Clinical effect of biliary stenting combined with percutaneous transhepatic cholangial drainage in treatment of different types of malignant obstructive jaundice

Objective To investigate the clinical effect and surgical experience of percutaneous transhepatic cholangial drainage (PTCD) combined with biliary stenting in patients with different types of malignant obstructive jaundice (MOJ) .Methods A retrospective analysis was performed for the early clinical outcomes of 185 patients with MOJ who were admitted to Beijing Air Force General Hospital from July2013 to July 2018 and underwent PTCD combined with biliary stenting.Major observation indices included location and type of obstruction, related hematological parameters before surgery and at 3-5 and 6-10 days after surgery, including total bilirubin (TBil) , direct bilirubin (DBil) , alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, and gamma-glutamyl transpeptidase, and stent implantation.The t-test was used for comparison of normally distributed continuous data between two groups, and an analysis of variance was used for comparison between three groups;the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups, and the Kruskal-Wallis H test was used for comparison between three groups.The chi-square test was used for comparison of categorical data between groups.Results Of all 185 patients, 102 had low-level obstruction, 75 had high-level obstruction, 4had complete biliary obstruction, and 4 had anastomotic obstruction.All patients underwent PTCD+biliary stenting successfully, and catheter drainage was performed with a technical success rate of 100%.A total of 233 stents were implanted for 185 patients, and all patients had reduced jaundice, increased appetite, and improved liver function after surgery, among whom 146 had marked response and 39 had response.The patients with low-level obstruction had a significantly better surgical outcome than those with high-level obstruction (χ2=10.866, P=0.001) .There was no significant difference in bilirubin between the patients with type I high-level obstruction who underwent single-stent drainage and those who underwent double-stent drainage before and after surgery (P>0.05) .The patients with typeⅡ/Ⅲ/Ⅳhigh-level obstruction who underwent double-stent drainage had a significantly better outcome than those underwent single-stent drainage (χ2=6.412, P=0.011) , as well as significantly lower levels of TBil and DBil at 6-10 days after stent drainage (t=2.62 and2.06, P<0.05) .ConclusionPTCD combined with biliary stenting can improve liver function, appetite, and quality of life in patients with MOJ, and patients with low-level obstruction have significantly better outcomes than those with high-level obstruction.Double-stent drainage is recommended for patients with typeⅡ/Ⅲ/Ⅳhigh-level obstruction.Biliary stenting also has a good clinical effect in patients with complete biliary obstruction and anastomotic obstruction, and biliary and duodenal stenting can be performed for patients with biliary obstruction combined with duodenal obstruction.