The Effect Comparison Of Four Kinds Of Palliative Conductions In Treatment Of Obstructive Jaundice Caused By Unresectalbe Malignancy Of Hipatic Portal

The only method to treat malignant obstructive jaundice of hepatic is radical surgery. But the cure rate is low (with hilar cholangiocarcinoma for example cure rate less than 25%). Without palliative drainage of patients will eventually lead to liver and kidney failure and systemic other organs attenuation cased by jaundice, and die the finally. The average surial data of domestic shows only for 2 months. If take effective palliative drainage, the average survival period can reach 9.1 months. The one year surial rate was 38.10%. Foreign data shows that patients after palliative surgery can live for 6～9 months.For Hepatic portal's complex anatomic, it is difficuly to drainage for this kinds of patients who have obstructive jaundice. There is not less than twenty kinds of palliative drainages to treat hepatic portal malignant obstructive jaundice. But all sorts of drainages' effect is differ.And the postoperatives'long-range curative effect and patient tolerance are very difference.Purpose We observe four commonly used palliative drainages'drainage effect and long-range curative effect that used to treat hepatic portal malignant obstructive jaundice (PTCD; Through the tumor intubation and outside bridge form drainage; Intrahepatic biliary-jejunal R-Y anastomosis; Bridge form internal drainage). We can choose more appropriate palliative operation method through comparison and analysis. That to improve the quality of life and surial for this patients. To put forward guiding Suggestions for clinical works.Methods Collect and arrangement 96 patients'materials between 2006.01 and 2010.10 that surgical treatment for high obstructive jaundice. According to the different ways of operation we can divided into:PTCD group(40cases); Intrahepatic biliary-jejunal R-Y anastomosis group (16 cases); Through the tumor intubation and outside bridge form drainage group (22 cases); Bridge form internal drainage group (18 cases). We analysis every group's intraoperatie situation% postoperative recent bilirubin change,the postoperative complications, postoperative recovery and long-term drainage effect and long-term complications.Result Four operation modes are all effective. But biliary-jejunal R-Y anastomosis group,bridge form internal drainage group and through the tumor intubation and outside bridge type drainage group'postoperative bilirubin decreases are more effective than PTCD group. And there are no significant difference between the first three groups. Surgical aspects:Bridge form internal drainage is superior to other two groups in shorter operation time and intraoperatie less bleeding and simple operation. And bridge form internal drainage was significantly better than that of the other two groups in Postoperative functional recovery of gastrointestinal and postoperative patients tolerance. And bridge form internal drainage is superior to other two kinds in the hospitalization time and hospitalization expenses.Conclusion:1. Four kinds of drainages can effectively deduce the biliopancreatic obstruction. But PTCD group'effect is poorer than others.2. PTCD can be regarded as no wound operation. It can be used as the firstly choose for that patients who cannot to tolerate surgery. When the patients' general conditions changed that can tolerate surgery can change bridge form internal drainage.3. Through the tumor intubation and outside bridge form drainage type have the external drainage and internal drainage's advantages. It can observate the bile drainage effect in vitro and rinse in vitro to prevent the catheter obstruction and infections etc. But it increased patients'discomfort and nursing around the drainage tube postoperative. And it affected the quality of life of the patients for the most important. And simultaneous the biliary infection rate were not obviously reduced. So we do not recommend to use widely.4. Intrahepatic biliary-jejunal anastomosis were traumatic seriously and the postoperative complications and the drainage effect without obvious advantage than others. So we do not recommend to use also.5. Bridge form internal drainage'surgical trauma and drainage effect are better than others. Meanwhile it has fewer complications and postoperative reactions and shorter hospitalization time etc. Meanwhile patients haved no discomfort. This type operation can apply to all causes of malignant obstructive jaundice. It is relatively appropriate choice in all sorts of operation.