Clinical effect of ultrasound-guided intrahepatic bile duct puncture and drainage on elderly patients with malignant hilar biliary obstruction

Ding Lei; Zhang Zhen; Liu Fuquan

doi:10.3760/j.issn.1673-4777.2018.08.019

Abstract：Objective To analyze the clinical effect of ultrasound-guided intrahepatic bile duct puncture and drainage on elderly patients with malignant hilar biliary obstruction.Methods A total of 146 elderly patients with malignant hilar biliary obstruction were enrolled from August 2013 to August 2016 in Beijing YouAn Hospital,Capital Medical University.The patients were randomly divided into observation group and control group,with 73 cases in each group.The observation group was treated with ultrasound-guided intrahepatic bile duct puncture and drainage.The control group was treated with CT-guided intrahepatic bile duct puncture and drainage.Serum levels of total bilirubin and direct bilirubin were tested before and 7 d after operation.Occurrence of complications was observed in 7 d after operation.Prognosis of patients was followed up in 12 months after operation.Results The first time successful puncture rate was 100.0％ (73/73) in observation group and 95.9％ (70/73) in control group.At 7 d after operation,serum levels of total bilirubin and direct bilirubin significantly decreased compared to those before operation;serum levels of total bilirubin and direct bilirubin in observation group were significantly lower than those in control group [(166±76) μmol/L vs (202 ± 78) μmol/L,(141 ± 57) μmol/L vs (178 ± 61) μmol/L] (P ＜ 0.05).Incidence of postoperative complications in observation group was significantly lower than that in control group [4.1％ (3/73) vs 24.7％ (18/73)] (P ＜ 0.05).Survival time of patients [(9.4 ± 1.3)months vs (10.0 ± 1.4)months] and the 1-,2-,3-,6-and 12-month survival rates showed no significant differences between observation group and control group(P ＞ 0.05).Conclusion Intrahepatic bile duct puncture and drainage with guidance of ultrasound treating elderly patients with malignant hilar biliary obstruction can improve the first time successful puncture rate,promote liver function recovery,reduce complications and improve postoperative survival.