Hong Hyun Pyo, Kim Seung Kwon, Seo Tae-Seok
Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 108, Pyung-Dong, Jongro-ku, Seoul, 110-746 Korea.
J Vasc Interv Radiol. 2008 May;19(5):748-54. doi: 10.1016/j.jvir.2007.12.455. Epub 2008 Mar 17.
To evaluate the technical success and clinical efficacy of percutaneously placed self-expandable metallic stents in patients with obstructive jaundice due to hepatocellular carcinoma (HCC).
Fifteen men (mean age, 59.3 years) with obstructive jaundice resulting from HCC were treated with self-expandable metallic stents (28 stents in 19 sessions). The authors evaluated the technical success, clinical success (decrease of 30% of total serum bilirubin level or <2 mg/dL [34.2 micromol/L]), treatment efficacy according to lowest total serum bilirubin level, complications, and duration of stent patency.
Technical success was achieved in all patients. Clinical success was achieved in 11 of the 15 patients (73%). After stent placement, seven patients (47%) had a low bilirubin level (<2 mg/dL [34.2 micromol/L]), three (20%) had an intermediate bilirubin level (2-10 mg/dL [34.2-171 micromol/L]), and five (33%) had a high bilirubin level (>10 mg/dL [171 micromol/L]). A low bilirubin level was achieved in all patients with Child-Pugh A disease and stage T2 or T3 HCC. Major complications such as hemobilia necessitating transfusion (n=1) or abscess formation (n=1) occurred in two of the 19 sessions (10%). The overall mean stent patency was 149.8 days (range, 12-790 days). The mean stent patency in patients with Child-Pugh class A disease (257.8 days) was significantly longer than that of patients with Child-Pugh class B and C disease (123.2 and 63 days, respectively) (P<.05).
The percutaneous placement of a self-expandable metallic stent is a feasible and effective palliative treatment for patients with obstructive jaundice resulting from HCC, especially for those with Child-Pugh class A disease and stage T2 or T3 HCC.
评估经皮置入自膨式金属支架治疗肝细胞癌（HCC）所致梗阻性黄疸患者的技术成功率和临床疗效。
15例因HCC导致梗阻性黄疸的男性患者（平均年龄59.3岁）接受了自膨式金属支架治疗（19次手术置入28枚支架）。作者评估了技术成功率、临床成功率（总血清胆红素水平降低30%或<2mg/dL[34.2μmol/L]）、根据最低总血清胆红素水平评估的治疗效果、并发症以及支架通畅持续时间。
所有患者均取得技术成功。15例患者中有11例（73%）取得临床成功。支架置入后，7例患者（47%）胆红素水平较低（<2mg/dL[34.2μmol/L]），3例（20%）胆红素水平中等（2 - 10mg/dL[34.2 - 171μmol/L]），5例（33%）胆红素水平较高（>10mg/dL[171μmol/L]）。所有Child-Pugh A级疾病且HCC处于T2或T3期的患者胆红素水平均降低。19次手术中有2次（10%）发生了需要输血的胆道出血（n = 1）或脓肿形成（n = 1）等严重并发症。支架总体平均通畅时间为149.8天（范围12 - 790天）。Child-Pugh A级疾病患者的平均支架通畅时间（257.8天）显著长于Child-Pugh B级和C级疾病患者（分别为123.2天和63天）（P <.05）。
经皮置入自膨式金属支架是治疗HCC所致梗阻性黄疸患者的一种可行且有效的姑息治疗方法，尤其适用于Child-Pugh A级疾病且HCC处于T2或T3期的患者。
