Retrospective Review of Bile Duct Stent Insertion with Different Pathway in Treatment of Malignant Biliary Obstruction with 42 Cases_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

LI Haiyang , SUN Chengyi , PAN Yaozhen , HAN Min , LIU Xinggui , YANG Nenghong , HU Kang , HU Yun.

Department of Hepatobiliary Surgery, Affiliated Hospital of Guiyang Medical College, Guiyang 550004, ChinaCorresponding Author: LI Hai-yang, E-mail: haiyang_li@sina.com.cn;

Corresponding author：

Keywords：

Biliary stent; Malignant biliary obstruction; Percutaneous transhepatic cholangial drainage; Endoscopic retrograde cholangiopancreatography

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Objective 　To discuss the value of biliary stent in treatment of malignant biliary obstruction with different pathways of bile duct stent insertion.
Methods 　Fourty-two cases of malignant biliary obstruction whose biliary stent insertions were through operation (n=18), PTCD (n=17) and ERCP (n=7) respectively were reviewed retrospectively.
Results　 The bile duct stents were successfully inserted in all patients through the malignant obstruction and achieved internal biliary drainage. Compared with the level of the bilirubin before operation, it decreased about 100 μmol/L one week after the stent insertion in all patients. Compared with the levels of glutamic oxalacetic transaminase, glutamic pyruvic transaminase, alkaline phosphatase and glutamyltranspeptidase before operation, they decreased 1 week after the stent insertion （P lt;0.05). The median survival time was 22 weeks. The average survival time was (32.89±33.87) weeks. Two patients died in hospital after PTCD, and the mortality was 4.76%. Complications included 8 cases of cholangitis, 3 cases of bile duct hemorrhage and 2 cases of hepatic failure.
Conclusion 　The bile duct stent insertions through operation, PTCD and ERCP are all effective in relieving the bile duct construction with malignant biliary obstruction. Each method should be chosed according to the systemic and local condition for every patient so as to improve the safety and efficiency, and to decrease the occurrence of complications.

Citation： LI Haiyang,SUN Chengyi,PAN Yaozhen,HAN Min,LIU Xinggui,YANG Nenghong,HU Kang,HU Yun.. Retrospective Review of Bile Duct Stent Insertion with Different Pathway in Treatment of Malignant Biliary Obstruction with 42 Cases. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2009, 16(4): 300-303. doi: Copy

1.	Han YM, Jin GY, Lee SO, et al. Flared polyurethane-covered self-expandable nitinol stent for malignant biliary obstruction [Ｊ]. J Vasc Interv Radiol, 2003; 14(10): 1291-1301．.
2.	王欣，孙志为，李新宇. 开腹手术放置胆道支架治疗晚期恶性梗阻性黄疸疗效观察 [Ｊ]. 中国误诊学杂志, 2005; 5（12）: 2252-2253．.
3.	胡冰, 周岱云, 龚彪, 等. 1 215例次恶性胆管梗阻内镜治疗的体会 [Ｊ]. 中华外科杂志， 2001; 39(3): 195-198．.
4.	黄晓东, 范彦, 张姮, 等. 内镜下胆道支架置入术治疗恶性胆道梗阻122例 [Ｊ]. 世界华人消化杂志, 2008；　16（28）: 3234-3237．.
5.	Hammarstrm LE. Endobiliary stents for palliation in patients with malignant obstructive jaundice [Ｊ]. J Clin Gastroenterol, 2005; 39(5): 413．.
6.	D’alincourt A, Hamy A, Thibaud C, et al. Malignant obstructive jaundice: the role of percutaneous metallic stents [Ｊ]. Gastroenterol Clin Biol， 2000; 24(8-9): 770-775．.
7.	Inal M, Akgül E, Aksungur E, et al. Percutaneous placement of biliary metallic stents in patients with malignant hilar obstruction: unilobar versus bilobar drainage [Ｊ]. J Vasc Interv Radiol， 2003; 14(11): 1409-1416．.
8.	谢宗贵, 苑青龙, 赵琦, 等. 经皮经肝内支架植入治疗恶性胆道梗阻（附35例报告） [Ｊ]. 介人放射学杂志, 1998; 7(3): 138-1４０．.
9.	Singh SM, Longmire WP Jr, Reber HA. Surgical palliation for pancreatic cancer. The UCLA experience [Ｊ]. Ann Surg， 1990; 212(2): 132-139.
10.	倪泉兴, 杨峰. 规范诊治，努力提高胰腺癌的远期生存率 [Ｊ]. 中国普外基础与临床杂志, 2006; 13(5): 493-495.
11.	邹声泉. 胆管癌外科治疗的现状与展望 [Ｊ]. 中国普外基础与临床杂志, 2008; 15（2）: 77-79.
12.	戴放, 黄信华, 陈勇, 等. 胆道支架与外科分流术姑息性治疗恶性梗阻性黄疸临床疗效对比分析 [Ｊ]. 中华肝胆外科杂志, 2001; ７(2): 100-102.
13.	Koyama K, Takagi Y, Ito K, et al. Experimental and clinical studies on the effect of biliary drainage in obstructive jaundice [Ｊ]. Am J Surg， 1981; 142(2): 293-299.
14.	Indar AA, Lobo DN, Gilliam AD, et al. Percutaneous biliary metal wall stenting in malignant obstructive jaundice [Ｊ]. Eur J Gastroenterol Hepatol， 2003; 15(8): 915-919.
15.	Urbach DR, Bell CM, Swanstrom LL, et al. Cohort study of surgical bypass to the gallbladder or bile duct for the palliation of jaundice due to pancreatic cancer [Ｊ]. Ann Surg, 2003; 237(1): 86-93.
16.	Oikarinen H, Leinonen S, Karttunen A, et al. Patency and complications of percutaneously inserted metallic stents in malignant biliary obstruction [Ｊ]. J Vasc Interv Radiol, 1999; 10(10): 1387-1393.
17.	夏焱，朱玉华，张彪. 经内镜放置自膨式不带膜金属支架治疗胆管中下段恶性狭窄的疗效观察 [Ｊ]. 中国普外基础与临床杂志， 2004; 11（2）: 151-153.
18.	李晓林，崔毅，李初俊，等. 内镜下置入金属支架对恶性胆道梗阻的姑息治疗 [Ｊ]. 中国内镜杂志， 2003; 11（3）: 288-290.
19.	Pedersen FM, Lassen AT, Schaffalitzky de Muckadell OB. Randomized trial of stent placed above and across the sphincter of Oddi in malignant bile duct obstruction [Ｊ]. Gastrointest Endosc, 1998; 48(6): 574-579.
20.	张文，施维锦，姜广杰，等. 影响阻塞性黄疸预后的多因素分析 [Ｊ]. 肝胆胰外科杂志， 1997; 9（3）: 109-111.
21.	白钢，马元桂. 肝门胆管癌预后与胆道引流关系的探讨 [Ｊ]. 中国普外基础与临床杂志, 2000; 7（2）: 89-90.

1. Han YM, Jin GY, Lee SO, et al. Flared polyurethane-covered self-expandable nitinol stent for malignant biliary obstruction [Ｊ]. J Vasc Interv Radiol, 2003; 14(10): 1291-1301．.
2. 王欣，孙志为，李新宇. 开腹手术放置胆道支架治疗晚期恶性梗阻性黄疸疗效观察 [Ｊ]. 中国误诊学杂志, 2005; 5（12）: 2252-2253．.
3. 胡冰, 周岱云, 龚彪, 等. 1 215例次恶性胆管梗阻内镜治疗的体会 [Ｊ]. 中华外科杂志， 2001; 39(3): 195-198．.
4. 黄晓东, 范彦, 张姮, 等. 内镜下胆道支架置入术治疗恶性胆道梗阻122例 [Ｊ]. 世界华人消化杂志, 2008；　16（28）: 3234-3237．.
5. Hammarstrm LE. Endobiliary stents for palliation in patients with malignant obstructive jaundice [Ｊ]. J Clin Gastroenterol, 2005; 39(5): 413．.
6. D’alincourt A, Hamy A, Thibaud C, et al. Malignant obstructive jaundice: the role of percutaneous metallic stents [Ｊ]. Gastroenterol Clin Biol， 2000; 24(8-9): 770-775．.
7. Inal M, Akgül E, Aksungur E, et al. Percutaneous placement of biliary metallic stents in patients with malignant hilar obstruction: unilobar versus bilobar drainage [Ｊ]. J Vasc Interv Radiol， 2003; 14(11): 1409-1416．.
8. 谢宗贵, 苑青龙, 赵琦, 等. 经皮经肝内支架植入治疗恶性胆道梗阻（附35例报告） [Ｊ]. 介人放射学杂志, 1998; 7(3): 138-1４０．.
9. Singh SM, Longmire WP Jr, Reber HA. Surgical palliation for pancreatic cancer. The UCLA experience [Ｊ]. Ann Surg， 1990; 212(2): 132-139.
10. 倪泉兴, 杨峰. 规范诊治，努力提高胰腺癌的远期生存率 [Ｊ]. 中国普外基础与临床杂志, 2006; 13(5): 493-495.
11. 邹声泉. 胆管癌外科治疗的现状与展望 [Ｊ]. 中国普外基础与临床杂志, 2008; 15（2）: 77-79.
12. 戴放, 黄信华, 陈勇, 等. 胆道支架与外科分流术姑息性治疗恶性梗阻性黄疸临床疗效对比分析 [Ｊ]. 中华肝胆外科杂志, 2001; ７(2): 100-102.
13. Koyama K, Takagi Y, Ito K, et al. Experimental and clinical studies on the effect of biliary drainage in obstructive jaundice [Ｊ]. Am J Surg， 1981; 142(2): 293-299.
14. Indar AA, Lobo DN, Gilliam AD, et al. Percutaneous biliary metal wall stenting in malignant obstructive jaundice [Ｊ]. Eur J Gastroenterol Hepatol， 2003; 15(8): 915-919.
15. Urbach DR, Bell CM, Swanstrom LL, et al. Cohort study of surgical bypass to the gallbladder or bile duct for the palliation of jaundice due to pancreatic cancer [Ｊ]. Ann Surg, 2003; 237(1): 86-93.
16. Oikarinen H, Leinonen S, Karttunen A, et al. Patency and complications of percutaneously inserted metallic stents in malignant biliary obstruction [Ｊ]. J Vasc Interv Radiol, 1999; 10(10): 1387-1393.
17. 夏焱，朱玉华，张彪. 经内镜放置自膨式不带膜金属支架治疗胆管中下段恶性狭窄的疗效观察 [Ｊ]. 中国普外基础与临床杂志， 2004; 11（2）: 151-153.
18. 李晓林，崔毅，李初俊，等. 内镜下置入金属支架对恶性胆道梗阻的姑息治疗 [Ｊ]. 中国内镜杂志， 2003; 11（3）: 288-290.
19. Pedersen FM, Lassen AT, Schaffalitzky de Muckadell OB. Randomized trial of stent placed above and across the sphincter of Oddi in malignant bile duct obstruction [Ｊ]. Gastrointest Endosc, 1998; 48(6): 574-579.
20. 张文，施维锦，姜广杰，等. 影响阻塞性黄疸预后的多因素分析 [Ｊ]. 肝胆胰外科杂志， 1997; 9（3）: 109-111.
21. 白钢，马元桂. 肝门胆管癌预后与胆道引流关系的探讨 [Ｊ]. 中国普外基础与临床杂志, 2000; 7（2）: 89-90.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Retrospective Review of Bile Duct Stent Insertion with Different Pathway in Treatment of Malignant Biliary Obstruction with 42 Cases

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