Percutaneous biliary drainage for treatment of malignant biliary obstruction

Objective To introduce the technique of percutaneous biliary drainage for treatment of malignant biliary obstruction and to eveluate its therapeutic effect. Methods Percutaneous biliary drainage was performed in 47 patients with malignant biliary obstruction. The biliary obstruction occurred in the common bile duct of 10 patients, in the common hepatic duct for 13, at the conjuction of right and left hepatic ducts in 24. The inner outer draining catheter, the metallic stent or plastic endoprosthesis was placed to drain the bile internally if the obstruction could be passed with guide wire after percutaneous transhepatic cholangiography, or the outer drainage could only be carried out. Results The internal drainage was done with stent in 15 patients and with plastic endoprosthesis in 3, the inner outer drainage in 15, and the external drainage in 14. The serum total bilirubin decreased from 514.1±204.3μmol/L before the procedure to 238.4± 142.8 μmol/L one week after the procedure( P 0.001), and both alkaline phosphatase and transaminase significantly decreased( P 0.001). Four patients died of irrelevant situation to drainage within one month after the procedure. Thirty seven of 43 patients who survived for more than one month were followed up with an average of 5.3 months, including 8 patients alive. The serum total bilirubin decreased to the normal level within the period of follow up in 18 patients(48.6%), and to less than half of the value before the procedure in 15(40.5%). Conclusions The percutaneous transhepatic biliary drainage is a safe and effective palliative therapy of malignant biliary obstruction with improving liver function, life quality, and survival rate.