| Objective: Malignant obstructive jaundice is a commen disease clinically, and when diagnose ,most of the patients have lost the opportunity of operative eradication, which causing sever trauma , high mortality and short life span after operation. PTCD have become one of the main therapeutic method of malignant obstructive jaundice which have lost operative opportunity. They have certain curative effect, small trauma and little complication. This study aim at discussing operative skill of interventional therapy in different location of obstruction and following up the curative effect of different therapy of PTCD, to probe into and analyze the correlative factor which affect the curative effect in short time and life span.Methods: 83 patients of malignant bile duct obstruction were included in this study, including: 35 cases of common bile duct obstruction, 15 cases of common hepatic duct obstruction, and 33 cases of hilar obstruction. They were treated with different therapy of PTCD, according to the different type of bile duct obstruction. The lately curative effect observed. And then 55 (66.3%) of them were followed up by 0.4-28 months and were observed survival time. We analyze different of survival time between the different location of biliary obstruction and different therapy types of PTBD. In addition we analyze the affect of other common factors to the survival time.Results: In my study, all of the 83 patients cases were treated technological successful (100%), and stents were placed in 78 cases, external drainage in 5 cases and internal /external drainage tube in 9 cases. Their clinical symptom are better than that before operation. The serllm total bilirubin decreased from 327.90±170.24μmol/L to 172.45±137.46μmol/L one week after the procedure(P<0.001). The lately clinical effective rate is 89.16% (74/83), and the mean survival time is 10.32±1.38 months. The clinical outcome of three different types of bile duct obstruction is like this: 1) common bile duct obstruction, with a lately clinical effective rate of 94.30% (33/35), and the mean survival time of 12.64±2.44 months. 2) common hepatic duct obstruction with a lately clinical effective rate of 86.67% (13/15), and the mean survival time of 5.46±1.60 months. 3) hilar obstruction with a lately clinical effective rate of 84.85% (28/33), and the mean survival time of 9.59±1.80months. 15 cases of common hepatic duct obstruction, and 33 cases of hilar obstruction. Five cases died within 1 month (6.02%) after operate. Complications occurred in 13 cases (15.66%). The value of preoperative serum total bilirubin, albumin and hemoglobin is the relatedfactors influencing survival time.Conclusion:(1) PTCD is an effective palliative method of therapy in malignant obstructive jaundice. It can release the clinical symptom and alleviate Jaundic effectually, hence the patients should receive PTCD in the early time to improve the life quality maximumly.(2) The therapy of PTCD should be chosen, according to the different type of bile duct obstruction.(3) The value of preoperative serum total bilirubin, albumin and hemoglobin is the related factors influencing survival time.And they can forecast the prognosis initially and provide consult for the choice of operative way.
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