Different percutaneous transhepatic biliary stent placements and catheter drainage in the treatment of middle and low malignant biliary obstruction

ARTICLE HIGHLIGHTS

Research background

For cases of middle and low biliary obstruction with left and right hepatic duct dilatation, the type of approach and whether different approaches affect the difficulty of puncture operation and intraoperative and postoperative complications have not been discussed in detail.

Research motivation

This study compared the clinical efficacy of two different puncture paths in treating middle and low biliary obstruction. The study prioritized the optimal puncture pathway.

Research objectives

This study compared the efficacy of different pathways to find the best improvement in patient quality of life and survival rate.

Research methods

A retrospective analysis was performed on the medical records of 424 patients with middle and low biliary obstruction who underwent percutaneous liver puncture biliary stent placement and catheter drainage between March 2016 and March 2022. Based on the puncture path, patients were categorized into two groups: subxiphoid left hepatic lobe approach group (Group A) and right intercostal, right hepatic lobe approach group (Group B). Liver function improvement, postoperative biliary bleeding incidence, postoperative pain duration, and abdominal effusion leakage around the drainage tube were compared between the two groups at 3 d and 1 wk after the operation.

Research results

The decreased rates for total bilirubin, direct bilirubin, and alkaline phosphatase 1 wk after surgery were significantly faster in Group A than in Group B. The decreased rate of gamma-glutamyl transpeptidase was also significantly faster in Group A at both 3 d and 1 wk after surgery. Group A experienced significantly less peritoneal effusion leakage around the drainage tube than Group B. The patient survival rate was higher in Group A compared to Group B.

Research conclusions

The study proposed a humanistic care perspective, improving patient survival treatment in the later stage and prioritized the optimal puncture pathway.

Research perspectives

This research was carried out retrospectively and reflected the experiences of a single institution. More studies should be performed in the future.