Department of Hepatobiliary and Pancreatic Surgery, Leicester General Hospital, Leicester, UK.
Surg Endosc. 2010 Feb;24(2):423-31. doi: 10.1007/s00464-009-0586-0. Epub 2009 Jun 30.
In patients in whom attempted endoscopic stenting of malignant biliary obstruction fails, combined percutaneous-endoscopic stenting and percutaneous stenting using expandable metallic endoprostheses offer alternative approaches to biliary drainage. Despite the popularity of the percutaneous route, there is no available evidence to support its superiority over combined stenting in this patient group. The objective of this study was to present the short- and long-term results of a large series of combined percutaneous-endoscopic stenting procedures and identify factors associated with adverse outcome.
Data were retrospectively collected on patients undergoing combined percutaneous-endoscopic biliary stenting for malignant biliary obstruction between January 2002 and December 2006. Short- and long-term outcomes were recorded, and pre-procedure variables correlated with adverse outcome.
Combined biliary stenting was technically successful in 102 (96.2%) of 106 patients. Procedure-associated mortality rate was 0%. In-hospital morbidity and mortality rates were 24.5% and 16.7%, respectively, with the majority of deaths resulting from biliary sepsis. Median survival was 100 days, with a 13.7% stent occlusion rate. On multivariable analysis, baseline American Society of Anaesthesiologists (ASA) grade, decreasing serum albumin and increasing leucocyte count were independently associated with in-hospital mortality following combined stenting.
Combined biliary stenting is associated with short- and long-term outcomes equal to those reported in recent series of percutaneous transhepatic stenting. Randomised control trials, including cost-effectiveness analyses, are required to further compare these techniques. Outcomes following combined stenting may be further improved by early recognition and treatment of sepsis and scrupulous management of co-morbid disease.
在尝试内镜下治疗恶性胆道梗阻失败的患者中，经皮内镜下联合支架置入术和经皮扩张金属支架置入术是胆道引流的替代方法。尽管经皮途径很受欢迎，但目前尚无证据支持其在该患者群体中的优势。本研究旨在介绍一组大型经皮内镜下联合胆道支架置入术的短期和长期结果，并确定与不良预后相关的因素。
回顾性收集 2002 年 1 月至 2006 年 12 月期间接受经皮内镜下联合胆道支架置入术治疗恶性胆道梗阻的患者数据。记录短期和长期结果，并分析术前变量与不良预后的相关性。
106 例患者中，102 例（96.2%）技术上获得成功。手术相关死亡率为 0%。住院期间发病率和死亡率分别为 24.5%和 16.7%，大多数死亡是由胆道感染引起的。中位生存时间为 100 天，支架阻塞率为 13.7%。多变量分析显示，基线美国麻醉医师协会（ASA）分级、血清白蛋白降低和白细胞计数增加与联合支架置入术后住院期间死亡独立相关。
经皮内镜下联合胆道支架置入术的短期和长期结果与近期经皮经肝胆道支架置入术的报道结果相当。需要进行随机对照试验，包括成本效益分析，以进一步比较这些技术。早期识别和治疗感染以及认真管理并存疾病可能会进一步改善联合支架置入术后的结局。
