Comparision Of Two Palliative Reducing Jaundice Treatment In Elderly Patients With Hilar Cholangiocarcinoma

Objective: Comparision of endoscopic biliary metal stent and percutaneous transhepatic biliary drainage in elderly patients with hilar cholangiocarcinoma.Methods: From October 2015 to December 2017,99 elderly patients with hilar cholangiocarcinoma were treated in the second Department of Hepatobiliary and Pancreatic surgery,First Hospital of Jilin University(Preoperative evaluation of all patients indicated that the tumor could not undergo radical surgery or was physically unable to tolerate the operation or that the family refused to undergo radical surgery).42 cases were treated with endoscopic metal stenting and 57 cases with percutaneous transhepatic biliary drainage.By comparing the effect of reducting jaundice,Short-term and long-term complications after surgery ?the curative effect of single and double metal stent on reducting jaundice ? postoperative hospitalization indexesand survival time,to evaluate the difference of reducting jaundice operations between the two palliative.Results: Between two palliative jaundice reduction procedures,there was no significant difference in length of stay,feeding time and survival time(P>0.05);In terms of postoperative complications,hyperamylase in EMBEgroup was significantly higher than that in the PTCD group(P < 0.05)during rencent postoperative complications,and the long-term total postoperative complication in the PTCD group was significantly higher than that in the EMBE group.The difference was statistically significant(P < 0.05).The incidence of catheter displacement or prolapse in the PTCD group was significantly higher than in the EMBE group,the difference was statistically significant(P < 0.05);After operation,the time of getting out of bed in EMBE group was significantly earlier than that in PTCD group,and the difference was statistically significant(P<0.05).The scores of pain and postoperative pain in EMBE group were significantly lower than those in PTCD group.The difference was statistically significant(P<0.05).The hospitalization cost of PTCD group was significantly higher than that of EMBE group(P<0.05).Conclusion: For the elderly patients with advanced hilar cholangiocarcinoma whose tumor and body condition refuse to undergo radical surgery,palliative yellow reduction surgery can effectively improve the quality of life and survival time of the patients.This retrospective study shows that when economic conditions permit and physical conditions are tolerable for intravenous anesthesia,the authors recommend that EMBE be given priority.This procedure is more in line with the physiological structure of the human body and can improve the quality of life of the patients.In addition,according to the volume of effective bile drainage during the operation,bimetallic stentcould be taken into account.PTCD takes bile out of the body,which caused the loss of body fluid.The drainage tube should be cared for regularly and the risk of exfoliation should be warned.It can be used as a remedy for EMBE.