Treatment of endoscopic refractory malignant biliary obstruction by percutaneous transhepatic biliary drainage

Objective To approach the clinical value of percutaneous transhepatic biliary drainage(PTBD) for malignant biliary obstruction after the ERCP failure. Methods Twenty-three patients with malignant obstructive jaundice were studied(14 male and 9 female patients; age from 61-88 years,mean age 72.6±10.9 years). Ten had cholangiocarcinoma (5 had been treated by surgery), 3 pancreatic carcinoma, 7 gastric carcinoma after surgery,1 primary hepatocellular carcinoma and 2 duodenolpapillo carcinoma. PTBD or stent were performed on all the patients after failure of ERCP. Results PTBD was successfully performed in all the patients. Six patients had PTBD of the external drainage, and 13 selected internal-external drainage (both left and right bile ducts had been drained in 3 cases). The other 4 received stents. The levels of serum total bilirubin(TBIL) decreased significantly one week after the procedure. The serum TBIL decreased from 321.6±132.1 μmol/L to 88.6±10.1 μmol/L(P0.05),direct bilirubin decreased from 252.3±36.3 μmol/L to 53.3±9.4 μmol/L(P0.05). Conclusions PTBD is a safe and effective therapy method for malignant biliary obstruction.