| Objective:(1)To analysis of causes and treatment measures about the complications of biliary stenting combined with125 I radioactive seeds strip implantation.(2)Compare with the conventional self-expandable metal stent placement.Methods: A retrospective analysis of 100 patients with malignant obstructive jaundice who were treated in our hospital during 2014.4~2016.6,in these 100 patients,75 cases were male,25 female,age 34~81 years old,the average age is 60.4,including 57 cases of bile duct carcinoma,11 cases of carcinoma of head of pancreas,7 cases of gallbladder carcinoma,6 cases of liver cancer,4 cases of liver metastasis of colon cancer,4 cases of liver metastasis of gastric cancer,2 cases of breast cancer with liver metastasis,4 cases of periampullary carcinoma,5 cases of pancreatic cancer.All of these patients were confirmed malignant tumor and the presence of extrahepatic bile duct dilatation by B-ultrasound,CT and MRI.The clinical manifestation of different degree of jaundice,fever,weight loss,liver pain and pruritus.All of these patients received PTCD,then they were divided into study group(n=60)and control group(n=40).The study group received biliary stents placement and radioactive seeds strip implantation 3 days later,and the control group received conventional biliary stent only.The successful rate of stent implantation,the changes of total bilirubin and direct bilirubin,the patency of stent,the median survival of patients and the incidence of short-term and long-term complications were compared between the two groups.Results: Biliary stents were placed in 97 of 100 patients,and radioactive particles were successfully implanted in 58 patients in the study group.There were 8 cases of biliary tract infection after operation,including 5 cases in experimental group and 3 cases in control group,the difference was not statistically significant(c2=0.05,P>0.05).4 cases of biliary tract hemorrhage,including 2 cases in the experimental group,2 cases in the control group,the difference was not statistically significant(c2=0.01,P>0.05);3 cases of peritonitis,including 2 cases in the experimental group,1 cases in the control group,the difference was not statistically significant(c2=0.12,P>0.05);6 cases poor drainage caused by drainage tube obstruction and shift,including 4 cases in the experimental group,2 cases in the control group,the difference was not statistically significant(c 2=0.01,P>0.05).5 cases of biliary cardiac reflex,of which 3 cases in the experimental group,2cases in the control group,the difference was not statistically significant(c 2=0.21,P>0.05);2 cases of biliary pancreatitis,including 1 cases in the experimental group,1cases in the control group,the difference was not statistically significant(c 2=0.12,P>0.05);4 cases of stent migration,including 3 cases in the experimental group,1 cases in the control group,the difference was not statistically significant(c2=0.01,P>0.05).The total bilirubin and direct bilirubin of two groups were compared 4 weeks after the operation,the experimental group and the control group total bilirubin were reduced to35.5±16.6 mol/L and 34.5±19.6 mol/L;direct bilirubin were reduced to 25.6±15.5mol/L and 20.1 ± 10.1 mol/L,bilirubin index decreased significantly with statistical significance(P<0.01),no significant changes of bilirubin level differences between the two groups(P>0.05).Stent patency time of patients in the study group range from 2 to14.5 months,an average of 8.7 months;the stent patency time of control group range from 0.7 to 12.5 months,an average of 5.6 months,the difference was statistically significant(P<0.01);12 months after the operation,the survival rate were compared between two groups.40 cases died in experimental group(40/58,68.97%),36 cases died in control group(36/39,92.31%),The median survival time of the experimental group was9.8 months,the median survival time of the control group was 4.5 months,and the median survival time of the treatment group was significantly longer than that of the control group,the difference was statistically significant(c2=7.49,P<0.01).Conclusion: Biliary stenting is an effective method in the palliative treatment of malignant obstructive jaundice,the reasonable treatment and standardized operation during perioperative period are crucial to reduce the incidence of complications.Biliary stenting combined with125 I radioactive seeds strip implantation can significantly prolong the time of restenosis and the survival time of patients than conventional biliary. |
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