Different approaches of metal stent placement for advanced malignant obstructive jaundice in 162 patients

Objective To discuss the curative effect of different ways in metal stent placement for advanced malignant obstructive jaundice for the basis in selecting a better method in clinic. Methods Treatment on 162 cases of malignant biliary obstruction were reviewed retrospectively,whose biliary stent insertions were through endoscopic retrograde cholangiopancreatography(ERCP)(n=129),percutaneous transhepatic cholangial drainage(PTCD)(n=25),ERCP joint PTCD(n=8).By comparison in liver function indexes before and after operation,including total bilirubin(TBIL),direct bilirubin(DBIL),indrect bilirubin(IBIL),alanine amintransferase(ALT),and aspartate transaminase(AST),the efficacy of three approaches were evaluated. Results Compared with before operation,TBIL,DBIL,IBIL,ALT and AST decreased one week after the stent insertion(P0.01).The main complications were infection,hemorrhage,pancreatitis.The patients had remission after treatment and there was no operation-related death happened.Three approaches all significantly reduced the levels of liver function indexes,and post-operation complications showed no statistic difference between ERCP and PTCD(P0.05).ERCP+PTCD presented no post-operation complication,due to fewer cases. Conclusion The curative effect for different approaches of metal stent placement in treatment of advanced malignant obstructive jaundice is definite.Each method should be chosen according to the patients' condition so as to remove the jaundice and improve the liver function and the quality of life.