| ObjectiveMalignant obstructive jaundice is caused mainly by pancreatic cancer, gallbladder cancer, cholangiocarcinoma,and metastatic tumors such as biliary duct metastasis of gastric cancer. The main clinical manifestations of malignant obstructive jaundice are stained yellow skin and mucosa and sclera, which can cause the body a series of physiological and pathological disorders such as decreased immune function, blood coagulation dysfunction, decreased cardiac function, malnutrition, etc. As the disease gradually worsened, malignant obstructive jaundice can cause liver and kidney failure and even death. Since founded in 1974, Molnar and Stocknm percutaneous biliary drainage for malignant obstructive jaundice remission since, PTCD and biliary stent placement as a minimally invasive technique has become the palliative treatment of malignant obstructive jaundice the most common method. PTCD or/and biliary stent placement can effectively relieve malignant obstructive jaundice symptoms, prolong survival and improve quality of life of patients who should not be treated with surgery. However, previous studies showed that the complications of PTCD and/or biliary stent placement can affect the treatment, and even lead to death. Which, the pancreatitis after PTCD or/and biliary stent placement is one of the more serious complications. In percutaneous transhepatic cholangiography, when imaging to understand the case of biliary patency after the treatment(biliary drainage and/or stent), sometimes we can see bile duct and pancreatic duct develop at the same time. Normally, bile duct and pancreatic duct do not connect with each other,which are subject to control of Oddi sphincter.The pressure in bile duct is higher than the pressure in the duodenum, and the pressure in pancreatic duct is higher than the pressure in the bile duct, so when cholangiography, the pancreatic duct does not develop. This study aims at retrospectively analyzing the clinical data of the patients with obstructive jaundice who were treated by intervention in Shengjing Hospital of China Medical University between September 2008 and September 2009 to analysis the relationship between the visualization of pancreatic duct in percutaneous transhepatic cholangiography and the pancreatitis preliminarily.Materials and MethodsCollecting the clinical data of consecutive 82 Patients with obstructive jaundice(OJ) are receiving the Interventional therapy in our hospital from September 2008 to September 2009. Clinical findings and cholangiopancreatographic results were analyzed. Meanwhile the standard to be selected for cases and the criteria for exclusion were established,70 patients selected. Among them,44 males and 26 females, aged 28 to 88 years,the average age of whom was 67.6±12.6 years. The main clinical manifestations of malignant obstructive jaundice are different degrees of painless stained yellow skin and mucosa and sclera, loss of appetite, yellow urine, clay colored stools. All patients was diagnosed with malignant biliary obstruction by CT and/or MR. Laboratory examination of liver function is mainly determined, including TBIL,DBIL,IBIL,AST,ALT andAlb.All patients were underwent percutaneous transhepatic puncture befor PTCD and biliary stent placement. After interventional therapy, the skin color, urine color, stool color, abdominal signs and changes of symptoms are the major observation,the test review after 1 weeks. All of the data are analyzed by SPSS 13.0 statistical package.Results1,PTCD or/and biliary stent placement were performed successful for all patients.Among them,only 18 cases received PTCD, meanwhile,52 cases accepted biliary stent placement,100% success rate.The levels of TBIL,DBIL,IBIL,AST,ALT were in decline,and the levels of albumin also decreased significantly.2,Among all 70 patients,9 patients with pancreatitis occurred.The incidence rate was 12.9%. The incidence rate of pancreatitis of two cases were significant. The incidence of pancreatitis of the patients whose pancreatic duct intraoperative visualization was higher than that of pancreatic duct don't develop. Spearman analysis of correlation show that there is positive correlation between the visualization of pancreatic duct in the operation of Cholescintigraphy and the pancreatitis after the operation of Cholescintigraphy.ConclusionThe incidence of pancreatitis of the patients whose pancreatic duct intraoperative visualization was higher than that of pancreatic duct don't develop.There is positive correlation between the visualization of pancreatic duct in the operation of Cholescintigraphy and the pancreatitis after the operation of Cholescintigraphy. |
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