Cao Guang, Yang Ren jie
Department of Interventional Therapy, Beijing Cancer Hospital, Peking University School of Oncology, Beijing Institute for Cancer Research, Beijing 100036, China.
Beijing Da Xue Xue Bao Yi Xue Ban. 2008 Apr;40(2):121-4.
To analyze and evaluate of the long-term follow-up data of 152 patients with inoperable malignant biliary obstruction who underwent percutaneous placement of metallic stents.
From 2000 through 2006, 152 consecutive patients with malignant biliary obstruction were treated with PTCD or placement of metallic stents. The causes of obstruction were bile duct carcinoma (n=35)ìpancreatic carcinoma (n=32), hepatocellular carcinoma and metastatic (n=61), lymphadenopathy in the hepatoduodenal ligament (n=24). We used 86 stents: 31 Cook Zilver Stentsì25 Sinus Superflex Stentsì12 Wall Stentsì3 Sinus-s Iliaca Stentsì3 ZA-S Bliary Design Stentsì5 Smart Stents and 7 other stents. Every three months we followed up all patients except those who died. Patient survival and stent patency rates were estimated by life-table analysis. The Kaplan-Meier method (log-rank test) was used to compare the patency and survival rates among different groups. And the COX regression model was established to compare the relative risks.
The overall median length of patency of all stents was 314 days. The median length of survival for the entire patient group was 215 days. The survival rate was 79.1%ì51.7% and 26.8% after 3, 6, and 9 months, respectively. Six patients developed recurrent jaundice or cholangitis. The patients with hepatic hilar obstruction group indicated worse prognosis (P< or =0.05).
Metallic stents showed a favorable patency rate with regard to patient survival. In patients with hilar obstruction, the clinical prognosis was worse than that in patients with common bile duct (CBD) obstruction. We believe that the placement of metallic stents is the procedure of choice for palliation of malignant biliary obstruction.
分析和评估152例无法手术的恶性胆管梗阻患者经皮置入金属支架后的长期随访数据。
2000年至2006年，连续152例恶性胆管梗阻患者接受了经皮肝穿胆管引流术（PTCD）或金属支架置入术。梗阻原因包括胆管癌（n = 35）、胰腺癌（n = 32）、肝细胞癌及转移癌（n = 61）、肝十二指肠韧带淋巴结病（n = 24）。我们使用了86个支架：31个库克Zilver支架、25个Sinus Superflex支架、12个Wall支架、3个Sinus - s髂动脉支架、3个ZA - S胆管设计支架、5个Smart支架和7个其他支架。除死亡患者外，每三个月对所有患者进行随访。通过寿命表分析评估患者生存率和支架通畅率。采用Kaplan - Meier法（对数秩检验）比较不同组之间的通畅率和生存率。并建立COX回归模型比较相对风险。
所有支架的总体中位通畅长度为314天。整个患者组的中位生存长度为215天。3、6和9个月后的生存率分别为79.1%、51.7%和26.8%。6例患者出现复发性黄疸或胆管炎。肝门部梗阻患者组预后较差（P≤0.05）。
金属支架在患者生存方面显示出良好的通畅率。肝门部梗阻患者的临床预后比胆总管（CBD）梗阻患者差。我们认为，金属支架置入术是缓解恶性胆管梗阻的首选方法。
