| Malignant obstructive jaundice was caused by different malignant tumors with the narrow of different part of biliary duct,the patients suffered from a series of symptoms,such as icteric sclera and skin,whole trunk pruritus,and the change of urine and stool. At this time ,medical treatment was hard to get the intended effect,and the recover rate was 7% by surgery radical correction,while the interventional method was one kind of popular treatment.The interventional method was convenient to operate, the wound caused by it was small, it had a few complications,and was easy to be achieved.It had become the most popular treatment to cure obstructive jaundice.The interventional method included PTCD and the placement of metallic stent in biliary duct.As a kind of alleviative treatment,the effect of it was the patients living without jaundice. but it had no effect on primary carcinomar. If the primary carcinomar was't controlled,the stent might be obturaded by tumor and it would become nonfunctional. So the patients shoud be treated in time after the jaundice was decreased by interventional method.Purpose:To verificate the therapeutic efficacy of the inter- ventional method to malignant obstruction jaundice; to compare the curative rate and life span difference between stented group and non-stented proup;to compare the curative rate and life span difference between group treated only by PTCD and group treated not only by PTCD but also by transcatherter arterial chemoembolization and transcatherter arterial infusion.Method:42 cases had treated by PTCD from 2004,Jan to 2007,Mar were analyzed,24 cases were male,18 cases were female,from 41 to 83 years old,the average age was 63.All patients had been operated on Siemens Agiostar and AIXOM Atrits digital machine made in Germany. All patients had been performed by conventional PTCD. They had been treated by only external drainage, external and interal drainage, and endoprosthesis placement respectively. Some patients had been added TAE or TAI by Seldinger's puncturation.All the cases had been rechecked with biliary tract opacification after operation in 2-6days and had been treated by anti-inflammatory or other symptomatic treatment. The blood routine and hepatic function had been surveyed after one or two weeks, and they had been performed CT and MRI on order to know the change of the biliary duct. The therapeutic efficacy had been analyzed according to the change of serum bilirubin level. The patients had been followed up for 24 months, 6 of them were lost. The actual number was 36, the ratio was 85.71%.The life span had been compared between stented group and non-stented proup. The life span were compared between group treated only by PTCD and group treated not only by PTCD but also by TAE and TAI.Results: The operations on all 42 cases were successful,the ratio was 100%. 21 were treated by stent placement,8 of them were done 3-7days after PTCD. The TBIL,DBIL,IBIL level surveyed one and two weeks after opteration were statical different from the ones before operation (p﹤0.05). 36 cases had been followed up,the life span was statical different between stented group and drainaged group. One of them had been verificated by pathology as primary hepatic carcinomar,the tumor plug had be seen by CT , MRI. The stained yellow and pruritus decreased after operation,but the patient died 1 month later because of liver function failure. The deathrate was 2.78%(1/36).13 cases had been added TAE/TAI, their life span was obviously longer than patients only drainaged.Conclusion: PTCD could relieve jaundice obviously ,but it didn't wound seriously, and it had a few complications. It was a nice alleviative treatment to relieve malignant obstructive jaundice. PTCD added TAI/TAE could extend the life span for malignant obstructive jaundice patients. Without pre-dilation with sacculus rotundus, most of biliary tract self-expandable stent can expand itself. |
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