Clinical effectiveness analysis on biliary stent combined with 125I seed implantation in the treatment of malignant obstructive jaundice / 中国现代普通外科进展

ABSTRACT

Objective:To investigate the clinical effectiveness analysis on biliary stent combined with 125I seed implantation in the treatment of malignant obstructive jaundice.Methods:98malignant obstructive jaundice patients undergoing percutaneous transhepatic biliary drainage requirement of biliary stent were divided into combined group(n=53) and simple group(n=45).Patients in combined group were taken biliary stent combined with 125I seed implantation,while in simple group were only taken biliary stent.All patients were followed up for 4 to 28 months.The changes of total bilirubin were recorded before percutaneous bile duct drainage,7 d,30 d and 90 d after biliary stent implantation.The recurrences of biliary obstruction of the two groups were recorded.The changes of T lymphocyte subsets in peripheral blood were detected before percutaneous bile duct drainage and after biliary stent implantation 7 d.The survival times of the two groups were compared.Results:All patients were successfully completed biliary stent implantation,surgical success rate was 100％.The total bilirubin levels of patients in combined group 30 d and 90 d after stent implantation were significantly lower than the simple group,the differences were statistically significant (P＜0.05).After surgery 7 d,the CD4 level and CD4/CD8 ratio in combined group were increased compared with before surgery,while in the simple group were declined,the differences were statistically significant (P＜0.05).Compared with the simple group,the CD4 level and CD4/CD8 ratio in combined group after surgery 7d were significantly increased (P＜0.05).2 cases (3.8％) of patients were recurrence of biliary obstruction,which were lower than 17 cases (37.8％) in the simple group,the difference was statistically significant (P＜0.001).The median survival time in combined group was 10.6 months,which was significantly longer than 7.5 months in the simple group,the difference was statistically significant (P＜0.05).Conclusion:Biliary stent combined with 125I seed implantation in the treatment of malignant obstructive jaundice might relieve the symptom of biliary obstruction,and helped to improve cellular immune function of patients and reduce the recurrence of biliary obstruction.It had great significance to improve the quality of life of patients and prolong the survival time.