经内镜分步置入姑息性双侧胆管引流治疗晚期恶性肝门梗阻

时间:2019-10-24 作者:翻译:王君俊 审校 点击:328次

       内镜下逆行性胰胆管造影(ERCP)治疗肝门部恶性梗阻(MHO)的理想支架类型尚不清楚。我们旨在确定MHO患者理想的支架选择。在这项回顾性研究中,将不能切除的MHO患者分为塑料支架(PS)组和自膨胀金属支架(SEMS)组。主要指标是补救性经皮经肝胆管引流术(PTBD)的风险和发生率。次要指标是无进展生存期、总生存期和无需行PTBD时长(天)。PS组36例入选,SEMS组38例入选。SEMS组PTBD发生率较高(HR = 2.205, 95% C.I. 0.977-4.977, P = 0.057)。PS组PTBD发生率明显降低。(22.2%对50.0%,p=0.017)总生存率和无进展生存率无差异(PS组410和269,SEMS组395和266,p=0.663和p=0.757)。PS组无需行PTBD时长明显延长。(836.43 vs 586.40,p=0.039)虽然在临床疗效上类似,但MHO患者在ERCP下使用PS可避免行PTBD,延长无需行PTBD时长,从而减少患者的不适。

Step-wise endoscopic approach to palliative bilateral biliary drainage for unresectable advanced malignant hilar obstruction.

Jin HoChoi , Sang Hyub Lee, Min SuYou,et al.Scientific Reports.2019 Sep 13;9(1):13207. 

The ideal type of stent utilized at index endoscopic retrograde cholangiopancreatography (ERCP) in management of malignant hilar obstruction (MHO) remains unclear. We aimed to determine the ideal stent choice in patients with MHO. In this retrospective study, patients with unresectable MHO were separated into the plastic stent (PS) group and the self-expandable metal stent (SEMS) group. The primary outcome was the risk and rate of rescue percutaneous transhepatic biliary drainage (PTBD). The secondary outcomes were the progression-free survival, the overall survival and the PTBD-free period (days). Thirty-six patients in the PS group and 38 patients in the SEMS group were enrolled. The risk for PTBD was higher in SEMS group (HR = 2.205, 95% C.I. 0.977-4.977, P = 0.057). The rate of PTBD was significantly lower in the PS group. (22.2% vs 50.0%, P = 0.017) There were no differences in overall survival and progression-free survival (410 and 269 in the PS group, 395 and 266 in the SEMS group, P = 0.663 and P = 0.757). The PTBD-free period was significantly longer in the PS group. (836.43 vs 586.40, P = 0.039) Although comparable in clinical efficacy, utilization of PS at index ERCP may reduce patient's discomfort by avoiding PTBD and prolonging PTBD-free period in patients with MHO.

翻译:王君俊    审校:张立超、侯森林