ObjectiveTo study the diagnostic value of imaging examinations and their accuracy in evaluating the malignant obstructive jaundice and their resectability. MethodsThe clinical data of 674 malignant obstructive jaundice within 10 years were collected and analyzed.ResultsFor BUS, CT, PTC, ERCP and MRCP, the preoperative accuracy in malignant obstructive jaundice were 74.0%, 86.5%, 88.4%, 92.9% and 94.0%, while the ratio of actual removals in those who had been assessed removable preoperatively were 63.4%, 68.5%, 86.8%, 87.3% and 93.9%, respectively. Conclusion MRCP， PTC, CT and ERCP are better than BUS in the diagnosis of malignant obstructive jaundice (P＜0.05 vs. P＜0.01), while MRCP，ERCP and PTC are much better than BUS and CT in evaluating resectability (P＜0.01). Combination of two or more imaging examinations can improve the accuracy of preoperative diagnosis and assessing resectability.
Objective To explore the influencing factors of palliation efficacy in malignant obstructive jaundice. Methods Clinical data of 107 patients with malignant obstructive jaundice who treated in Department of General Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, from March 2014 to December 2017, were retrospectively collected to analyze the influencing factors of palliation efficacy in 1 week and1 month after operation. Results Multivariate analysis results showed that, hilar obstruction and preoperative albumin level were influencing factors of palliation efficacy in 1 week after operation (P<0.05), patients with hepatic portal obstruction, and low preoperative albumin level had poor effect; hilar obstruction, preoperative albumin and total bilirubin level were influencing factors of palliation efficacy in 1 month after operation (P<0.05), patients with hepatic portal obstruction, low preoperative albumin level, and high total bilirubin level had poor effect. Conclusions The obstruction location, preoperative albumin level, and total bilirubin level are the independent influencing factors of palliation efficacy which played an important role in prognostic assessment.
Objective To compare the therapeutic effect of percutaneous transhepatic cholangial drainage (PTCD) and operation drainage for the patients with inoperable malignant obstructive jaundice. Methods A total of 131 patients with inoperable malignant obstructive jaundice were treated in this hospital, in which 102 patients had PTCD by placement of metallic stent and (or) plastic tubes to remove obstruction of bile duct (interventional treatment group). Simultaneously 29 patients were selected for operation by intraexternal drainage (operation drainage group). The patients were followed up for comparison of the serum level of total bilirubin, postoperative complications, average length of hospitalization and average cost between the two groups. Results PTCD was successfully performed in all the patients of the interventional treatment group. There were no significant differences of 50% decrease period of average total bilirubin level or postoperative complications between the two groups (Pgt;0.05). The average length of hospitalization and average cost of interventional treatment group were less than those of operation drainage group (Plt;0.05). Conclusions Compare with operation drainage, interventional treatment can reduce average length of hospitalization and average cost, without increase of postoperative complications, which is a main chance of treatment for malignant obstructive jaundice.
ObjectiveTo compare clinical effect of biliary metallic stent implantation via endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous transhepatic cholangial drainage (PTCD) approaches in treatment of malignant obstructive jaundice. MethodsOne hundred and thirty-six patients with malignant obstructive jaundice who received the biliary metallic stent implantation from June 2010 to June 2015 in this hospital were selected. There were 53 cases via ERCP approach (ERCP group), in which 44 patients with low malignant obstructive jaundice, 9 patients with high malignant obstructive jaundice. There were 83 cases via PTCD approach (PTCD group), in which 24 patients with low malignant obstructive jaundice, 59 patients with malignant obstructive jaundice. The surgical success rate, effective rate, incidence of postoperative complications, hospital stay, and hospitalization expenses were compared in these two groups. Results① The total surgical success rate had no significant difference between the ERCP group and the PTCD group (P > 0.05). The surgical success rate of the patients with low malignant obstructive jaundice had no significant difference between the ERCP group and PTCD group (P > 0.05), which of the patients with high malignant obstructive jaundice in the ERCP group was significantly lower than that in the PTCD group (P < 0.05). ② The total effective rate had no significant difference between the ERCP group and PTCD group (P > 0.05), which of the patients with low malignant obstructive jaundice in the ERCP group was significantly higher than that in the PTCD group (P < 0.05), which of the patients with high malignant obstructive jaundice in the ERCP group was significantly lower than that in the PTCD group (P < 0.05). ③ The hospital stay of the ERCP group was significantly shorter than that in the PTCD group (P < 0.05). The hospitalization expenses had no significant difference between the ERCP group and PTCD group (P > 0.05). ④ The total incidence of complications in the ERCP group was significantly lower than that in the PTCD group (P < 0.05), which of the patients with low malignant obstructive jaundice in the ERCP group was significantly lower than that in the PTCD group (P < 0.05), which of the patients with high malignant obstructive jaundice in the ERCP group was significantly higher than that in the PTCD group (P < 0.05). ConclusionsThe biliary metallic stent implantation via ERCP and PTCD approaches in treatment of malignant obstructive jaundice could all obtain a better clinical efficacy. It has more advantages in patients with low malignant obstructive jaundice via ERCP approach and in the patients with high malignant obstructive jaundice via PTCD approach.
ObjectiveTo understand the related application and future development trend of enteral nutrition (EN) support in the treatment of patients with malignant obstructive jaundice (MOJ), and provide a reference for clinical decision-making. MethodThe relevant literatures on EN support in the treatment of MOJ at home and abroad in recent years were reviewed. ResultsIn the treatment of patients with MOJ, EN support treatment could maintain the integrity of intestinal mucosal barrier function, reduce intestinal permeability, and reduce bacterial ectopic. At the same time, it could effectively improve the immune function of patients, promote the recovery of liver function, reduce the stress response of patients, reduce the incidence of complications, accelerate the postoperative recovery of patients and shorten the hospitalization time of patients. ConclusionEN support is an important measure in treatment of MOJ, which can obviously promote recovery of patients.
ObjectiveTo research the association between the prognostic nutritional index (PNI) and the prognosis of patients with malignant obstructive jaundice (MOJ) after interventional treatment. MethodsThe clinicopathologic data of patients with MOJ who were clinically diagnosed and underwent interventional treatment in the Affiliated Hospital of Southwest Medical University, from September 2018 to June 2021, were gathered retrospectively. The X-Tile statistical software was used to determine the optimal critical value of PNI before treatment, then the patients were allocated into the high PNI group (PNI was the optimal critical value or more) and low PNI group (PNI was less than the optimal critical value). The clinicopathologic characteristics of the two groups were compared. The Kaplan-Meier method was used to draw survival curve for survival analysis, and the Cox proportional hazards regression model was used to analyze the risk factors affecting the prognosis of patients with MOJ (the prognostic index was overall survival). ResultsA total of 205 patients were included in this study. The optimal critical value of PNI was 37.5. There were 154 cases in the high PNI group and 51 cases in the low PNI group, respectively. The proportions of the patients with biliary infection, CA19-9 ≥400 kU/L, hemoglobin <120 g/L, albumin <30 g/L, total bilirubin ≥300 μmol/L, and alanine aminotransferase <300 U/L were higher in the low PNI group as compared with the high PNI group (P<0.05). The median overall survival of patients in the high PNI group and low PNI group was 7.1 months and 3.6 months, respectively. The overall survival curve of the former was better than that the latter (χ2=18.514, P<0.001). The median follow-up time of 205 patients was 6.2 months, with a median overall survival of 5.3 months. The multivariate results of Cox proportional hazards regression model analysis showed that the probability of overall survival lengthening was increased for the patients with more times of PTCD, with stent implantation, with treatment for primary tumor, without metastasis, and with preoperative PNI ≥37.5 (P<0.05). ConclusionFrom the results of this study, preoperative peripheral blood PNI has a certain association with the prognosis of patients with MOJ after interventional treatment, and it is expected to be used to predict the prognosis of patients with MOJ in the future.
Objective To investigate the protection of renal function and the prevention of acute renal failure （ARF） in patients with malignant obstructive jaundice in perioperative period of radical resection. Methods A series of clinical interventions had been taken since 2004 in our treatment team, including control of endotoxemia, depression of biliary tract before operation, maintenance of adequate effective blood volume, nutritive support, administration of mannitol and low dose of furosemide, and avoidance of disseminated intravascular coagulation. The incidence of perioperative ARF in 206 patients with malignant obstructive jaundice who had been radically resected from 2000 to 2007 was retrospectively studied, and the RIFLE criteria was used for ARF classification. This study was progressed in two periods. The first one was from Jan. 2000 to Dec. 2003, and the second one was from Jan. 2004 to Dec. 2007. Results After 2003, the proportion of radical resection rose from 44.8% to 57.1% （P＜0.05), and the rate of perioperative ARF dropped from 15.1% to 6.7%（P＜0.05), among which the proportion in the RIFLE-R (Risk) stage had no significant change, while in the RIFLE-F (Failure) stage it dropped from 10.5% to 2.5% (P＜0.05). Finally, perioperative mortality rate dropped from 16.3% to 5.8% (P＜0.05). Therefore, the reduction of ARF was mainly attributed to the reduction in RIFLE-F stage. Conclusion By using the latest RIFLE criteria to classify ARF, it illustrates that our perioperative interventions have effectively decreased ARF, limited ARF in its early and reversible stage, and prevented advancing.
ObjectiveTo investigate the efficacy of different methods of reducing jaundice in patients with low malignant obstructive jaundice undergoing pancreaticoduodenectomy. Methods A retrospective analysis was performed on the clinicopathological data of patients admitted to the Department of Hepatobiliary Surgery of The Affiliated Hospital of Guizhou Medical University from January 2014 to June 2020 who were considered to have low malignant obstructive jaundice before operation and confirmed by postoperative pathological examination as pancreatic cancer, ampulla cancer, duodenal cancer or carcinoma of the lower segment of the common bile duct. Patients were devide into percutaneous transhepatic cholangial drainage (PTCD) group and endoscopic retrograde biliary drainage (ERBD) group according to preoperative biliary drainage (PBD) methods. In order to reduce selection bias, SPSS propensity matching module was used for propensity score matching analysis. The age, basic diseases (hypertension, diabetes), biochemical indexes, time of reduction of jaundice, total hospitalization time, and postoperative complications of PBD and pancreaticoduodenectomy were compared between the 2 groups. Then, the patients were divided into pancreatic cancer group and non-pancreatic cancer group (including ampulla cancer, duodenal carcinoma and lower common bile duct carcinoma) by tumor type, and compared the effect of two groups of patients receiving different PBD methods. Results A total of 84 patients, 43 males and 41 females, were included in this study, 58 (69.0%) patients with PTCD and 26 (31.0%) patients with ERBD. After PBD the serum total bilirubin, direct bilirubin, γ-glutamyl transferase, and alkaline phosphatase of the PTCD and the ERBD groups patients were lower than before PBD, the differences were statistically significant (P<0.05). Alanine aminotransferase did not change significantly before and after PBD with PTCD (P>0.05), but decreased significantly after PBD with ERBD (P<0.05). Aspartate aminotransferase did not change significantly before and after PBD with ERBD (P>0.05), but decreased significantly after PBD with PTCD(P<0.05). The PBD time and total hospitalization time of the ERBD group were shorter than those of the PTCD group, the differences were statistically significant (P<0.05). The incidences of PBD related complications (cholangitis and pancreatitis) in the ERBD group were higher than those the PTCD group, and the incidence of bleeding in the ERBD group was lower than that the PTCD group, but the differences were not statistically significant (P>0.05). In the patients with pancreatic cancer group, the PBD time by ERBD was shorter than that of the receiving PTCD, the difference was statistically significant (P=0.006). In the non-pancreatic cancer group, the total hospitalization time and PBD time of patients receiving ERBD were shorter than those receiving PTCD, and the differences were statistically significant (P<0.05). In all patients, the median survival time of PTCD group (14 months) was shorter than that in ERBD group (18 months), P=0.002; pancreatic cancer group (12 months) was shorter than non-pancreatic cancer group (16 months), P=0.034; in non-pancreatic cancer group, ERBD group (20 months) was longer than PTCD group (15 months), P=0.008. Conclusions ERBD can shorten the waiting time of operation and hospital stay as compared with PTCD, and has a longer median survival time. It can be used as the first choice for PBD in patients with low malignant obstructive jaundice.
ObjectiveTo systematically review efficacy of endoscopic ultrasonography guided biliary drainage (EUS-BD) and percutaneous transhepatic biliary drainage (PTBD) on patients with malignant obstructive jaundice.MethodsThe PubMed, EMbase, The Cochrane Library, CBM, WanFang Data, and CNKI were searched online to collect the randomized controlled trials or cohort studies of EUS-BD versus PTBD on the patients with malignant obstructive jaundice from inception to November 30, 2018. Two reviewers independently screened the literatures, extracted the data and assessed the risk of bias of included the studies, then the meta-analysis was performed by using the RevMan 5.3 software.ResultsThree randomized controlled trials and 6 cohort studies involving 496 patients were included. The results of meta-analysis showed that: compared with the PTBD, the EUS-BD had the lower occurrence of complications [OR=0.30, 95% CI (0.20, 0.47), P<0.000 01], lower rate of reintervention [OR=0.11, 95% CI (0.06, 0.22), P<0.000 01], shorter hospital stay [MD=–3.42, 95% CI (–6.72, –0.13), P=0.04], and less hospital costs [SMD=–0.83, 95% CI (–1.16, –0.49), P<0.000 01]. There were no significant differences in the technical success rate [OR=0.88, 95% CI (0.20, 3.85), P=0.86] and clinical effective rate [OR=1.73, 95% CI (0.97, 3.11), P=0.06] between the two groups.ConclusionsCurrent evidence shows that EUS-BD has some advantages of lower occurrence of complications, lower rate of reintervention, shorter hospital stay, and less hospital costs in treatment of patients with malignant obstructive jaundice as compared with PTBD. There are no significant differences between two groups in technical success rate and clinical effective rate. Due to limited quality and quantity of included studies, more high quality studies required to be verified above conclusions.