Salim Adnan, Jabbar Sadia, Amin Farhan Ul, Malik Kashif
Department of Gastroenterology & Hepatology, Shaikh Zayed Hospital, Lahore, Pakistan.
J Ayub Med Coll Abbottabad. 2018 Oct-Dec;30(4):571-575.
Obstructive jaundice due to malignancies of the biliary tree, gall bladder and pancreas account for a significant number of patients managed by tertiary centres. Management options are curative or palliative, depending on disease stage. This study was performed to see the effectiveness of treatment modalities for these patients and eventual outcome.
This cross-sectional analytical study was conducted at the Department of Gastroenterology and Hepatology, Shaikh Zayed Hospital Lahore, from January 2015 to June 2016. All adult patients aged 18 and above of either sex presenting with obstructive jaundice secondary to malignant disease originating from the gallbladder, biliary-tree or pancreas were included in the study. The disease was staged after admission. The patients then underwent endoscopic, surgical or percutaneous drainage and were followed up for a period of one year.
Two hundred & sixty-two patients presenting with jaundice due to malignancy arising from the biliary tree, gall bladder or pancreas were enrolled between January 2015 and June 2016, 141 (53.8%) males and 121 (46.2%) females. Eighty (30.5%) had cholangiocarcinoma, 70 (26.7%), had gall bladder tumours, 61 (23.3%) pancreatic cancer and 51(19.5%) had ampullary tumours. 31 (11.8%) patients had disease qualifying curative surgical resection. One hundred & eighty-five (70.6%) patients underwent palliative therapy in the form of percutaneous in 86 (32.9%) and endoscopic drainage in 126 (48.1%). Twenty-eight (10.7%) patients refused all treatment. Eighteen (6.9%) patients died before undergoing any therapeutic intervention. Thirty-three (12.6%) died during hospital stay. Survival at 3, 6 and 12 months was 49.2% (129 patients), 28.2% (74 patients) and 8.4% (22 patients), respectively. These 22 included all patients who had undergone curative resection. We attributed the largest number of deaths, 197 (75.2%) patients, to metastatic/advanced disease and associated complications.
The results showed that patients with advanced disease who were only eligible for palliative therapy, at first presentation, constituted the majority of patients. These patients require skilled endoscopy and interventional radiology teams for successful biliary drainage.
因胆管、胆囊和胰腺恶性肿瘤导致的梗阻性黄疸患者数量众多，需由三级医疗中心进行管理。治疗方案根据疾病阶段分为根治性或姑息性。本研究旨在观察这些患者的治疗方式效果及最终结局。
本横断面分析研究于2015年1月至2016年6月在拉合尔谢赫扎耶德医院胃肠病学和肝病科进行。纳入所有年龄在18岁及以上、因胆囊、胆管或胰腺恶性疾病继发梗阻性黄疸的成年患者。入院后对疾病进行分期。患者随后接受内镜、手术或经皮引流，并随访一年。
2015年1月至2016年6月期间，共纳入262例因胆管、胆囊或胰腺恶性肿瘤导致黄疸的患者，其中男性141例（53.8%），女性121例（46.2%）。80例（30.5%）为胆管癌，70例（26.7%）为胆囊肿瘤，61例（23.3%）为胰腺癌，51例（19.5%）为壶腹肿瘤。31例（11.8%）患者疾病符合根治性手术切除条件。185例（70.6%）患者接受了姑息治疗，其中86例（32.9%）为经皮引流，126例（48.1%）为内镜引流。28例（10.7%）患者拒绝所有治疗。18例（6.9%）患者在接受任何治疗干预前死亡。33例（12.6%）患者在住院期间死亡。3个月、6个月和12个月的生存率分别为49.2%（129例患者）、28.2%（74例患者）和8.4%（22例患者）。这22例患者包括所有接受根治性切除的患者。我们将最多的死亡病例，即197例（75.2%）患者，归因于转移性/晚期疾病及相关并发症。
结果显示，初诊时仅适合姑息治疗的晚期疾病患者占大多数。这些患者需要专业的内镜和介入放射科团队以成功进行胆管引流。
