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

percutaneous  transhepatic  biliary  drainage  for obstructive jaundice caused by metastatic gastric cancer: efficacy and complications

wenchang yu, kongzhi zhang, shiguang chen, mingzhi hao福建省肿瘤医院肿瘤介入治疗科余文昌

department of interventional radiology, fujian provincial cancer hospital, fuzhou 350014, china.

objective: 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.

methods: hospital records were reviewed for 32 consecutive patients with biliary obstruction caused by metastatic gastric cancer who underwent ptbd at our institution between october 2004 and april 2010. patients (23 males and 9 females) ranged in age from 35 to 72 years. the indexes of hepatic function before ptbd and within one month after ptbd were compared. the incidence of complications and corresponding treatments were also documented.

results: the level of obstruction was defined as the distal bile duct（beyond the level of the liver hilum）in 22 patients (group1) and the liver hilum in 10 patients (group2). successful decompression of the biliary system after ptbd was defined by a total bilirubin decrease of more than 30% of the baseline value. success rates were 100% (22/22) for group1, 70% (7/10) for group2, and 90.6% (29/32) for all patients. differences in success rates between group1 and group2 were significant (p=0.024). serum tbil, alt, and ast significantly decreased from 292.8 ± 179.9μmol/l，174.5±107.4 iu/l, 159.9± 103.9 iu/l before ptbd to 111.5 ± 92.5μmol/l，58.5 ± 46.3 iu/l，59.6 ± 48.9 iu/l, respectively within one month after ptbd (p < 0.05). complications associated with ptbd included cholangitis in 13 patients (40.5%), drainage tube displacement in 6 patients (18.8%), hemobilia in 4 patients (12.5%), tube occlusion in 2 patients (6.3%), and pancreatitis in 1 patient (3.1%). all complications were successfully treated with appropriate measures.

conclusion: hepatic function can be improved by ptbd without serious complications in patients with obstructive jaundice caused by metastatic gastric cancer.

key words: gastric cancer; obstructive jaundice; percutaneous transhepatic biliary drainage

chinese-german journal of clinical oncology,2011,10(3):157-161