Outcomes of iodine-125 seed strips combined with double self-expandable metallic stent for Bismuth type III and IV malignant biliary obstruction

Figure 3 Hilar cholangiocarcinoma in a 49-year-old female patient. A: Abdominal contrast-enhanced computed tomography shows hilar cholangiocarcinoma with intrahepatic metastasis, intrahepatic bile duct dilation, and multiple hilar region lymph node metastases; B: Cholangiography shows hilar biliary obstruction, Bismuth type IV. Intraductal biopsy reveals poorly differentiated adenocarcinoma; C: Double guiding tubes were selected from the left and right intrahepatic bile ducts to the duodenum; D: Double iodine-125 (¹²⁵I) seed strip combined with double self-expandable metallic stent implantation (type Y). The right bile duct is connected to the common bile duct (8 mm × 80 mm, 20 ¹²⁵I seeds) and the left bile duct is connected to the common bile duct (8 mm × 80 mm, 20 ¹²⁵I seeds); E: One month postoperatively, cholangiography showed that the left biliary stent was patent, and the left drainage tube was removed; F: Two months postoperatively, cholangiography showed that the right biliary stent was patent and the right drainage tube was removed.