Malignant biliary obstruction: treatment with interventional radiology.
- Author:
Renyou ZHAI
1
;
Xiaojun QIAN
;
Dingke DAI
;
Ping YU
Author Information
- Publication Type:Journal Article
- MeSH: Adult; Aged; Aged, 80 and over; Bile Duct Neoplasms; complications; Cholangiocarcinoma; complications; Cholestasis; diagnostic imaging; therapy; Drainage; Female; Humans; Liver Neoplasms; complications; Male; Middle Aged; Palliative Care; Pancreatic Neoplasms; complications; Radiography, Interventional; Stents
- From: Chinese Medical Journal 2003;116(6):888-892
- CountryChina
- Language:English
-
Abstract:
OBJECTIVETo evaluate the method of palliative drainage by means of metallic indwelling stents or plastic tubes for patients with malignant biliary obstruction.
METHODSFrom January 1995 to February 2001, 243 consecutive patients (161 men and 82 women; aged 26 - 91 years, mean of 61.3 years) with malignant biliary obstruction were treated with transhepatic placement of metallic stents and/or plastic tubes. Among them, 47 patients had pancreatic carcinoma, 98 cholangiocarcinoma, 28 metastatic carcinoma and 60 hepatic carcinoma. 169 stents of nine types were used in this series. After stenting, 47 patients were treated for local tumors. Procedure- and device-related complications were recorded. Patient survival and stent patency rates were calculated with Kaplan-Meier survival analysis.
RESULTSOne hundred and three patients underwent successfully stent placement for the first time. Others had their stents installed 1 - 2 weeks after catheterization. Stents were used in 132 patients. Ninety-five patients were treated with a single stent. Seventeen patients had two stents installed for bilateral drainage, 20 patients had two stents installed from top to bottom to create stenting of adequate length, and 12 patients had stents placed across the ampulla. The 2-month mortality rate was 8.64% (21/243). Major complications occurred in two patients (0.8%, 2/243). Minor complications included self-limited bleeding into the drainage tubes and fever. The average patency of the initial stent was 7.5 months and average survival was 9 months. Thirteen patients received brachytherapy in their stents, 15 extra radiation therapy, and 19 intra-arterial infusion chemotherapy. The 47 patients treated for local tumors had an average survival of 11.3 months (log rank 32.8, P < 0.001) with an average patency of 9.7 months (log rank 4.7, P < 0.05).
CONCLUSIONPercutaneous transhepatic bile drainage as a palliative procedure is well tolerated by patients. After stenting, treatment for local tumor may prolong the duration of stent patency and the survival of patients.
