Gerhardt T, Rings D, Höblinger A, Heller J, Sauerbruch T, Schepke M
Department of Internal Medicine I, University Hospital, Bonn, Germany.
Z Gastroenterol. 2010 Jan;48(1):28-32. doi: 10.1055/s-0028-1109983. Epub 2010 Jan 13.
Endoscopic biliary drainage is the mainstay of palliative treatment in patients with unresectable malignant hilar biliary obstruction. While self-expandable metal stents have shown significant advantages in distal tumors, bilateral hilar stenting is technically demanding. Moreover, ingrowth is a significant problem in uncovered stents. We evaluated the feasibility and efficacy of endoscopic bilateral JoStent SelfX deployment in patients with proximal malignant biliary obstruction in combination with photodynamic therapy (PDT) and/or chemotherapy. Twenty-one consecutive patients with malignant hilar biliary strictures were treated with transpapillary bilateral insertion of JoStentSelfX metal stents. Additional PDT was applied in 8 patients (PDT plus chemotherapy n = 4, only PDT n = 4). Solely chemotherapy was performed in 5 patients. Mean (+/- SD) stent patency was 173.9 +/- 201.8 days. The median estimated survival was 12.3 months (95 % CI: 8.5; 15.9). PDT was safely and efficaciously performed after endoscopic stent deployment (1.8 +/- 1.1 sessions/patient). There was a trend towards a longer stent patency in patients receiving additional therapy (202.2 +/- 197.6 vs. 128 vs. 213.2 days; p = 0.38). Furthermore, we observed a significantly longer survival in this cohort (16.5 [12.2; 20.1] vs. 12.3 [1.9; 8.5] months, p < 0.005). Additional therapy had no significant impact on cumulative hospitalization time (16.3 +/- 15.8 vs. 14.4 +/- 22.5 days; p = 0.54). Bilateral insertion of Jostent SelfX in patients with proximal cholangiocarcinoma is feasible and effective and can be safely combined with trans-stent photodynamic therapy.
内镜下胆道引流是不可切除的恶性肝门部胆管梗阻患者姑息治疗的主要手段。虽然自膨式金属支架在远端肿瘤中已显示出显著优势，但双侧肝门部支架置入技术要求较高。此外，支架内生长是裸支架的一个重大问题。我们评估了内镜下双侧JoStent SelfX支架置入联合光动力疗法（PDT）和/或化疗在近端恶性胆管梗阻患者中的可行性和疗效。连续21例恶性肝门部胆管狭窄患者接受了经乳头双侧插入JoStentSelfX金属支架治疗。8例患者接受了额外的PDT治疗（PDT加化疗n = 4，仅PDT n = 4）。5例患者仅接受化疗。支架平均通畅时间（±标准差）为173.9±201.8天。估计中位生存期为12.3个月（95%CI：8.5；15.9）。内镜下支架置入后安全有效地进行了PDT（1.8±1.1次/患者）。接受额外治疗的患者支架通畅时间有延长趋势（202.2±197.6天对128天对213.2天；p = 0.38）。此外，我们观察到该队列患者生存期显著延长（16.5[12.2；20.1]个月对12.3[1.9；8.5]个月，p < 0.005）。额外治疗对累计住院时间无显著影响（16.3±15.8天对14.4±22.5天；p = 0.54）。对近端胆管癌患者双侧插入Jostent SelfX是可行且有效的，并且可以安全地与经支架光动力疗法联合使用。
