Retrospective Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Jul 27, 2023; 15(7): 1397-1404
Published online Jul 27, 2023. doi: 10.4240/wjgs.v15.i7.1397
Different percutaneous transhepatic biliary stent placements and catheter drainage in the treatment of middle and low malignant biliary obstruction
Yao-Bo Yang, Zhao-Yong Yan, Yang Jiao, Wei-Hao Yang, Qi Cui, Si-Pan Chen
Yao-Bo Yang, Zhao-Yong Yan, Yang Jiao, Wei-Hao Yang, Qi Cui, Si-Pan Chen, Department of Interventional Radiology, Shaanxi Provincial People’s Hospital, Xi’an 710068, Shaanxi Province, China
Author contributions: Chen SP initiated the project and designed the experiment; Yang YB conducted clinical data collection; Yan ZY, Yang WH, and Cui Q performed postoperative follow-up and recorded data; Jiao Y conducted data collation and statistical analysis; Yang YB wrote the original manuscript; Chen SP revised the paper; all authors reviewed and approved the final manuscript.
Institutional review board statement: The Ethics Committee of Shaanxi Provincial People’s Hospital approved the study.
Informed consent statement: Due to the retrospective nature of this study, the requirement for informed consent of patients was waived.
Conflict-of-interest statement: The author(s) declare having no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Data sharing statement: All data generated or analyzed during this study are included in this published article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Si-Pan Chen, Doctor, Professor, Department of Interventional Radiology, Shaanxi Provincial People’s Hospital, No. 256 Youyi West Road, Beilin District, Xi’an 710068, Shaanxi Province, China. panda_spph@163.com
Received: March 13, 2023
Peer-review started: March 13, 2023
First decision: March 28, 2023
Revised: April 21, 2023
Accepted: May 6, 2023
Article in press: May 6, 2023
Published online: July 27, 2023
Processing time: 130 Days and 11.6 Hours
Abstract
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.

AIM

To compare the efficacy of different percutaneous transhepatic biliary stent placements and catheter drainage in treating middle and low biliary obstruction.

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 at the Department of Interventional Radiology, Shaanxi Provincial People’s Hospital 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, 224 cases) and right intercostal, right hepatic lobe approach group (Group B, 200 cases). 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 surgery. Patient survival time was recorded during follow-up.

RESULTS

All 424 surgeries were successful without adverse events. Group A comprised 224 cases, and Group B had 200 cases. There was no statistically significant difference in basic data between Group A and Group B (P > 0.05). No significant difference in postoperative biliary bleeding incidence was observed between the groups (P > 0.05). The decreased rates for total bilirubin (Group A: 69.23 ± 4.50, Group B: 63.79 ± 5.65), direct bilirubin (Group A: 79.30 ± 11.19, Group B: 63.62 ± 5.64), and alkaline phosphatase (Group A: 60.51 ± 12.23, Group B: 42.68 ± 23.56) in the 1st 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 (Group A: 40.56 ± 10.32, Group B: 32.22 ± 5.12) and 1 wk (Group A: 73.19 ± 7.05, Group B: 58.81 ± 18.98) after surgery (P < 0.05). Group A experienced significantly less peritoneal effusion leakage around the drainage tube than Group B (P < 0.05). The patient survival rate was higher in Group A compared to Group B (P < 0.05).

CONCLUSION

In treating jaundice patients with middle and low biliary obstruction, a percutaneous left liver puncture demonstrated better clinical efficacy than a percutaneous right liver puncture.

Keywords: Biliary obstruction; Puncture route; Stent placement; Survival rate; Malignant tumor; Digestive tract

Core Tip: For patients with unresectable middle to low level malignant biliary obstruction, percutaneous transhepatic biliary drainage has been widely used in clinical practice. The selection of the approach and whether different approaches will affect the difficulty of puncture surgery, as well as intraoperative and postoperative complications, have not been discussed in detail. This study compared the clinical efficacy of two different puncture pathways in the treatment of middle and low level biliary obstruction. The authors found that the clinical efficacy of patients undergoing percutaneous left liver puncture was superior to that of patients undergoing percutaneous right liver puncture.