Department of Ultrasound, Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou, China.
Sci Rep. 2024 May 30;14(1):12481. doi: 10.1038/s41598-024-63424-x.
The main cause of distal biliary malignant obstructive jaundice (DBMOJ) is the stricture of the extrahepatic biliary tract by malignant tumors, including pancreatic head and uncinate process cancer, low-grade cholangiocarcinoma, duodenal cancer, papillary duodenal cancer and other malignant tumors. The most effective treatment is radical pancreaticoduodenectomy. However, preoperative obstructive jaundice can affect the patient's liver function and blood coagulation function, increase local inflammation and oedema, and make surgery more difficult. Patients with severe obstructive jaundice require preoperative biliary drainage, which can be achieved by various methods, including ultrasound endoscopic biliary drainage (EUS-EBD) and endoscopic retrograde biliary drainage (ERBD). The latter is mainly divided into endoscopic nasobiliary drainage and endoscopic biliary stent. Some patients underwent percutaneous transhepatic biliary drainage (PTBD) when ERBD and EUS-EBD failed. In this study, we aimed to identify PTBD in DBMOJ and to further investigate the role of the puncture pathway in DBMOJ. The relationship between PTBD and bile duct internal diameter was confirmed by analysing and collating clinical data. In this study, DBMOJ was grouped according to bile duct internal diameter and liver function was used as an indicator to examine the improvement in liver function with PTBD in patients undergoing DBMOJ. Analysis of puncture complications showed that PTBD puncture was safe. DBMOJ with different bile duct internal diameters had different rates of liver function improvement after PTBD. The right-side approaches had significantly lower alanine aminotransferase (ALT) and alanine transaminase (AST) than the left-side approaches. This study showed that PTBD for DBMOJ is associated with a low complication rate and good reduction of jaundice. Liver function recovery was faster in patients with DBMOJ treated with PTBD in the right-sided approach compared with the left-sided approach. PTBD is an effective tool to be used in patients who have failed ERBD and EUS-EBD.
远端恶性胆道梗阻性黄疸（DBMOJ）的主要原因是肝外胆道由恶性肿瘤引起的狭窄，包括胰头和钩突部癌、低级别胆管癌、十二指肠癌、乳头十二指肠癌和其他恶性肿瘤。最有效的治疗方法是根治性胰十二指肠切除术。然而，术前梗阻性黄疸会影响患者的肝功能和凝血功能，增加局部炎症和水肿，使手术更加困难。严重梗阻性黄疸的患者需要术前胆道引流，可以通过各种方法实现，包括超声内镜下胆道引流（EUS-EBD）和内镜逆行胆道引流（ERBD）。后者主要分为内镜鼻胆管引流和内镜胆管支架。当 ERBD 和 EUS-EBD 失败时，一些患者进行经皮经肝胆道引流（PTBD）。在本研究中，我们旨在确定 DBMOJ 中的 PTBD，并进一步探讨在 DBMOJ 中穿刺途径的作用。通过分析和整理临床资料，确定了 PTBD 与胆管内径的关系。本研究根据胆管内径将 DBMOJ 分组，并以肝功能为指标，检查 DBMOJ 患者行 PTBD 后肝功能的改善情况。穿刺并发症分析表明，PTBD 穿刺是安全的。不同胆管内径的 DBMOJ 行 PTBD 后肝功能改善率不同。右侧入路的丙氨酸氨基转移酶（ALT）和天冬氨酸氨基转移酶（AST）明显低于左侧入路。本研究表明，PTBD 治疗 DBMOJ 并发症发生率低，黄疸减轻效果好。与左侧入路相比，右侧入路治疗的 DBMOJ 患者肝功能恢复更快。PTBD 是 ERBD 和 EUS-EBD 失败患者的有效治疗工具。
