[Endoscopic and transhepatic intubation of malignant bile duct strictures for postoperative jaundice].
Out of 625 patients referred for stenting for a malignant stricture of the biliary tract, 97 (15.8%) had undergone previous surgery. Resection had been performed in 43 cases, by-pass in 15, surgical stenting in 11, laparotomy in 28. The stricture was located in the porta hepatis in 48 patients (49.5%) in the middle common bile duct (CBD) in 47 (48.5%) and juxtapapillary in 2 (2%). Endoscopic retrograde transhepatic stenting was successful in 51 patients (52.5%). Percutaneous transhepatic stenting was successful in 41 cases out of 46 (85%) and in 5 cases, only external drainage was possible. A 75% reduction in serum bilirubin was observed in 78 patients (81.5%) and normalization was observed in 66 (90%) who survived more than one month. The complication rate was 31.3% in the endoscopic group and 47.7% in the percutaneous transhepatic group, with a mortality related to early complications of 9.8% and 19.6% respectively. The higher complication rate of transhepatic stenting is at least partially related to an unfavourable selection of patients in this group: failures of endoscopic stenting, high frequency of hilar strictures. The mortality at D 30 was 24%, significantly higher in hilar strictures than in middle CBD strictures (p less than 0.02). A late obstruction of the stent occurred in 43 patients (58%) after an interval of 103 +/- 52 days, and endoscopic retreatment was possible in 65% of cases. The median survival was 153 days in subhilar strictures and 104 days in hilar strictures. These results justify considering the possibility of palliative stenting after failure of a surgical treatment especially in peri-ampullary and middle CBD strictures.
Centre Médico-Chirurgical de l'Alma, Paris.
C
C
Liguory
J F
JF
Lefebvre
G
G
Vitale
D
D
Bonnel
F
F
Cornud
D000368:Aged; D002779:Cholestasis / Q000209:etiology / Q000628:therapy*; D004322:Drainage; D016145:Endoscopy, Digestive System / Q000379:methods; D005260:Female; D005706:Gallbladder Neoplasms / Q000150:complications* / Q000601:surgery; D006801:Humans; D007440:Intubation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000150:complications* / Q000601:surgery; D011183:Postoperative Complications; D019736:Prostheses and Implants
Intubation des sténoses biliaires malignes par voie endoscopique et transhépatique pour ictère après chirurgie.