Ultrasound-Guided Percutaneous Transhepatic Cholangial Drainage for Distal biliary malignant obstructive jaundice

Abstract

Abstract Biliary drainage can significantly improve prognosis in patients with malignant obstructive jaundice (MOJ). The purposes of this study are to evaluate the effect of ultra-sound (US)-guided percutaneous transhepatic cholangial drainage (PTCD) on the treatment of different degrees of biliary dilatation caused by distal biliary malignant obstructive jaundice (DBMOJ). We retrospectively reviewed the medical record of PTCD of DBMOJ, they were prospectively randomized to the right of left access for PTCD. A total of 89 patients that had undergone successful biliary drainage with more than 1 months of follow-up. Patients were grouped according to the diameter of four-grade bile duct: group A with < 4mm, group B with 4-8mm, and group C with > 8mm. Puncture success rate, complications and liver function tests of the patients were recorded. There was no significant difference in puncture success rate and complication rate among the three groups. The early complications (bleeding, biliary fistula, bile reflex) and late complications (catheter comes off, catheter obstruction) of PTCD occurred in 2, 3, 3 cases and 2, 2, 3 cases in the 3 groups, respectively. After drained to drainage, the TBIL and DBIL declined linearly, with slope of 43 and 117. The levels of ALT and AST declined rapidly within postoperative 1 week, with no statistical difference between the groups. There was also no significant difference in levels between the groups between 1 week and 2 weeks postoperatively. PTCD were performed through right access in 53 cases and 36 cases through left access. The ALT and AST slope of right-side approach is significantly greater than that of the left-side approach, and the difference was statistically significant. The right-sided approach PTCD has a faster rate of liver function recovery in patients than the left-sided approach. Thus, PTCD for DBMOJ has the characteristics of low complication rate and good efficacy in reducing jaundice. The right-sided approach PTCD has a faster rate of liver function recovery in DBMOJ patients than the left-sided approach. We suggest that patients with malignant obstructive jaundice should biliary drainage. The less severe the obstruction, the faster the recovery of liver function.