocellular carcinoma, cholangiocarcinoma 61 cases, 10 cases of gallbladder cancer, 17 cases of pancreatic cancer. 62 patients with metastatic cancer, and 28 cases were diagnosed as hilar mass.The mean serum total bilirubin before treatment was 320.12 umol/l,and direct bilirubin 183.75 umol/l. Follow-up information obtained through telephone review or reinterventional records.All datas were analysed with spss11.5 statistical software package.The statistical test methods included two independent samples t test, chi-square analysis for table 4 georgia, one-way analysis of variance and Kaplan-meier survival analysis. Results : The success rate of technique was 100%.3~5days after treatment, the serum total bilirubin of 15 metalic stents cases decreased 178.04±42.32umol/l, and direct bilirubin fell 83.97±23.63 umol/l.28 plastic cathers : 95.67±34.28umol/l, 49.84±28.21umol/l. The differences between metalic stent group and plastic drainage catheter group were statistically significant (P = 0.017. P =0.035). After 6-9 days, the serum total bilirubin of 28 cases of metalic stent group fell 188.22±79.90umol/l,and of 126 cases of plastic drainage catheter group was 141.39±65.32umol/l. The difference had statistic significance (P = 0.014).But the decline value of direct bilirubin was no significant difference.The complication rate of metalic stent group was 8%(4/49), 52%(84/161) of plastic drainage catheter group .The former was far lower than the later(P=0.000). Most of them have no relation with the puncture procedure. The median patency period and the median survival time of the group of plastic drainage catheter were 60 days , 148 days,the metalic stent 197 days, 245 days. There were statistically significant differences(P<0.05). Risk factors are age, poor liver function, abnormal renal function, infection before treatment, and the site of tumor invasion and hemoglobin content.Conclusion: PTCD under the guidence of ultrasound with DSA is a safe ,simple method with a high success rate in treatment of malignant obstructive jaundice.Metalic stents have better short-term and long-term efficacy.