Efficacy of percutaneous transhepatic biliary drainage for treatment of malignant obstructive jaundice

Objective To investigate the therapeutic efficacy of percutaneous transhepatic biliary drainage (PTBD) for malignant biliary obstruction and its affecting factors. Methods A total of 233 patients with malignant biliary obstruction were treated in our hospital with PTBD by placement of metallic stent and/or plastic tubes. After percutaneous transhepatic cholangiography, the dilated biliary duct was punctured and the metallic stent or plastic catheter withdrawn. The patients were followed up with clinical and radiographic evaluation. Meanwhile, the serum levels of total protein, hemoglobin, ALT, HBDH, ALP, GGT, BUN and Cr were determined. Procedure-and device-related complications were recorded. The patients' survival and stent potency were calculated with Kaplan-Meier survival analysis. Results PTBD was successfully performed in all the patients. Stent placement was conducted in 136 patients. Of these 136 patients, 100 were treated with only 1 stent, 20 had 2 stents for bilateral drainage and 16 had 2 stents for long stricture. The other 97 patients received plastic catheters. The serum level of total bilirubin reduced from 349.2±155.6 mol/L before to 178.9±141.2 mmol/L after PTBD (t=17.90, P=0.000). Sixty-two patients had incorporative infection before PTBD and 23 of them were cured after the procedure. Twenty-nine patients got inflammation after the procedure. Thirty patients died within 30 d. The mortality within 30 d was related to age and serum levels of bilirubin, protein and BUN etc. After PTBD, the re-occlusion occurred in 51 patients and catheters broke off in 7. The median survival time was 7.3 month and median patency time was 14 months. Conclusions PTBD can provide good palliative drainage. It can also improve other conditions caused by biliary obstruction.