A Study On The Right Single Channel Biliary Double Stent Implantation With Internal Drainage In Malignant High Biliary Obstruction Of Aged Patients And Geriatric Multimorbidity

Objective:To explore the application value and GM of bilateral double channel and right single channel BDSI drainage in old patients with MHBO and provide the theoretical basis for the selection of old MHBO biliary stent implantation methods and GM management and prevention.Methods:Retrospective analysis of 87 elderly MHBO patients.In group A,23 cases of DSA underwent bilateral approach of puncturing the right hepatic and left hepatic bile ducts respectively and establishing the right hepatic and left hepatic biliary stent-graft channels.In group B,64 cases of DSA underwent transrectal right hepatic bile duct puncture through the right approach and BDSI was performed on the right hepatic monobiliary stent implantation channel.The types and numbers of preoperative and postoperative liver biochemical indicators(ALT,AST,TBIL,DBIL)and the incidence of recent complications were recorded.The utility was TBIL descending over 50% on the 21 st day after operation.Results:1.There was no significant difference in comorbidity and comorbidity between the two groups(P>0.05).The first three cases of comorbid diseases were high blood pressure accounted for 44.83%,coronary heart disease 39.08%,diabetes 33.33%,merger of a disease 18.39%,two diseases 45.98%,three diseases 24.14%.2.There was no significant difference in liver biochemical indexes(ALT,AST,TBIL,DBIL)between the two groups before operation 3 days and on the 7th and 14 th day after intervention(P>0.05).3.The levels of liver biochemical indexes(ALT,AST,TBIL,DBIL)in the two groups before intervention were respectively compared with the 7th and 14 th days after operation,and there was significant difference(P<0.001).4.There was no significant difference in the level of TBIL between the two groups on the 21 st day after intervention(P>0.05).The TBIL level on the 21 st day after the intervention in both groups was significantly lower than that before intervention(P<0.001).In group A,the percentage of patients decreased 92.25% compared with that before intervention and in group B 90.87% compared with those before intervention.The effective rate was 100% in both groups.5.Group A was significantly higher than group B about puncture point pain,biliary reflex,biliary bleeding,biliary tract infection and the rate of bile leakage,and the differences were statistically significant(P<0.05).In the two groups of patients with bacteremia,extrahepatic drainage tube effusion and the incidence of displacement,the difference was not statistically significant(P>0.05).6.There was no significant difference in the incidence of comorbid comorbidity between the two groups except for the biliary heart reflex(P>0.05).The incidence of biliary and cardiac reflex in the two groups of patients with coronary heart disease(34 cases)during PCI was significantly higher than that in patients without coronary heart disease(53 cases),the difference was statistically significant(P<0.05).Conclusion: BDSI drainage within the right side of the single-channel operation which is the preferred method of treatment of elderly MHBO reduces trauma and postoperative complications.EPWC have more comorbidities,the monitor and treatment of intraoperative bile heart reflex were the important measure to ensure biliary stent implantation successful,the strengthening of GM management and preventive treatment after surgery were the important guarantee to improve EPWC expected results and life expectancy.