| Object:To investigate the effect of different bile drainage on the treatment of malignant obstructive jaundice,and to analyze the distribution and characteristics of bile in patients with malignant biliary obstruction, to select appropriate drainage way for patients with malignant obstructive jaundice and provide references for the the clinic to applicate antimicrobial agents rationally and individually.Methods:We collected 97 cases of advanced malignant obstructive jaundice, which were enrolled in the First affiliated hospital of Shihezi university from January 2008 to September 2013.According to the different ways of drainage all patients can be divided into ERCP drainage group(group A, n=57),PTCD/PTGD group(group B, n =40).Observe the successful rate,the change of the clinical symptoms and sign preoperative,liver function(TBIL, DBIL and ALP), hospitalization duration after operation and the incidence of complications in each group.Bile bacteria culture is also accomplished,Analyse the bacteria spectrum in malignant obstructive jaundice.Results:1.Clinical data were collected from 97 cases of malignant patients with obstructive jaundice, group A:ERCP group consists of 57 cases, male 29 cases, female 28 cases, age 38-87 years old, the age obeys normal distribution, the average age is(67.1±12.2) years old; B group: PTCD/PTGD group 40 cases, male25 cases, female 15 cases, age 39-90 years old, the age does not obey the normal distribution, the median age is 74 years. The difference of ages and gender of the two groups of patients has no statistical significance(P>0.05). There is comparability;2. The clinical symptoms of 97 cases of patients occurred mainly as follows: jaundice in 95 cases, 21 cases of white stool, deep yellow urine in 39 cases, abdominal pain in 48 cases, 20 cases of skin itching, anorexia and weakness in 82 cases, 95 cases, 15 cases of fever, 7 cases of vomiting or nausea;3.The 97 cases of malignant obstructive jaundice were divided into ERCP drainage group(group A, n =57),54 cases were successfully embedded with biliary stents and performed different endoscopic drainage,including endoscopic biliary metallic stent drainage(EBMSD) 18 cases,endoscopic retrograde biliary drainage(ERBD)26 cases,endoscopic nasal biliary drainage(ENBD)4 cases and endoscopic stent implantation joint nasal biliary drainage 6 cases.The successful rate of ERCP was 94.7%(54/57).PTCD/PTGD group(group B, n =40).,38 cases were successfully accomplished external drainage of biliary tract, including percutaneous transhepatic cholangiography drainage(PTCD) 24 cases,percutaneous transhepatic gallbladder drainage(PTGD)10 cases,and percutaneous transhepatic cholangiography drainage joint percutaneous transhepatic gallbladder drainage 4 cases.PTCD/PTBD leads to 95%(38/40) successful rate;4.The clinical symptoms such as abdominal pain, pruritus and sign such as jaundice,white excrement,deep yellow pee were relieved in different degrees in 82 cases;5.One week after drainage the levels of TBIL, DBIL and ALP of the patients undergoing treatment decreased in comparison with those before the treatment(P<0.05),The decreased of the levels in each group showed no significant difference(P>0.05);6.There were totally 44 biles samples(including ERCP harvested 12 biles samples,PTCD/PTGD harvested32 biles samples),25 patients were found bacterial growth in their bile drainage(56.8%). 30 strains were trained,Mainly including escherichia coli(30%),Klebsiella pneumoniae(20%), pseudomonas(16.7%).There were no obvious signs of infection but bile culture positive phenomenon in the two groups before surgery;7.The hospitalization duration after operation in each group showed no significant difference(P>0.05).8.The incidence of complications of group A was 27.8%,group B was 81.6%,group B was significantly higher than group A(P< 0.05).Conclusion:1.ERCP and PTCD/PTGD drainage were both technically and clinically successful for palliative treatment of malignant biliary obstruction,they have their own respective indications, complementary advantages.2.The incidence rate of complications of ERCP is relatively lower than PTCD/PTGD.3.PTCD treatment for high malignant biliary obstruction may have its advantages.4.Gram-negative bacterium remained the commonest pathogens in patients with obstructive jaundice.The top three predominant pathogenic bacteria were escherichia coli,Klebsiella pneumoniae, pseudomonas.Whether the clinical symptoms of patients with malignant obstructive jaundice accompanied with abdominal pain, fever and other clinical symptoms can only serve as a reference index of the infection of biliary tract, but cannot be an exclusion criteria. |
PDF Full Text Request