Interventional treatment of malignant obstructive jaundice

  Bile is an important substance involved in human digestion, metabolism, absorption and other physiological functions. It is produced by hepatocyte secretion and enters the intestine through hepatic ducts inside and outside the liver, extrahepatic gallbladder and common bile duct. If malignant tumor invades or presses any of the above mentioned parts, it will cause different degrees of bile excretion obstruction, and bile will flow backward from hepatocytes into blood causing yellowing of skin and sclera all over the body, forming hyperbilirubinemia, also called malignant obstructive jaundice. As bile enters the intestinal tract, it has a toxic effect on liver cells and other organs, causing varying degrees of damage to liver, kidney and lung functions, cardiovascular, digestive system, fat metabolism and coagulation function, which seriously affects the patient’s quality of life and even endangers life. Malignant obstructive jaundice is one of the more common and serious complications of hepatobiliary system tumors.  The development and progress of modern medical science and technology have made it possible to provide interventional treatment (i.e. minimally invasive treatment) for obstructive jaundice caused by tumors, forming a complementary advantage between disciplines and providing new treatment methods for patients. The main method of interventional treatment is to puncture the intrahepatic bile duct with a 1-mm needle under X-ray television surveillance and place a drainage tube into the duodenum under the guidance of a micro-guide wire (0.8 mm) for internal and external drainage. Through internal and external drainage, part of the bile can be directly drained to the duodenum and the other part to the outside of the body, which is conducive to substantially reducing the toxic side effects of bile and improving the jaundice symptoms of the patient in the shortest possible time, and at the same time, bile can be extracted for bacterial culture for targeted anti-infection treatment. After one week of drainage, a memory alloy metal internal stent is placed at the site of biliary stricture, the drainage tube is withdrawn, and the puncture tract is closed to restore physiological bile drainage channels. The characteristics of this treatment method are: less trauma, the treatment purpose can be achieved without open surgery; quick recovery, normal activities can be carried out after surgery; good effect, the effect is completely comparable to surgery.  The modern concept of tumor treatment is comprehensive treatment, which should not only treat the tumor but also control the complications. According to the treatment experience of hundreds of cases of malignant obstructive jaundice in Tianjin Cancer Hospital in recent years, another interventional technique, i.e. arterial chemoembolization, can be used when the jaundice subsides, liver function recovers and physical condition improves, in which a catheter is inserted into the tumor blood supply artery for chemotherapy, which can increase the local drug concentration of the tumor and reduce side effects, and at the same time embolize the tumor nutrient vessels to improve the therapeutic effect. If the tumor involvement is small, radiation therapy can be administered again. Therefore, both primary and secondary treatment not only improve the survival quality of patients, but also prolong the survival period.