To explore the therapeutic effect in malignant obstructive jaundice with PTBD and PTBS combined with gemcitabine-base intraarterial chemoperfusion and chemoembolization.

We choosed 240 patients with malignant obstructive jaundice who had been successfully drained(TBIL<50umol/L), and performed intraarterial chemoperfusion and chemoembolization. Patients were back in the outpatient clinic for a follow-up visit at 1 month, 3 months, 6 months, 12 months, 18 months and 24 months thereafter. Contents included general health related questions, laboratory results, image examination, drainage catheter, patency of stent and treatment of stent obstruction. Records were entered into CRF for subsequent processing and analysis. Compare survival, quality of life and rate of stent patency with non-perfusing chemotherapy group.

Of the 60 patients 27 were initially treated with PTBD and 33 with PTBS. Most of them received intraarterial chemoperfusion and chemoembolization for 2-3 times. Major toxicities included myelosuppress, digestive reaction, rash and lesion of hepatic function, and most of them belonged to 1 to 2 grade. The mean survival was (311.03±170.23) d. The rate of survival was 100%, 93.33%, 78.33% and 28.33% for 1 month, 3 months, 6 months and 12 months, respectively. The Kaplan-Meier analysis showed survival rate of chemoperfusion group was prior to non-chemoperfusion group (χ²=8.693, P=0.003). The mean stent patency time was (238.48±171.26) d. The rate of patency was 100%, 90.91%, 57.58 and 9.09% for 1 month, 3 months, 6 months and 12 months, respectively. Stent patency times between two groups were not different statistically by log-rank test (χ²=0.975, P=0.324). Karnofsky index was 83.05±6.38 after intraarterial chemoperfusion and chemoembolization, and was significantly higher than pretherapy (t=12.79, P<0.001).

Patients received gemcitabine-base intraarterial chemoperfusion and chemoembolization had the low toxic effects and high rate of clinical benefit. It could significantly prolong stent patency time.