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Objective To discuss the method, safety and clinical value of biliary stenting combined with 125I seed implantation intracavitary irradiation in treating malignant obstructive jaundice. Methods A total of 36 patients with malignant obstructive jaundice were enrolled in this study. PTCD was carried out in all patients, which was followed by biliary stenting combined with 125I seed implantation intracavitary irradiation treatment. The results were analyzed. Results During the interventional management, displacement of the stent and 125I seeds were observed in two cases, and the displaced stent and 125I seeds were replaced to the right position with the help of biliary biopsy forceps. The technical success rate was 100%, and the remission rate of the jaundice was 100%. All the patients were followed up for 1-23 months. No radioactive particles leaking or complications such as radiation enteritis occurred. No in-stent obstruction due to tumor recurrence was observed although slight dilatation of intrahepatic bile duct was detected in 25%of patients, which was resulted from intimal hyperplasia at the stent mesh and/or biliary stone formation. The median survival time was 10.9 months. Conclusion For the treatment of malignant obstructive jaundice, biliary stenting combined with 125I seed implantation intracavitary irradiation is safe, reliable and effective. This technique can prolong stent patency time as well as the patient’s survival time.
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Objective To evaluate the clinical effect of intervertional devascularization and surgical devascularization in treatment of patients with upper gastrointestinal hemorrhage .Methods Ninety-nine cases treated with intervertional devaacularization or surgical devascularization were retrospectively studied including 48 cases in intervertional group and 51 cases in surgical group.The postoperative resection, complications and rebleeding time were compared by X2 test and t test between two methods.Results The 12 months, 24 months and 36 months cumulative rebleeding rates after intervertional devascularization were 12.5% (6/47) ,24.5% (11/45), 27.9% (12/43) respectively.The rate after surgical devaacularization were 29.2% (14/48) ,44.7% (21/47), 48.9% (22/45) respectively.There were statistically significant differences between the intervertional and surgical groups (X2=3.843,4.150,4.083, P < 0.05).The complications of intervertional devascularization included fever 85.4% (41/48), bellyache 81.3% (39/48), portalvein thrombosis 4.2% (2/48), intraabdominal hemorrhage 2.1% (1/48), infection 2.1% (1/48) and death 2.1% (1/48).The complications of surgical devaacularization included fever 68.6% (35/51), bellyache 62.7% (32/51), generous hydroperitoneum 25.5% (13/51), portalvein thrombosis 37.3% (19/51), splenic vein thrombosis 11.8% (6/51), hepatic encephalopathy 3.9% (2/51), hepatorenal syndrome 2.0% (1/51), intraabdominal hemorrhage 2.0% (1/51), death 3.9% (2/51) and infection 15.7% (8/51).There were statistically significant differences of fever, bellyache, generous hydroperitoneum, portalvein thrombosis, splenic vein thrombosis between the intervertional and surgical groups(X2=4.174,3.098,16.199,6.011,5.536,14.085,P <0.05).Conclusions The intervertional devascularization procedure is simple, safe and effective method for treating upper gastrointestinal hemorrhage for portal hypertensive.The clinical effect is better than that of surgical devascularization.
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Objective To study the clinical application of self-expanding nitinol stent in benign and malignant esophageal obstruction as well as in postoperative anastomotic stenosis and anastomotic leakage. Methods 22 cases of benign or malignant esophageal stenosis were treated by placing metallic stents inserted into the stenosis segment through per-oral intubation under the fluoroscopic guidance. Results The degreee of dysphagia was improved, Stooler′s staging of dysphagia was down from 3.1 preoperatively to 1.2 postoperatively. 2 cases of anastomotic leakage and 1 case of esophagorespiratory fistula were cured. All have been followed up for one to twelve months. 3 cases died with carcinoma cachexia and one succumbed to severe hemorrahage of digestive tract. The other 18 cases are still followed up. Conclusions Placement of esophageal expandable stent is one of the ideal methods to treat benign and malignant esophageal stenosis and anastomotic leakage. It can also play an important role in the improvement of the patients' life quality and prolongation of life.
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Objective To evaluate the value of interventional embolism therapy for metastatic carcinoma of adrenal gland.Methods Fifty four patients with metastatic carcinoma of adrenal gland were treated with interventional catheterization perfusion and embolism therapy.Results Except one case with failure of finding the feeding artery, totally 76 sessions of interventional therapy were performed on 53 patients. Technical successful rate was 98.1% with 100% of complete release of clinical sign in 14 patients. Good deposition of iodized oil in tumor area reached 75.4% in three months after the procedure. Severe complication rate ocurred in 1.88%. Conclusion Interventional therapy seemed to be safe and effective for patients with metastatic carcinoma of adrenal gland.