经内镜鼻胆管引流术治疗肝门部胆管癌的并发症发生率更低

Lower incidence of complications in endoscopic nasobiliary drainage for hilar cholangiocarcinoma
经内镜鼻胆管引流术治疗肝门部胆管癌的并发症发生率更低
 
Abstract （摘要）
AIM: To identify the most effective endoscopic biliary drainage technique for patients with hilar cholangiocarcinoma.
目的：明确治疗肝门部胆管癌最有效的经内镜胆道引流的方法
 
METHODS: In total, 118 patients with hilar cholangiocarcinoma underwent endoscopic management [endoscopic nasobiliary drainage (ENBD) or endoscopic biliary stenting] as a temporary drainage in our institution between 2009 and 2014. We retrospectively evaluated all complications from initial endoscopic drainage to surgery or palliative treatment. The risk factors for biliary reintervention, post-endoscopic retrograde cholangiopancreatography (post-ERCP) pancreatitis, and percutaneous transhepatic biliary drainage (PTBD) were also analyzed using patient- and procedure-related characteristics. The risk factors for bilateral drainage were examined in a subgroup analysis of patients who underwent initial unilateral drainage.
方法：我们回顾性分析了在2009年-2014年间经内镜临时胆道引流（经鼻胆管引流或经内镜胆管支架引流）治疗肝门部胆管癌的患者共118例。从最初的内镜引流到手术或姑息治疗，我们对所有并发症进行了回顾性评估。 还使用与患者相关和手术相关的特征分析了胆道再次干预，ERCP术后胰腺炎和经皮肝胆道穿刺引流（PTBD）的危险因素。 在对初次单侧引流的患者进行的亚组分析中分析了双侧引流的危险因素。
 
RESULTS: In total, 137 complications were observed in 92 (78%) patients. Biliary reintervention was required in 83 (70%) patients. ENBD was significantly associated with a low risk of biliary reintervention [odds ratio (OR) = 0.26, 95%CI: 0.08-0.76, P = 0.012]. Post-ERCP pancreatitis was observed in 19 (16%) patients. An absence of endoscopic sphincterotomy was significantly associated with post-ERCP pancreatitis (OR = 3.46, 95%CI: 1.19-10.87, P = 0.023). PTBD was required in 16 (14%) patients, and Bismuth type III or IV cholangiocarcinoma was a significant risk factor (OR = 7.88, 95%CI: 1.33-155.0, P = 0.010). Of 102 patients with initial unilateral drainage, 49 (48%) required bilateral drainage. Endoscopic sphincterotomy (OR = 3.24, 95%CI: 1.27-8.78, P = 0.004) and Bismuth II, III, or IV cholangiocarcinoma (OR = 34.69, 95%CI: 4.88-736.7, P < 0.001) were significant risk factors for bilateral drainage.
结果：总共在92例患者（78％）中出现137例并发症。 83例（70％）患者需要进行胆道再干预。 ENBD与胆道再干预的低风险呈显著相关 [比值比（OR）= 0.26，95％CI：0.08-0.76，P = 0.012]。在19名（16％）患者中发生ERCP术后胰腺炎。不进行内镜括约肌切开术与ERCP术后胰腺炎显著相关（OR = 3.46，95％CI：1.19-10.87，P = 0.023）。 16（14％）位患者需要PTBD，而III型或IV型肝门胆管癌是一个重要的危险因素（OR = 7.88，95％CI：1.33-155.0，P = 0.010）。在初期行102例单侧引流的患者中，有49例（48％）需要双侧引流。内镜下括约肌切开术（OR = 3.24，95％CI：1.27-8.78，P = 0.004）和II，III或IV型肝门胆管癌（OR = 34.69，95％CI：4.88-736.7，P <0.001）是双侧引流的重要危险因素。
 
CONCLUSION: The endoscopic management of hilar cholangiocarcinoma is challenging. ENBD should be selected as a temporary drainage method because of its low risk of complications.
结论：经内镜治疗肝门部胆管癌具有挑战性。因ENBD的发生并发症的风险小，应作为临时引流的方法。

翻译 于廷廷 审校 张立超 侯森林

Kawakubo K , Kawakami H , Kuwatani M , et al. Lower incidence of complications in endoscopic nasobiliary drainage for hilar cholangiocarcinoma[J]. World Journal of Gastrointestinal Endoscopy, 2016, 8(9).