Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh-160012, India. virendrasingh100@ hotmail.com
Hepatobiliary Pancreat Dis Int. 2010 Feb;9(1):88-92.
Endoscopic palliation in malignant hilar biliary obstruction requires endoscopic retrograde cholangiopancreatography (ERCP), whereas contrast injection leads to cholangitis. Contrast-free metal stenting with or without magnetic resonance cholangiopancreatography (MRCP) has shown encouraging results, but MRCP and metal stents are costly. There have been no reports on the use of air cholangiography.
We prospectively evaluated the role of air cholangiography-assisted unilateral plastic stenting in 10 patients with type II malignant hilar biliary obstruction. A retrospectively analysed group of 10 patients treated with contrast-free unilateral metal stenting served as historical controls.
Ten patients with unresectable type II malignant hilar biliary obstruction were studied. Air cholangiography detected type II obstruction in all patients, similar to MRCP. The patients underwent unilateral stenting. Successful endoscopic drainage was achieved in all patients. The mean patency of the stent was 95.8+/-17.5 days in the study group and 143.9+/-115.1 days in the control group (P=0.20). The mean survival was 121.8+/-41.6 days in the study group and 154.9+/-122.5 days in the control group (P=0.42). Kaplan-Meier analysis showed an estimated median survival of 100:95% CI (65.9, 134.1) days in the study group and 98:95% CI (84.1, 111.9) days in the control group (P=0.62). Cholangitis occurred in none of the patients and there were no 30-day deaths nor major complications. Air cholangiography-assisted unilateral plastic stenting was cheaper than contrast-free unilateral metal stenting.
Air cholangiography-assisted unilateral plastic stenting is as safe and effective as contrast-free unilateral metal stenting in type II malignant hilar biliary obstruction for palliating patients, but it is cheaper.
恶性肝门胆管梗阻的内镜姑息治疗需要内镜逆行胰胆管造影（ERCP），而造影剂注射会导致胆管炎。无对比剂的金属支架置入术联合或不联合磁共振胰胆管成像（MRCP）已显示出令人鼓舞的结果，但 MRCP 和金属支架成本较高。目前尚无关于空气胆管造影的报道。
我们前瞻性评估了空气胆管造影辅助单侧塑料支架置入术在 10 例 II 型恶性肝门胆管梗阻患者中的作用。一组 10 例接受无对比剂单侧金属支架置入术治疗的回顾性分析患者作为历史对照。
研究了 10 例不可切除的 II 型恶性肝门胆管梗阻患者。空气胆管造影在所有患者中均检测到 II 型梗阻，与 MRCP 相似。患者接受单侧支架置入术。所有患者均成功进行内镜引流。研究组支架通畅时间的平均为 95.8+/-17.5 天，对照组为 143.9+/-115.1 天（P=0.20）。研究组的平均生存时间为 121.8+/-41.6 天，对照组为 154.9+/-122.5 天（P=0.42）。Kaplan-Meier 分析显示，研究组估计中位生存时间为 100：95%CI（65.9，134.1）天，对照组为 98：95%CI（84.1，111.9）天（P=0.62）。所有患者均未发生胆管炎，无 30 天内死亡或严重并发症。空气胆管造影辅助单侧塑料支架置入术比无对比剂单侧金属支架置入术更便宜。
空气胆管造影辅助单侧塑料支架置入术在 II 型恶性肝门胆管梗阻的姑息治疗中与无对比剂单侧金属支架置入术同样安全有效，但更便宜。
