Keywords:
Oncology, Interventional non-vascular, Liver, Percutaneous, CT, Fluoroscopy, Stents, Drainage, Technical aspects, Cancer, Multidisciplinary cancer care, Outcomes
Authors:
B. C. Kang, D. E. Goo; Seoul/KR
DOI:
10.1594/ecr2013/C-0029
Methods and Materials
From June 2011 to June 2012,
we inserted the Y-shaped covered stents to treat palliatively in the patients with the hilar malignant biliary obstruction.
They were 16 patients including 12 women and four men.
Mean age of patients was 69.5 years old.
They had inoperable intrahepatic choanlgiocarcinomas in 15 and two metastatic biliary obstructions due to breast and stomach cancer.
Obstructive types were 2 in I,
7 in II,
5 in IIIa and 2 in IV.
To have a Y-configuration for the biliary drainage of both lobes of liver,
we used two pieces of covered stent system; one covered main piece stent and one contra-lateral covered stent .
One main piece stent consisted of a long leg covered stent and another short leg covered stent.
First,
we inserted this main piece into the common bile duct through the left PTBD tract.
The proximal long leg’s end of the main piece was located into the left main bile duct.
Another second piece of covered stent was used to connect into the short leg of the main piece through the right PTBD tract.
It was to drain the bile of the right intrahepatic bile duct.
All procedures were done under the guidance of a 0.035-inch guide wire (Figure 1).
Before and 3-days after Y covered stent insertion,
cholangiograms were obtained through the intrahepatic bile duct for the evaluation of biliary drainage of both lobes of liver.
We checked the blood bilirubin levels before,
1 week-after and every 1 month-after the stenting.
We also had a closer observation even if the clinical infection signs or not.
Statistical analyses were [erformed with a use of Statistical Package for Social Science(version 18.0).
Cumulative stent patency and survival were estimated by Kaplan-Meier analysis,
and curves were compared by the log-rank chi-squared test.