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Objective To investigate the indication and value of metallic stent in the management of patients with malignant obstructive jaundice(OJ). Method The clinical data of 15 patients with malignant OJ treated in our hospital were analysed retrospectively. All the 15 patients were treated with metallic stent including cholangiocarcinoma in 8 cases, carcinoma of gallbladder in 3 cases, pancreatic carcinoma in 2 cases, porta hepatis metastasis of gastric carcinoma after radical gastrectomy in 2 cases. Result All the patients' jaundice disappeared 11-38 days after the stent placement. No severe complications or death occurred in this series. One patient had cholimia 5 days after the stent placement, which was cured by non-operative method. All cases were followed up periodically, the survival time was 30-384 days(averag 180.5 days). Conclusions Installing stent of Titanium-Nickel metallic alloy for the patient with unresectable malignant OJ is an ideal palliative therapy which is simple and less discomfortable.and less complications.The effect of reducing jaundice is satisfactory. This method may offer a new alternative method in the management of malignant OJ.
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Objective To study a simple and effective internal bilioenterostomy for the malignant bile duct obstruction.Methods 58 obstructive jaundice patients caused by advanced carcinoma were divided into 2 groups(1)Bridge bilioenterostomy(BBES) group.Biliojejunal bypass procedue by using silica gel tube inserted into dilated bile duct and jejunum respectively combination with Bardport TM pump was performed on 25 patients .The biliary sludge were washed away through Bardport TM pump by injecting normal saline, antibiotic and 5-fluorouracil.(2)Control group.33 patients were treated with traditional biliojejunostomy. Results There was no difference in alleviating jaundice between the two groups ,but in BBES group the cholangitis rate (20.83%)and recurrent jaundice rate (9.52%) were much lower than those in control group ( 51.61% and 32.14% respectively, P
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0.05). Intraoperative blood transfusion in drainage group (1 300ml) was significantly increased than that in non-drainage group( 939ml)(P0.05). The hospital stay in drainage group[ average 71(43-101)days] was significantly longer than that in non- drainage group [ average 47(29-81)days](P=0.05). Conclusions If a sufficient preoperative preparation is performed,one stage PD operation is a benificial method for peri-ampullar carcinoma patients complicated with severe obstructive jaundice.