title: [Clinical efficacy of malignant obstructive jaundice treated by domestic biliary metallic stent insertion].
abstract: OBJECTIVE
  To evaluate the clinical efficacy of implanted biliary metallic stents in the management of malignant obstructive jaundice (MOJ).
  
  
  METHODS
  Percutaneous transhepatic cholangiography and stent insertion were performed in 241 consecutive patients to treat malignant biliary obstruction between December 1998 and February 2009. The study end point was patient death. All patients were followed-up until death or until February 2010. The therapeutic efficacy was determined by statistical analysis of life span and pre- and post-operative laboratory indices.
  
  
  RESULTS
  All 241 patients were successfully stented. The level of bilirubin descended obviously within four weeks of implantation (P less than 0.05), and the early mortality rate was 4.56% (11/241). Two-hundred-and-two patients were followed-up (range: 8-193 weeks post-transplantation) and showed a median survival of 43.55 weeks. The survival rates at 13, 26, 39 and 52 weeks post-transplantation were 87%, 66%, 56%, and 41%, respectively. The stent patency rates at 13, 26, 39 and 52 weeks post-transplantation were 70%, 46%, 36% and 24%, respectively; the mean stent patency was 27.57 weeks. Cox regression analysis identified the strong predictors of improved survival as an initial bilirubin level of less than 221 mumol/L (P = 0.01) and a stent-induced bilirubin reduction of more than 50% (P = 0.002).
  
  
  CONCLUSIONS
  Transhepatic metallic biliary stenting is a safe and effective therapeutic intervention for malignant biliary obstruction. Significant periods of survival and palliation of jaundice can be achieved with this method. Hyperbilirubinemia and a stent-induced bilirubin reduction of less than 50% are independent predictive factors for the survival of MOJ patients.
authors.affiliation: Department of Interventional Radiology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
authors.forename: Zhen
authors.initials: Z
authors.lastname: Li
authors.forename: Ya
authors.initials: Y
authors.lastname: Li
authors.forename: Teng-fei
authors.initials: TF
authors.lastname: Li
authors.forename: Jin-xue
authors.initials: JX
authors.lastname: Zhou
authors.forename: Xin-wei
authors.initials: XW
authors.lastname: Han
authors.forename: Qing-liang
authors.initials: QL
authors.lastname: Chen
authors.forename: Jian-zhuang
authors.initials: JZ
authors.lastname: Ren
authors.forename: Hui-feng
authors.initials: HF
authors.lastname: Yuan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001662:Biliary Tract Surgical Procedures; D001663:Bilirubin / Q000378:metabolism; D005260:Female; D006801:Humans; D041781:Jaundice, Obstructive / Q000601:surgery*; D008297:Male; D008670:Metals; D008875:Middle Aged; D015607:Stents; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D008670:Metals; D001663:Bilirubin