Zhai Renyou, Qian Xiaojun, Dai Dingke, Yu Ping
Department of Interventional Radiology, Beijing Chaoyang Hospital, Capital University of Medical Sciences, Beijing 100020, China.
Chin Med J (Engl). 2003 Jun;116(6):888-92.
To evaluate the method of palliative drainage by means of metallic indwelling stents or plastic tubes for patients with malignant biliary obstruction.
From January 1995 to February 2001, 243 consecutive patients (161 men and 82 women; aged 26 - 91 years, mean of 61.3 years) with malignant biliary obstruction were treated with transhepatic placement of metallic stents and/or plastic tubes. Among them, 47 patients had pancreatic carcinoma, 98 cholangiocarcinoma, 28 metastatic carcinoma and 60 hepatic carcinoma. 169 stents of nine types were used in this series. After stenting, 47 patients were treated for local tumors. Procedure- and device-related complications were recorded. Patient survival and stent patency rates were calculated with Kaplan-Meier survival analysis.
One hundred and three patients underwent successfully stent placement for the first time. Others had their stents installed 1 - 2 weeks after catheterization. Stents were used in 132 patients. Ninety-five patients were treated with a single stent. Seventeen patients had two stents installed for bilateral drainage, 20 patients had two stents installed from top to bottom to create stenting of adequate length, and 12 patients had stents placed across the ampulla. The 2-month mortality rate was 8.64% (21/243). Major complications occurred in two patients (0.8%, 2/243). Minor complications included self-limited bleeding into the drainage tubes and fever. The average patency of the initial stent was 7.5 months and average survival was 9 months. Thirteen patients received brachytherapy in their stents, 15 extra radiation therapy, and 19 intra-arterial infusion chemotherapy. The 47 patients treated for local tumors had an average survival of 11.3 months (log rank 32.8, P < 0.001) with an average patency of 9.7 months (log rank 4.7, P < 0.05).
Percutaneous transhepatic bile drainage as a palliative procedure is well tolerated by patients. After stenting, treatment for local tumor may prolong the duration of stent patency and the survival of patients.
评估采用金属内支架或塑料引流管对恶性胆管梗阻患者进行姑息性引流的方法。
1995年1月至2001年2月，对243例连续的恶性胆管梗阻患者（男161例，女82例；年龄26 - 91岁，平均61.3岁）行经肝金属支架和/或塑料引流管置入术。其中胰腺癌47例，胆管癌98例，转移性癌28例，肝癌60例。本系列共使用了9种类型的169个支架。置入支架后，47例患者接受了局部肿瘤治疗。记录与操作和器械相关的并发症。采用Kaplan-Meier生存分析计算患者生存率和支架通畅率。
103例患者首次成功置入支架。其余患者在插管后1 - 2周置入支架。132例患者使用了支架。95例患者置入单个支架。17例患者为双侧引流置入两个支架，20例患者从上到下置入两个支架以形成足够长度的支架，12例患者的支架横跨壶腹。2个月死亡率为8.64%（21/243）。2例患者发生严重并发症（0.8%，2/243）。轻微并发症包括引流管自限性出血和发热。初始支架的平均通畅时间为7.5个月，平均生存期为9个月。13例患者在支架内接受近距离放射治疗，15例接受体外放射治疗，19例接受动脉内灌注化疗。47例接受局部肿瘤治疗的患者平均生存期为11.3个月（对数秩检验32.8，P < 0.001），平均通畅时间为9.7个月（对数秩检验4.7，P < 0.05）。
经皮经肝胆道引流作为一种姑息性治疗方法，患者耐受性良好。置入支架后，局部肿瘤治疗可延长支架通畅时间和患者生存期。
