The results of palliative percutaneous drainage of biliary ducts

Abstract

Backround

The aim of palliative treatment of advanced malignant tumours involving the hilus of the liver is to decompress mechanical jaundice. In some cases, percutaneous drainage of biliary ducts is the only possible effective treatment. The aim of this paper is to evaluate the results of palliative percutaneous drainage of biliary ducts.

Materials and methods

Percutaneous drainage of biliary ducts was carried out under ultrasound and x-ray control with a picture channel. A PIGTAIL catheter (9F diameter, 45 cm length) was installed by entering its end-part into intrahepatic billiary ducts and bile diversion. In 5 patients bile was inserted in back to the gastrointestinal tract by simultaneous endoscopic microgastrostomy. In 1996–2003, 52 percutaneous drainages of biliary ducts were installed in 38 patients. All of them suffered from mechanical jaundice with the bilirubin level of 170–510 umol/l caused by neoplasm constricting biliary ducts. The neoplastic disease in all cases was histologically confirmed. The quality of life was evaluated one month after installing percutaneous drainage of biliary ducts. Regression of symptoms connected with mechanical jaundice, independence and self-service when using a catheter and the physical and mental state of patients were taken into consideration.

Results

In all patients a decrease in the bilirubin level below 170 umol/l was observed 14 days after the procedure. In 20 patients jaundice regressed completely 4 weeks after the drainage. In a later period increased bilirubin levels were connected with temporary impairment of catheter patency or with infection of biliary ducts. Despite the advanced neoplastic disease patients showed total independence and selfservice. However neoplastic cachexia and the necessity to take analgesics deteriorated their quality of life.

Conclusions

1) Percutaneous drainage of biliary ducts decompresses mechanical jaundice and decreases ailments typical of cholestasis. 2) Percutaneous drainage of biliary ducts requires specialized long-term care and cooperation with the patient and or his or her family. 3) Deterioration in the quality of life in return for its prolongation is accepted by patients and their families.