Efficacy of percutaneous transhepatic biliary drainage combined with transarterial chemoembolization in treatment of malignant obstructive jaundice / 肿瘤研究与临床

ABSTRACT

Objective To observe the efficacy of percutaneous transhepatic biliary drainage (PTBD) combined with transarterial chemoembolization (TACE) in treatment of malignant obstructive jaundice, and to evaluate its application value in clinic. Methods A total of 82 patients with malignant obstructive jaundice who received PTBD from January 2017 to January 2019 in Taiyuan Central Hospital were collected. The patients were divided into the experimental group who received TACE (41 cases) and the control group who could not receive TACE (41 cases) after PTBD. Clinical symptoms, liver function, tumor markers, drainage tube patency rate and survival time of the two groups were compared before and after the treatment. T-test and chi-square test were used for statistical analysis, and Kaplan-Meier method was used for survival analysis. Results A total of 93 drainage tubes were placed in 82 patients, and 109 TACE treatments were performed in the experimental group. PTBD and TACE both had successful results. After PTBD, 72 patients felt jaundiceand obvious alleviation of other clinical symptoms. There were no serious complications after PTBD and TACE. Postoperative follow-up results showed that compared with the total bilirubin (TBIL) [(269±113)μmol/L], the direct bilirubin (DBIL) [(159 ±74) μmol/L], alanine transaminase (ALT) [(118 ±40) U/L] and aspartate aminotransferase (AST) [(111±55) U/L] before the operation, the TBIL [(46±11)μmol/L], DBIL [(28±10)μmol/L], ALT [(35±12) U/L] and AST [(33±12) U/L] in the experimental group were decreased significantly 3 months after the operation, and the differences were statistically significant (all P<0.05). TBIL [(48±9)μmol/L], DBIL [(25±10) μmol/L], ALT [(32±9) U/L] and AST [(30±12) U/L] in the control group were decreased significantly compared with TBIL [(291±114)μmol/L, DBIL [(171±66)μmol/L], ALT [(129±54) U/L] and AST [(114±43) U/L] before the operation, and the differences were statistically significant (all P< 0.05). There was no significant difference in liver function between the two groups before the operation and 3 months after the operation (both P>0.05). The level of carbohydrate antigen-199 in the experimental group at 6 months after PTBD was lower than that in the control group [(426 ±136) U/ml vs. (569 ±204) U/ml; t = 19.457, P < 0.05]. There were statistical differences in the patency rate of the both groups at 6, 9 and 12 months after PTBD (all P< 0.05). The median survival time in the experimental group was longer than that in the control group (310.4 d vs. 234.5 d; χ2= 12.678, P< 0.05). Conclusion The effect of PTBD in patients with malignant obstructive jaundice is obvious. The combination with TACE after PTBD can prolong the survival of patients and it is worthy of clinical application.