RESUMO
OBJECTIVE: Patients with proximal malignant jaundices are often diagnosed in an advanced stage and need biliary decompression treatments, such as percutaneous transhepatic biliary drainage (PTBD) and bare metal stenting (BMS), to improve the hepatic function. Whether it is better to perform those two procedures together or in a separate time, it is not well understood. The aim of this study was to investigate the effectiveness and cost-benefit of a combined "one-stage" PTBD/BMS procedure in patients with malignant jaundices. PATIENTS AND METHODS: Forty-five patients with malignant jaundice treated with "one-stage" PTBD/BMS were retrospectively enrolled to evaluate technical success, complications, survival, and length of hospitalization. RESULTS: A full technical success of the procedures was reported for all patients, with only one major complication among 45 treated patients. A better performance in terms of hospitalization rate was achieved by the one-stage procedure compared to the two-stage, also resulting in global saving of costs. A high survival rate was observed at the 3rd and 6th month (97.7% and 86.6%, respectively), with a median overall survival time of 271,58 days. CONCLUSIONS: Our study shows that performing PTBD/BMS as a "one-stage" procedure is useful, safe, and cost-effective with a high percentage of technical success and a similar occurrence of complications compared to the two-stage procedure.
Assuntos
Icterícia Obstrutiva/cirurgia , Stents , Idoso , Idoso de 80 Anos ou mais , Neoplasias dos Ductos Biliares/complicações , Neoplasias dos Ductos Biliares/mortalidade , Neoplasias dos Ductos Biliares/patologia , Procedimentos Cirúrgicos do Sistema Biliar , Colangiopancreatografia por Ressonância Magnética , Análise Custo-Benefício , Descompressão Cirúrgica , Drenagem/métodos , Feminino , Humanos , Icterícia Obstrutiva/etiologia , Tumor de Klatskin/complicações , Tumor de Klatskin/mortalidade , Tumor de Klatskin/patologia , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Taxa de SobrevidaRESUMO
This work describes an updated version of a beta spectrometer that measures pure beta emitter activities. The detection system consists of a plastic scintillator surrounded in a 4 pi geometry by large anticoincidence NaI(Tl) scintillators. A thin silicon detector, inserted between the plastic and the sample, helps to reduce the gamma background. A Monte Carlo code, used to calculate the quite complex spectrometer response function to any isotope, is also described.