Curative Effect Analysis Of Percutaneous Transhepatic Cholangial Drainage(PTCD) Combined With Chemotherapy In Treatment Of Advanced Pancreatic Cancer With Obstructive Jaundice

Objective: To evaluate the clinical value of percutaneous transhepatic cholangial drainage(PTCD) combined with arteriovenous or intravenous chemotherapy as the treatment of advanced pancreatic cancer with obstructive jaundice.Methods: Thirty-two patients who had been diagnosed with pancreatic cancer with obstructive jaundice and underwent PTCD to relieve biliary obstruction were analyzed retrospectively.after serum bilirubin index declined significantly,sixteen cases of patients were treated with arteriovenous combined chemotherapy,another sixteen cases with intravenous chemotherapy purely.Chemotherapy scheme selected gemcitabine combined cisplan or oxaliplatin,four weeks as interval.Totally,56 times chemotherapy were done in arteriovenous combined groups,44 times in intravenous purely goups.Hepatic artery embolization was used simultaneously in patients with liver metastatic and abundant vascularity.To analysis curative effect and adverse reactions of PTCD,efficiency and adverse reaction of the two chemotherapy ways.Results: In 32 patients,total serum bilirubin was decreased from(178.6±52.8) umol/L to(38.5±5.6) umol/L after PTCD.3 cases were complicated by hematobilia,5 cases by biliary tract infection.In arteriovenous combined chemotherapy group,4 achieved partial remission,8 had stable disease,4 had progressive disease,objective response rate(CR+PR) was 25%,disease control rate(CR+PR+SD) was 75%,the clinical benefitrate 75%,median survival time was 6.8 months.In intravenous chemotherapy group,1 achieved partial remission,4 had stable disease,11 had progressive disease,objective response rate(CR+PR) was 6.25%,disease control rate(CR+PR+SD) was 31.3%,the clinical benefit rate was 31.3%,median survival time was 6.3 months.In arteriovenous combined chemotherapy group,incidence of nausea、vomit and hematology toxicity were lower than that in intravenous chemotherapy group,the difference is statistically significant.IV chemotherapy adverse reactions were not occurred in all patients.Conclusion: 1.PTCD can effectively relieve the clinical symptoms of patients with obstructive jaundice;2.PTCD combined with chemotherapy is a safe and efficient therapy for advanced pancreatic cancer with obstructive jaundice;3.arteriovenous combined chemotherapy is of better clinical efficacy and lighter side effects than intravenous chemotherapy purely.It can be one of feasible schemes to improve curative effect of pancreatic cancer.