Hatzidakis A A, Tsetis D, Chrysou E, Sanidas E, Petrakis J, Gourtsoyiannis N C
Department of Radiology, University Hospital Heraklion, Medical School of Crete, Heraklion-Stavrakia, Greece.
Cardiovasc Intervent Radiol. 2001 Jul-Aug;24(4):245-8. doi: 10.1007/s00270-001-0030-x.
To evaluate the necessity of metallic stenting of the sphincter of Oddi in malignant obstructive jaundice when the tumor is more than 2 cm from the papilla of Vater.
Sixty-seven self-expandable biliary stents were used in 60 patients with extrahepatic lesions of the common hepatic or common bile duct and with the distal margin of the tumor located more than 2 cm from the papilla of Vater. Stents were placed above the papilla in 30 cases (group A) and in another 30 with their distal part protruding into the duodenum (group B).
The 30-day mortality was 15%, due to the underlying disease. The stent occlusion rate was 17% after a mean period of 4.3 months. No major complications were noted. Average survival was 132 days for group A and 140 days for group B. In group A, 19 patients survived < or = 90 days and in eight of these, cholangitis occurred at least once. Of 11 patients in group A with survival > 90 days, only two developed cholangitis. In group B, 13 patients who survived < or = 90 days had no episodes of cholangitis and in 17 with survival > 90 days, cholangitis occurred in three. There is a statistically significant difference (p < 0.05) regarding the incidence of cholangitis in favor of group A.
In patients with extrahepatic lesions more than 2 cm from the papilla and with a relative poor prognosis (< or = 3 months), due to more advanced disease or to a worse general condition, the sphincter of Oddi should also be stented in order to reduce the postprocedural morbidity.
评估当肿瘤距十二指肠乳头超过2 cm时，在恶性梗阻性黄疸中对Oddi括约肌进行金属支架置入的必要性。
60例肝外肝总管或胆总管病变且肿瘤远端边缘距十二指肠乳头超过2 cm的患者使用了67枚自膨式胆管支架。30例患者将支架置于乳头上方（A组），另外30例患者支架远端部分突入十二指肠（B组）。
30天死亡率为15%，系基础疾病所致。平均4.3个月后支架闭塞率为17%。未观察到严重并发症。A组平均生存期为132天，B组为140天。A组中，19例患者存活时间≤90天，其中8例至少发生过一次胆管炎。A组中存活时间>90天的11例患者中，仅2例发生胆管炎。B组中，存活时间≤90天的13例患者未发生胆管炎，存活时间>90天的17例患者中有3例发生胆管炎。胆管炎发生率在A组更有利，差异有统计学意义（p<0.05）。
对于肿瘤距乳头超过2 cm且因疾病进展或全身状况较差而预后相对较差（≤3个月）的肝外病变患者，也应置入Oddi括约肌支架以降低术后发病率。
