Improvement of percutaneous transhepatic biliary internal-external drainage and its initial experience in patients with malignant obstruction of the upper biliary tree

摘要

Background/Aims: To evaluate the feasibility and clinical results of modified percutaneous transhepatic biliary internal-external drainage (PTBIED) vs. conventional PTBIED in patients with malignant biliary obstruction. Methodology: Conventional PTBIED was modified by applying side-holes to an 8.5Fr external biliary drainage catheter. Eligible patients were randomly assigned 1:1 by the doctors to receive modified PTBIED (group A) or conventional PTBIED (group B). Technical success rate, complications, hepatic function and white cell count were recorded pre- and post-procedure. All patients were followed-up until death. Results: Twenty-two patients were assigned in group A and 21 patients were involved in group B. Successful drainage was all achieved in both groups. Biliary tract infections were significantly reduced in group A (1/22) compared to group B (7/21, p0.05). The leukocyte count fell slightly in group A post-procedure, while it rose in group B (group A: 8.45±3. 22×10 9/L to 7.53±2.46×10 9/L; group B: 7.92±3.08×10 9/L to 10.52±5.09×10 9/L). Both procedures had similar effects in the recovery of hepatic function, median survival time and alleviating clinical symptoms (such as pruritis and abdominal pain). Conclusions: Modified PTBIED can reduce the complications resulting from retrograde reflux of duodenal contents. Improved PTBIED should be used for patients with inoperable high malignant biliary obstruction.