Ducreux M, Liguory C, Lefebvre J F, Ink O, Choury A, Fritsch J, Bonnel D, Derhy S, Etienne J P
Service des Maladies du Foie et de l'Appareil Digestif, Hôpital Bicêtre, Le Kremlin Bicêtre.
Dig Dis Sci. 1992 May;37(5):778-83. doi: 10.1007/BF01296439.
Between January 1983 and December 1987, 103 patients who had hilar biliary obstruction (59 men, 44 women, median age 73 years) were referred to our institution. The causes of hilar biliary obstruction were carcinoma of the bile ducts (55), hepatic metastases or hepatocellular carcinoma (30), and carcinoma of the gallbladder (18). When endoscopic retrograde cholangiography was performed, the stricture was classified as type I in 28%, type II in 41%, and type III in 31% of the patients. In 92 patients, we tried to insert endoscopically a 10, 11, or 12 F Amsterdam type prosthesis; it proved possible in 66 (74%), and the prosthesis proved functional without further procedure in 49 cases (53%); no combined percutaneous and endoscopic method was used. At death or discharge, 45 patients (49%) had a successful drainage. Cholangitis was the main procedure-related complication and occurred in 25 patients. The 30-day mortality was 43%. Results varied according to type of stenosis: successful drainage was performed in 15% of the patients with type III stenosis, compared with 86% when the stenosis was of type I. Under a multivariate analysis the independent prognostic factors of 30-day mortality were: (1) development of infectious complications after endoscopic attempt at drainage (P less than 0.0001), and (2) absence of successful drainage (P less than 0.0001). In conclusion, endoscopic endoprosthesis placement allows a sufficient drainage in 53% of the cases. In type III stenosis, the high rate of 30-day mortality leads us the conclusion that endoscopic drainage must be avoided.
1983年1月至1987年12月期间，103例肝门部胆管梗阻患者（男性59例，女性44例，中位年龄73岁）被转诊至我院。肝门部胆管梗阻的病因包括胆管癌（55例）、肝转移瘤或肝细胞癌（30例）以及胆囊癌（18例）。行内镜逆行胆管造影时，28%的患者狭窄为I型，41%为II型，31%为III型。92例患者尝试在内镜下置入10F、11F或12F阿姆斯特丹型假体；66例（74%）成功置入，49例（53%）的假体无需进一步处理即发挥功能；未采用经皮与内镜联合方法。在死亡或出院时，45例患者（49%）引流成功。胆管炎是主要的与操作相关的并发症，25例患者发生。30天死亡率为43%。结果因狭窄类型而异：III型狭窄患者中15%引流成功，而I型狭窄患者为86%。多因素分析显示，30天死亡率的独立预后因素为：（1）内镜引流尝试后发生感染并发症（P<0.0001），（2）引流未成功（P<0.0001）。总之，内镜下置入假体在53%的病例中可实现充分引流。在III型狭窄中，30天死亡率较高，这使我们得出结论，应避免内镜引流。
