Percutaneous Transhepatic Biliary Drainage for the Treatment of Obstructive Jaundice Caused by Metastases from Nonbiliary and Nonpancreatic Cancers

The usefulness of percutaneous transhepatic biliary drainage(PTBD) in the treatment of obstructive jaundice caused by metastasesfrom nonbiliary and nonpancreatic cancers was evaluated. Eighteenpatients underwent PTBD during a 3-year period. The primarycancers were located in the stomach (nine cases), colon (four),lung (three), uterus (one), and breast (one). The causes ofobstructive jaundice and bile duct strictures were investigatedusing both abdominal computed tomography and abdominal ultrasonography.The causes of obstructive jaundice, the usefulness of PTBD interms of the relief of symptoms and laboratory data, survivalafter PTBD, and the relationship between patient characteristicsand survival were evaluated. Obstructive jaundice was most oftenattributable to metastases to the lymph nodes (17 of 18 cases).One case was attributed to metastasis to the liver. PTBD decreasedthe jaundice and relieved the symptoms caused by biliary tractobstruction. Median survival after PTBD was 59 days. Patientswhose performance status was 2 or less survived longer thanthose with a performance status of 3 or more (P = 0.018). Furthermore,patients aged less than 60 years tended to survive longer thanthose aged 60 or over (P = 0.057). Our results suggest thatPTBD is useful for relief of symptoms caused by obstructivejaundice in patients with nonbiliary and nonpancreatic cancers.     

超声引导经皮经肝胆管置管引流术在胆道梗阻疾病中的应用

目的评价超声引导经皮经肝胆管置管引流术在无手术适应证胆道梗阻疾病中的应用价值及疗效判断。方法本组39例,男22例,女17例。平均年龄51.2岁。使用自制穿刺辅助装置,日本八光S型引流套管（8F）。选择内径≥10 mm、走行较平坦、无扭曲的胆管为穿刺点,胆管周围加以彩色血流成像并注意避开血管。成功置管的38例中33例行左胆管置管,5例右胆管置管。结果39例除1例因术中出血未成功外,38例均成功置管,随访未发现胆漏、出血、感染等并发症。引流胆汁后患者症状明显改善,血清胆红素逐渐下降,其中6例降至正常。本组胆汁日引流量380～1400 ml。38例中术后生存2～5个月8例、〉6个月15例、〉9个月11例、〉1年4例,最长生存期17个月。结论超声引导肝胆管置管引流,操作简便、痛苦小、成功率高,使患者得到了持续性胆汁引流的机会,对改善梗阻导致的黄疸,减轻由其产生的损害和症状,延长患者生存期及提高晚期生存质量将起到重要的积极作用。     

PTC与PTBD在恶性梗阻性黄疸诊断治疗上的应用

本文报告对肿瘤性黄疸病人行PTC86例,PTBD30例的临床体会。指出PTC方法简单、成功率高、合并症少。PTBD治疗梗阻黄疸作用分为术前减黄和姑息外引流两方面。尤其是不需X线设备,床旁体表定位下的PTBD17例,15例成功,更为简便、合并症少,对梗阻性黄疸有治疗价值。作者建议,对肿瘤性黄疸病人采用以下诊治步骤:B超→ERCP→床旁PTBD→经管造影,决定治疗方案为进一步手术治疗或永久带管外引流,提供有力依据。     

Comparison of Infection between Internal-External and External Percutaneous Transhepatic Biliary Drainage in Treating Patients with Malignant Obstructive Jaundice

Purpose: Percutaneous transhepatic biliary drainage (PTBD) is a form of palliative care for patientswith malignant obstructive jaundice. We here compared the infection incidence between internal-externaland external drainage for patients with malignant obstructive jaundice. Methods: Patients with malignantobstructive jaundice without infection before surgery receiving internal-external or external drainage fromJanuary 2008 to July 2014 were recruited. According to percutaneous transhepatic cholangiography (PTC), ifthe guide wire could pass through the occlusion and enter the duodenum, we recommended internal-externaldrainage, and external drainage biliary drainage was set up if the occlusion was not crossed. All patients withinfection after procedure received a cultivation of blood and a bile bacteriological test. Results: Among 110patients with malignant obstructive jaundice, 22 (52.4%) were diagnosed with infection after the procedure inthe internal-external drainage group, whereas 19 (27.9%) patients were so affected in the external drainagegroup, the difference being significant (p<0.05). In 8 patients (36.3%) in the internal-external group infectionwas controlled, as compared to 12 (63.1%) in the external group (p< 0.05). The mortality rate for patients withinfection not controlled in internal-external group in one month was 42.8%, while this rate in external group was28.6% (p< 0.05). Conclusion: External drainage is a good choice, which could significantly reduce the chance ofbiliary infection caused by bacteria, and decrease the mortality rate at one month and improve the long-termprognosis.     

经皮经肝胆管引流术与ERCP对接术治疗恶性梗阻性黄疸

目的探讨经皮经肝胆管引流术(PTBD)与ERCP对接术治疗恶性肿瘤导致的梗阻性黄疸的技术特点和临床效果。方法总结因恶性肿瘤导致的梗阻性黄疸患者ERCP失败后,实施PTBD与ERCP对接胆道支架植入术的治疗方法与临床效果。结果17例PTBD与ERCP对接治疗恶性梗阻性黄疸均获得成功。其中采取右侧肝管穿刺8例,左侧肝管9例;一次性对接成功14例,分次进行3例;术后4天血清总胆红素水平下降46.89%;血清直接胆红素水平下降43.05%。主要并发症为围手术期的胆道感染。结论PTBD与ERCP对接术是治疗ERCP失败的恶性梗阻性黄疸的另一新方法,具有良好的临床应用价值。     

表阿霉素在恶性梗阻性黄疸治疗中的应用

目的 探讨表阿霉素治疗恶性梗阻性黄疸（MOJ）的安全性和可行性。方法39例MOJ患者接受胆道支架置放术或经皮穿肝胆道引流术（PTBD）后,血清胆红素未降至正常水平即接受动脉化疗栓塞术（TACE）。TACE方案：法玛新30mg／m^2和超液化碘油混合成乳剂。参照WHO抗癌药物毒性分级标准观察毒性反应,Child-Putgh分级观察肝脏损害。随访患者黄疸复发时间和生存期。结果39例MOJ患者TACE术前血清总胆红素浓度为52．1-91．4μmol／L,中位值72．7μmol／L。表阿霉素总量40-60mg,中位值55．0mg,超液化碘油2～25ml。白细胞计数下降：Ⅰ度41．0％,Ⅱ度35．9％,Ⅲ-Ⅳ度15．4％;恶心呕吐：Ⅲ～Ⅳ度100％。肝脏Child-Pugh分级：8例由A级升至B级,1例由A级升至C级,3例由B级升至C级。全部患者未出现心脏毒性。39例患者的生存期为2～72个月,中位值6．0个月。19例黄疸复发,复发率48．7％,黄疸复发时间2～20个月,中位值9．0个月。结论MOJ患者行有效引流后,即使胆红素未降至正常水平,用30mg／m^2表阿霉素和超液化碘油乳剂进行单纯化疗栓塞治疗原发病灶是安全和有效的。     

Analysis of Different Ways of Drainage for Obstructive Jaundice Caused by Hilar Cholangiocarcinoma

Objective: To evaluate the prognosis of different ways of drainage for patients with obstructive jaundicecaused by hilar cholangiocarcinoma. Materials and Methods: During the period of January 2006- March 2012,percutaneous transhepatic catheter drainage (PTCD)/ percutaneous transhepatic biliary stenting (PTBS) wereperformed for 89 patients. According to percutaneous transhepatic cholangiography (PTC), external drainagewas selected if the region of obstruction could not be passed by guide wire or a metallic stent was inserted if itcould. External drainage was the first choice if infection was diagnosed before the procedure, and a metallicstent was inserted in one week after the infection was under control. Selection by new infections, the degree ofbilirubin decrease, the change of ALT, the time of recurrence of obstruction, and the survival time of patients asthe parameters was conducted to evaluate the methods of different interventional treatments regarding prognosisof patients with hilar obstruction caused by hilar cholangiocarcinoma. Results: PTCD was conducted in 6 patientsand PTBS in 7 (p<0.05). Reduction of bilirubin levels and ALT levels was obvious after the procedures (p<0.05).The average survival time with PTCD was 161 days and with PTBS was 243 days (p<0.05). Conclusions: Withboth drainage procedures for obstructive jaundice caused by hilar cholangiocarcinoma improvement in liverfunction was obvious. PTBS was found to be better than PTCD for prolonging the patient survival.     

经皮胆道内支架置入术姑息性治疗恶性梗阻性黄疸临床观察

目的研究经皮胆道内支架置入术姑息性治疗恶性梗阻性黄疸的临床价值。方法28例恶性梗阻性黄疸接受经皮经肝胆道内支架置入术,男18例,女10例。胆管癌13例,胰头癌4例,胆囊癌3例,肝门区转移癌8例。共置入胆道内28枚金属内支架。结果28例采用经皮经肝穿刺置入胆道内支架均获得成功。结论经皮胆道内支架置入术是姑息治疗手术不能切除的恶性梗阻性黄疸的有效方法,配合动脉内灌注化疗可提高恶性阻塞患者的生存率。     

Drainage Alone or Combined with Anti-tumor Therapy for Treatment of Obstructive Jaundice Caused by Recurrence and Metastasis after Primary Tumor Resection

Aim: To compare drainage alone or combined with anti-tumor therapy for treatment of obstructive jaundicecaused by recurrence and metastasis after primary tumor resection. Materials and Methods: We collect 42 patientswith obstructive jaundice caused by recurrence and metastasis after tumor resection from January 2008 - August2012, for which percutaneous transhepatic catheter drainage (pTCD)/ percutaneous transhepatic biliary stenting(pTBS) were performed. In 25 patients drainage was combined with anti-tumor treatment, antineoplastic therapyincluding intra/postprodure local treatment and postoperative systemic chemotherapy, the other 17 undergoingdrainage only. We assessed the two kinds of treatment with regard to patient prognosis. Results: Both treatmentsdemonstrated good effects in reducing bilirubin levels in the short term and promoting liver function. The timeto reobstruction was 125 days in the combined group and 89 days in the drainage only group; the mean survivaltimes were 185 and 128 days, the differences being significant. Conclusions: Interventional drainage in thetreatment of the obstructive jaundice caused by recurrence and metastasis after tumor resection can decreasebilirubin level quickly in a short term and promote the liver function recovery. Combined treatment prolongsthe survival time and period before reobstruction as compared to drainage only.     

Every-other-day TS-1 administration for recurrent or non-curative advanced gastric carcinoma

We report 3 cases in which palliation was achieved with every-other-day administration of TS-1 for recurrent or non-curative advanced gastric carcinoma that had resulted in obstructive jaundice. Two patients had received MTX-5-FU chemotherapy as first-line therapy and showed progressive disease, presenting with obstructive jaundice 6-24 months later. One of them experienced obstructive jaundice 2 months after surgery. After lowering serum bilirubin via per-cutaneous transhepatic biliary drainage (PTBD), TS-1 was given not in full dose but every other day based upon Shirasaka's theory, as well as for fear of further liver damage. Palliation in terms of long NC and/or decreased serum CEA level persisted for 4-14 months without severe liver dysfunction. Other side effects of the drug were negligible. Shirasaka's theory stresses the difference in proliferation cycles between cancer cells and normal tissue cells (GI tract, bone marrow, etc.); therefore, with every-other-day administration of chemotherapeutic agents, the cytotoxic effects against tumors would be augmented while the adverse reactions in normal cells could be reduced. The present experience seems to support the theoretical and clinical feasibility of every-other-day TS-1 administration for unresectable gastric cancer.     

Outcomes in percutaneous stenting of non‐hepato‐biliary/pancreatic malignant jaundice

MELLER M.T., ARTS G.R.J. & DEAN J.R. (2010) European Journal of Cancer Care 19 , 664–668 Outcomes in percutaneous stenting of non‐hepato‐biliary/pancreatic malignant jaundice The aim of this study is to review the practice and outcomes at our institution of percutaneous transhepatic placement of metallic biliary stents for non‐hepato‐biliary/pancreatic (non‐HBP) malignant obstructive jaundice. A retrospective review was performed of the records of all patients undergoing transhepatic stenting for non‐HBP malignant obstructive jaundice over a 7‐year period. A total of 25 patients were successfully stented and linear regression analysis of a variety of demographic, clinical and laboratory markers against survival was performed. Survival after stenting varied from 1 to 1354 days (median 58, mean 152). An initial bilirubin level less than 300 µmol/L (P= 0.01) and a reduction of greater than 50% in bilirubin post stenting (P= 0.02) were strong predictors of improved survival. Older patients survived longer than younger ones (P < 0.01). There was a weak association of survival with an albumin >30 g/L (P= 0.06), but no statistically significant correlation with creatinine or haemoglobin levels or active tumour treatment after stenting. There were few major complications from the procedures. Transhepatic metallic biliary stenting for non‐HBP malignant biliary obstruction is a safe and effective procedure, and with careful patient selection, significant periods of survival and palliation of jaundice can be achieved.     

分步介入综合治疗巨大胰头癌30例临床分析

目的 :分析经皮经肝胆道引流 (PTBD)并药盒系统介入化疗分步治疗巨大胰头癌的效果。方法 :4 0例大胰头癌 ( >6cm ,均伴有黄疸 )患者随机分成 2组 :A组 30例采用综合介入治疗 ,先行B超及X线辅助下的PTBD以减轻黄疸 ,恢复肝功能。 10d～ 1个月后进行胃、十二指肠动脉药盒系统植入介入化疗 ,通过药盒定期给予 5 氟脲嘧啶、丝裂霉素、阿霉素化疗。B组 10例作为对照在PTBD术后 10d～ 1个月采用静脉全身化疗 ,化疗方案同A组。结果 :4 0例患者均行PTBD ,患者血清总胆红素水平术后 1个月和 3个月分别下降 161± 2 9μmol/L和 2 61± 92cμmol/L ,转氨酶逐渐降至正常 ,A组 30例患者共行局部药盒系统化疗3～ 10次 ,平均 8 2次 ,完全缓解 (CR) 1例 ,部分缓解 (PR) 2 0例 ,有效率 70 % ,生存期 3～ 34个月 ,中位生存时间 13 5个月 ,所有患者症状均有不同程度好转 ,未发生严重并发症或者毒副反应。B组完成化疗 1～ 7次 ,平均 3 8次。无完全缓解病例 ,部分缓解 2例 ,有效率为 2 0 % ,生存期 1～ 13个月 ,中位生存时间 6 2个月。两组对比有效率和生存期差异显著。结论 :综合介入治疗大胰头癌效果好 ,患者生存期与生存质量均得到明显改善     

经皮经肝胆道引流治疗转移性胃癌并发阻塞性黄疸的疗效与并发症

Objective  

The aim of our study was to evaluate the efficacy and incidence of complications of percutaneous transhepatic biliary drainage (PTBD) as palliative treatment of obstructive jaundice caused by metastatic gastric cancer.     

减量化疗肝动脉栓塞治疗肝癌合并梗阻性黄疸的研究

目的研究减量化疗肝动脉栓塞治疗伴有梗阻性黄疸原发性肝癌的安全性及疗效。方法回顾性分析24例首选减量化疗肝动脉栓塞治疗的伴有梗阻性黄疸的原发性肝癌病例。患者均为单个肿瘤。结果 24例患者中位生存期为9.0月,1、2、3年的生存率分别为33.3%、22.2%、16.6%。单因素及多因素生存分析显示,肿瘤大小及AFP水平是生存时间影响因素（P〈0.05）,总胆红素水平不是影响生存的因素（P〉0.05）。24例患者术前总胆红素水平平均为70.5μmol/L,术后1月33.2μmol/L,较术前明显下降（P=0.006）。所有患者均无严重并发症发生。结论首选减量化疗肝动脉栓塞治疗伴有梗阻性黄疸的原发性肝癌是安全、有效的。     

胆管引流术与胆管支架置入术治疗恶性阻塞性黄疸的临床疗效比较

目的 比较经皮经肝胆管引流术(PTBD)和经皮经肝胆管支架置入术(PTBS)治疗恶性阻塞性黄疸的疗效.方法 210例阻塞性黄疸患者中,161例行PTBD,49例行PTBS.收集患者的临床资料,并通过电话随访或从患者复检记录中获取随访资料.结果 技术成功率为100%.术后3～5 d,PTBS组(15例)血清总胆红素(TB)下降了(178.04±42.32)μmol/L,血清直接胆红素(DB)下降了(83.97±23.63)μmol/L;PTBD组(28例)血清TB下降了(95.67±34.28)μmol/L,血清DB下降了(49.84±28.21)μmol/L,两组差异有统计学意义(P=0.017,P=0.035).术后6～9 d,PTBS组(28例)血清TB下降了(188.22±79.90)μmol/L,PTBD组(126例)下降了(141.39±65.32)μmol/L,两组差异有统计学意义(P=0.014);两组血清DB下降值差异无统计学意义(P=0.567).PTBD组和PTBS组的中位通畅期分别为60和197 d,中位生存期分别为148和245 d,两组比较差异均有统计学意义(均P<0.01).结论 FIBS治疗恶性阻塞性黄疽的近期和远期疗效均优于PTBD.     

Efficacy of percutaneous transhepatic cholangiodrainage (PTCD) in patients with unresectable pancreatic cancer

For patients with pancreatic cancer who suffer from obstructive jaundice, percutaneous transhepatic cholangiodrainage (PTCD) is the treatment of choice. However, there are no standards for palliative care for patients undergoing this treatment. The aim of this study was to retrospectively evaluate the efficacy of post-palliative treatment in patients with unresectable pancreatic cancer who were previously treated with PTCD. The 47 patients included in this study had unresectable pancreatic cancer, presented with obstructive jaundice, had no prior history of chemotherapy, and underwent PTCD. They were divided into two groups. Group A was composed of 21 patients who received post-palliative treatment (chemotherapy, radiation, or chemoradiotherapy). Group B consisted of 26 patients who were under best supportive care (BSC). We compared the median overall survival time between the two groups to evaluate the efficacy of post-palliative treatment. The median overall survival time (MOST) of patients undergoing PTCD was 7.19 months. MOST was 9.07 months for patients in group A (P?=?0.017 vs. group B) and 5.52 months for those in group B. Among the patients receiving post-palliative treatment, 12 (57 % of patients) received only a single therapy (either chemo or radiation), and 9 (43 %) received chemoradiotherapy. Their median overall survival times were 8.31 and 11.15 months, respectively (P?=?0.325). Post-palliative treatment in patients with unresectable pancreatic cancer previously treated with PTCD is more effective than only best supportive care alone. Patients receiving both chemo and radiation may benefit more in terms of overall survival compared to patients receiving only one or the other.     

Internal-External Percutaneous Transhepatic Biliary Drainage for Patients with Malignant Obstructive Jaundice

Purpose: To evaluate the effect of internal-external percutaneous transhepatic biliary drainage (IEPTBD)for patients with malignant obstructive jaundice. Methods: During the period of January 2008 and July 2013,internal-external drainage was performed in 42 patients with malignant obstructive jaundice. During theprocedure, if the guide wire could pass through the occlusion and into the duodenum, IEPTBD was performed.External drainage biliary catheter was placed if the occlusion was not crossed. Newly onset of infection, degreeof bilirubin decrease and the survival time of patients were selected as parameters to evaluate the effect ofIEPTBD. Results: Twenty newly onset of infection were recorded after procedure and new infectious rate was47.6%. Sixteen patients with infection (3 before, 13 after drainage) were uncontrolled after procedure, 12 ofthem (3 before, 9 after drainage) died within 1 month. The mean TBIL levels declined from 299.53 umol/L beforedrainage to 257.62 umol/L after drainage, while uninfected group decline from 274.86 umol/L to 132.34 umol/Lp(P < 0.5). The median survival time for uninfected group was 107 days, and for infection group was 43 days (P< 0.05). Conclusions: The IEPTBD drainage may increase the chance of biliary infection, reduce bile drainageefficiency and decrease the long-term prognosis, and the external drainage is a better choice for patients withmalignant obstructive jaundice need to biliary drainage.     

恶性梗阻性黄疸的介入治疗

目的 :探讨介入治疗恶性梗阻性黄疸的临床价值。方法 :31例恶性梗阻性黄疸患者先行PTCD( 17例 )及金属支架置入术 ( 14例 ) ,1周后行肝动脉灌注化疗或栓塞治疗。结果 :31例PTCD或胆道内支架置入后 ,血清总胆红素下降。 2例患者 2个月内死于与本治疗无关的原因。 2例支架再狭窄。所有病例均获随访 ,平均生存 9个月 ,最长 2 6个月。结论 :介入治疗恶性梗阻性黄疸是一种有效的方法 ;介入治疗可以延长恶性梗阻性黄疸患者的生存时间。     

经皮肝穿刺胆管引流联合三维适形放疗治疗肝门部癌伴梗阻性黄疸

目的观察经皮肝穿刺胆管引流（PTCD）联合三维适形放疗（3D-CRT）治疗肝门部癌伴梗阻性黄疸的临床疗效。方法对26例肝门部癌伴梗阻性黄疸患者行经PTCD,胆红素下降后行3D-CRT。结果 26例患者均引流成功,术后胆红素均较术前明显下降（P〈0.05）;行3D-CRT后总有效率73.08%,中位生存期14.5个月。全组无治疗相关的严重并发症。结论 PTCD联合3D-CRT治疗肝门部癌伴梗阻性黄疸近期疗效好,且安全性高。     

三维适形放疗治疗胃肠道恶性肿瘤转移引起的梗阻性黄疸疗效观察

目的探讨三维适形放疗（3DCRT）治疗胃肠道恶性肿瘤转移引起的梗阻性黄疸的疗效。方法 28例胃肠道恶性肿瘤转移引起梗阻性黄疸患者采用3DCRT技术放疗,必要时行经皮肝穿刺外引流术或胆道内支架植入术完成后续放疗,分割剂量为2.5Gy/次,5次/周,总剂量55～65Gy。结果 28例患者中,8例完全缓解（CR）,13例部分缓解（PR）,2例稳定（NC）,3例进展（PD）。2例放弃治疗。总有效率（CR＋PR）75.0%（21/28）。黄疸、上腹部疼痛、腹部包块、白陶土样大便缓解率分别为64.3%、89.4%、81.8%和75.0%。0.5,1,2年生存率分别为82.1%（23/28）、53.6%（15/28）和14.3%（4/28）。结论 3DCRT治疗胃肠道恶性肿瘤转移引起的梗阻性黄疸是一种安全、有效的治疗方法,近期疗效好,症状改善满意,远期疗效有待进一步探讨。