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Endoscopic ultrasound-guided biliary drainage vs percutaneous transhepatic bile duct drainage in the management of malignant obstructive jaundice

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World Journal of Gastrointestinal Surgery 2024年第6期16卷 1592-1600页

作者： Qin-Qin Zhu Bing-Fang Chen Yue Yang Xue-Yong Zuo Wen-Hui Liu Ting-Ting Wang Yin Zhang Department of Gastroenterology The Third Affiliated Hospital of Soochow University(The First People’s Hospital of Changzhou)Changzhou 213000Jiangsu ProvinceChina Department of Hepatobiliary and Pancreatic Surgery The Third Affiliated Hospital of Soochow University(The First People’s Hospital of Changzhou)Changzhou 213000Jiangsu ProvinceChina

BACKGROUND malignant obstructive jaundice(MOJ)is a condition characterized by varying degrees of bile duct stenosis and obstruction,accompanied by the progressive development of malignant tumors,leading to high morbidity and mortality ***,the two most commonly employed methods for its management are percutaneous transhepatic bile duct drainage(PTBD)and endoscopic ultrasound-guided biliary drainage(EUS-BD).While both methods have demonstrated favorable outcomes,additional research needs to be performed to determine their relative *** compare the therapeutic effectiveness of EUS-BD and PTBD in treating *** This retrospective analysis,conducted between September 2015 and April 2023 at The Third Affiliated Hospital of Soochow University(The First People’s Hospital of Changzhou),involved 68 patients with *** patients were divided into two groups on the basis of surgical procedure received:EUS-BD subgroup(n=33)and PTBD subgroup(n=35).Variables such as general data,preoperative and postoperative indices,blood routine,liver function indices,myocardial function indices,operative success rate,clinical effectiveness,and complication rate were analyzed and compared between the *** In the EUS-BD subgroup,hospital stay duration,bile drainage volume,effective catheter time,and clinical effect-iveness rate were superior to those in the PTBD subgroup,although the differences were not statistically significant(P>0.05).The puncture time for the EUS-BD subgroup was shorter than that for the PTBD subgroup(P<0.05).Postoperative blood routine,liver function index,and myocardial function index in the EUS-BD subgroup were significantly lower than those in the PTBD subgroup(P<0.05).Additionally,the complication rate in the EUS-BD subgroup was lower than in the PTBD subgroup(P<0.05).CONCLUSION EUS-BD may reduce the number of punctures,improve liver and myocardial functions,alleviate traumatic stress,and decrease complication rates in MOJ treatment

关键词： Percutaneous hepatic biliary drainage Endoscopic ultrasound-guided biliary drainage malignant obstructive jaundice Clinical effect Liver function Postoperative complications

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Efficacy and safety of percutaneous transhepatic biliary radiofrequency ablation in patients with malignant obstructive jaundice

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World Journal of Clinical Cases 2024年第17期12卷 2983-2988页

作者： Ying Xing Zheng-Rong Liu You-Guo Li Hong-Yi Zhang Department of General Surgery Tiantan HospitalBeijing 100170China

BACKGROUND Percutaneous transhepatic cholangiodrainage(PTCD)and endoscopic retrograde cholangiopancreatography/endoscopic nasobiliary drainage are the most common clinical procedures for jaundice control in patients with unresectable malignant obstructive jaundice,yet the safety and effect of endobiliary radiofrequency ablation(EB-RFA)combined PTCD is rarely reported,in this article,we report our experience of EB-RFA combined PTCD in such *** To retrospectively study the efficacy and safety of EB-RFA combined PTCD in patients with unresectable malignant obstructive *** Patients with unresectable malignant obstructive jaundice treated with EB-RFA under PTCD were selected,the bile ducts of the right posterior lobe was selected as the target bile ducts in all *** general conditions of all patients,preoperative tumour markers,total bilirubin(TBIL),direct bilirubin(DBIL),albumin(ALB),alkaline phosphatase(ALP),and glutamyl transferase(GGT)before and on the 7th day after the procedure,as well as perioperative complications,stent patency time and patient survival were *** All patients successfully completed the operation,TBIL and DBIL decreased significantly in all patients at the 7th postoperative day(P=0.009 and 0.006,respectively);the values of ALB,ALP and GGT also decreased compared with the preoperative period,but the difference was not statistically *** biliary bleeding occurred in 2 patients,which was improved after transfusion of blood and other conservative treatments,pancreatitis appeared in 1 patient after the operation,no serious complication and death happened after *** for 3 patients with loss of visits,the stent patency rate of the remaining 14 patients was 100%71%and 29%at the 1^(st),3^(rd),and 6^(th)postoperative months respectively,with a median survival of 4 *** EB-RFA under PTCD in patients with unresectable malignant obstructive jaundice has a satisfactory therapeu

关键词： Biliary tract tumour malignant obstructive jaundice Percutaneous transhepatic cholangiodrainage Endoluminal radiofrequency ablation Biliary radiofrequency ablation

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Effect of preoperative biliary drainage on malignant obstructive jaundice:A meta-analysis

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World Journal of Gastroenterology 2011年第3期17卷 391-396页

作者： Yu-Dong Qiu Jian-Ling Bai Fang-Gui Xu Yi-Tao Ding Department of Hepatobiliary Surgery Affiliated Drum Tower Hospital Medical School Nanjing University Nanjing 210008 Jiangsu Province China Department of Epidemiology and Biostatistics School of Public Health Nanjing Medical University Nanjing 210029 Jiangsu Province China

AIM: To evaluate the effect of preoperative biliary drainage (PBD) on obstructive jaundice resulting from malignant tumors. METHODS: According to the requirements of Cochrane systematic review, studies in the English language were retrieved from MEDLINE and Embase databases from 1995 to 2009 with the key word "preoperative biliary drainage". Two reviewers independently screened the eligible studies, evaluated their academic level and extracted the data from the eligible studies confirmed by cross-checking. Data about patients with and without PBD after resection of malignant tumors were processed for meta-analysis using the Stata 9.2 software, including postoperative mortality, incidence of postoperative pancreatic and bile leakage, abdominal abscess, delayed gastric emptying and incision ***: Fourteen retrospective cohort studies involving 1826 patients with malignant obstructive jaundice accorded with our inclusion criteria, and were included in meta-analysis. Their baseline characteristics were comparable in all the studies. No significant difference was found in combined risk ratio (RR) of postoperative mortality and incidence of pancreatic and bile leakage, abdominal abscess, delayed gastric emptying between patients with and without PBD. However, the combined RR for the incidence of postoperative incision infection was improved better in patients with PBD than in those without PBD (P malignant obstructive jaundice, and therefore should not be used as a preoperative routine procedure for malignant obstructive jaundice.

关键词： malignant obstructive jaundice Preoperative biliary drainage Meta-analysis Mortality Incidence of complications

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Effect of postoperative early enteral nutrition on clinical outcomes and immune function of cholangiocarcinoma patients with malignant obstructive jaundice

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World Journal of Gastroenterology 2020年第46期26卷 7405-7415页

作者： Bing-Qiang Ma Shi-Yong Chen Ze-Bin Jiang Biao Wu Yu He Xin-Xin Wang Yuan Li Peng Gao Xiao-Jun Yang Department of General Surgery Gansu Provincial HospitalLanzhou 730000Gansu ProvinceChina School of Clinical Medicine Ningxia Medical UniversityYinchuan 750000Ningxia Hui Autonomous RegionChina School of Clinical Medicine Gansu University of Chinese MedicineLanzhou 730000Gansu ProvinceChina

BACKGROUND Most cholangiocarcinoma patients with malignant obstructive jaundice(MOJ)have varying degrees of malnutrition and immunodeficiency ***,perioperative nutritional support has important clinical significance in the treatment of *** To investigate the effects of postoperative early enteral nutrition(EEN)on immunity function and clinical outcomes of cholangiocarcinoma patients with *** This prospective clinical study included 60 cholangiocarcinoma patients with MOJ who underwent *** patients were randomly divided into an experimental group and a control group according to the nutrition support *** control group received postoperative total parenteral nutrition(TPN),whereas the experimental group received postoperative EEN and parenteral nutrition(PN;EEN+PN).The clinical outcomes,postoperative immune function,incidences of surgical site infection and bile leakage,intestinal function recovery time,average hospitalization days,and hospitalization expenses of the two groups were assessed on postoperative days(PODs)1,3,and *** The CD3+T,CD4+T,CD8+T,and CD4+T/CD8+T cell count and the immunoglobulin(Ig)G,IgM,and IgA levels in the EEN+PN group were significantly higher than those in the TPN group on PODs 3 and 7(P0.05).The intestinal function recovery time and postoperative hospital stay were shorter(P0.05).CONCLUSION A postoperativ

关键词： Clinical outcomes Early enteral nutrition Immune function Nutritional status malignant obstructive jaundice Cholangiocarcinoma

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Percutaneous biliary stent combined with brachytherapy using 125I seeds for treatment of unresectable malignant obstructive jaundice:A meta-analysis

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World Journal of Clinical Cases 2021年第35期9卷 10979-10993页

作者： Wei-Yue Chen Chun-Li Kong Miao-Miao Meng Wei-Qian Chen Li-Yun Zheng Jian-Ting Mao Shi-Ji Fang Li Chen Gao-Feng Shu Yang Yang Qiao-You Weng Min-Jiang Chen Min Xu Jian-Song Ji Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research/Department of Radiology Lishui Hospital of Zhejiang UniversityLishui 323000Zhejiang ProvinceChina

BACKGROUND malignant obstructive jaundice(MOJ)is a common pathologic manifestation of malignant biliary ***,several clinical trials have explored the clinical effectiveness of intraluminal^(125)I seed-based brachytherapy for MOJ patients,and various outcomes have been *** To assess the efficacy and safety of percutaneous biliary stents with^(125)I seeds compared to conventional metal stents in patients with unresectable *** A systematic search of English-language databases(PubMed,Embase,Cochrane Library,and Web of Science)was performed to identify studies published prior to June 2020 that compared stents with or without^(125)I seeds in the treatment of unresectable *** outcomes analyzed included primary outcomes(stent patency and overall survival)and secondary outcomes(complications and liver function parameters).RESULTS Six randomized controlled trials and four retrospective studies involving 875 patients were eligible for the *** the 875 included patients,404 were treated with^(125)I seed stents,while 471 were treated with conventional *** pooled analysis demonstrated that compared to conventional stents,^(125)I seed stents extended the stent patency time[hazard ratio(HR)=0.36,95%confidence interval(CI)=0.28-0.45,P<0.0001]and overall survival period(HR=0.52,95%CI=0.42–0.64,P<0.00001).Subgroup analyses based on the type of^(125)I seed stent and type of study design showed consistent ***,there were no significant differences in the occurrence of total complications[odds ratio(OR)=1.12,95%CI=0.75-1.67,P=0.57],hemobilia(OR=1.02,95%CI=0.45-2.3,P=0.96),pancreatitis(OR=1.79,95%CI=0.42-7.53,P=0.43),cholangitis(OR=1.13,95%CI=0.60-2.13,P=0.71),or pain(OR=0.67,95%CI=0.22-2,P=0.47).In addition,there were no reductions in the levels of serum indices,including total bilirubin[mean difference(MD)=10.96,95%CI=-3.56-25.49,P=0.14],direct bilirubin(MD=7.37,95%CI=-9.76-24.5,P=0.4),alanine aminotransferase(MD=7.52

关键词： malignant obstructive jaundice Brachytherapy 125I seed Patency Survival Meta-analysis

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Surgical mortality in patients with malignant obstructive jaundice: a multivariate discriminant analysis

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Hepatobiliary & Pancreatic Diseases International 2003年第3期2卷 435-440页

作者： Xi-Chun Han Jin-Long Li Gang Han the Department of Surgery, Second Hospital, Jilin University, Changchun 130041, China Department of Surgery Second Hospital Jilin University Changchun 130041 China. hanchun601@***

OBJECTIVE: To estimate the operative mortality in patients with malignant obstructive jaundice. METHODS: Twelve risk factors were analyzed using multivariate discriminant analysis in 90 patients who had been operated on. RESULTS: Operative mortality was significantly related to the following factors: age, duration of jaundice, packed RBC volume, white blood cell count and concentration of blood urine nitrogen; it was not significantly related to diseases and types of operation. The following formula was obtained: packed RBC volume×0.09954-age×0. 04018-blood urine nitrogen×0. 23693-duration of jaundice× 2. 07388-WBC count×0. 21118+5. 26593. With this formula, an operative mortality of 77. 8% was predicted. CONCLUSION: With a positive value from the formula, the patient should be operated on; otherwise non-operative treatment is advocated.

关键词： malignant obstructive jaundice postoperative mortality multivariate discriminant analysis

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Percutaneous intraductal radiofrequency ablation for treatment of biliary stent occlusion: A preliminary result

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World Journal of Gastroenterology 2017年第10期23卷 1851-1856页

作者： Ning Xia Ju Gong Jian Lu Zhi-Jin Chen Li-Yun Zhang Zhong-Min Wang Department of Radiology Ruijin Hospital Luwan BranchShanghai Jiao Tong University School of Medicine Department of Intervention Ruijin HospitalShanghai Jiao Tong University School of Medicine

AIM To assess the feasibility and effectiveness of a novel application of percutaneous intraductal radiofrequency (RF) for the treatment of biliary stent obstruction. METHODS We specifically report a retrospective study presenting the results of percutaneous intraductal RF in patients with biliary stent occlusion. A total of 43 cases involving biliary stent obstruction were treated by placing an EndoHPB catheter and percutaneous intraductal RF was performed to clean stents. The stent patency was evaluated by cholangiography and follow-up by contrast enhanced computed tomography or ultrasound after the removal of the drainage catheter. RESULTS Following the procedures, of the 43 patients, 40 survived and 3 died with a median survival of 80.5 (range: 30-243) d. One patient was lost to followup. One patient had the stent patent at the time of last follow-up. Two patients with stent blockage at 35 d and 44 d after procedure underwent percutaneous transhepatic drain insertion only. The levels of bilirubin before and after the procedure were 128 +/- 65 mu mol/L and 63 +/- 29 mu mol/L, respectively. There were no related complications (haemorrhage, bile duct perforation, bile leak or pancreatitis) and all patients' stent patency was confirmed by cholangiography after the procedure, with a median patency time of 107 (range: 12-180) d. CONCLUSION This preliminary clinical study demonstrated that percutaneous intraductal RF is safe and effective for the treatment of biliary stent obstruction, increasing the duration of stent patency, although randomized controlled trials are needed to confirm the effectiveness of this approach.

关键词： Percutaneous transhepatic cholangiography Intraductal radiofrequency malignant obstructive jaundice

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