Hwang Jae Chul, Kim Jin Hong, Lim Sun Gyo, Kim Soon Sun, Yoo Byung Moo, Cho Sung Won
Department of Gastroenterology, Ajou University School of Medicine, San-5, Woncheon-dong, Yongtong-gu, Suwon, Republic of Korea.
Scand J Gastroenterol. 2011 Mar;46(3):326-32. doi: 10.3109/00365521.2010.536253. Epub 2010 Nov 17.
Although still controversial, bilateral stenting may be the best option for palliative drainage of malignant hilar biliary obstruction. The aim of our study was to evaluate the technical and clinical efficacies of endoscopic bilateral metal stenting using a biliary Y-stent for the management of malignant hilar obstruction.
This prospective, uncontrolled study included 30 consecutive patients with unresectable malignant hilar strictures in whom we intended to perform endoscopic bilateral stent-in-stent deployment using a biliary Y-stent. After deployment of the Y-stent across the hilar stricture, a conventional biliary metal stent was inserted in a Y-configuration in which it traversed the wider-mesh central portion of the Y-stent to enter the opposite hepatic lobe.
Bilateral metal stenting using a Y-stent was successful in 26 of 30 patients (86.7%), and successful drainage was achieved in all 26 patients (100%). Early complications occurred in 3 patients (cholangitis, 1; cholecystitis, 2) without procedure-related mortality. As late complications during the follow-up period (median, 176 days; range, 70-473 days), stent occlusion occurred in 10 of 26 patients (38.5%). Four patients were managed with the insertion of a plastic stent through the occluded metal stent, and the remaining patients were treated with percutaneous biliary drainage. The median survival and stent patency were 176 days and 140 days, respectively.
Y-shaped endoscopic bilateral stenting using a Y-stent appears to be a feasible and effective method with high technical success and low stent-related complications for palliation of unresectable malignant hilar biliary obstruction.
尽管仍存在争议，但双侧支架置入术可能是恶性肝门部胆管梗阻姑息性引流的最佳选择。我们研究的目的是评估使用胆道Y形支架进行内镜下双侧金属支架置入术治疗恶性肝门部梗阻的技术和临床疗效。
这项前瞻性、非对照研究纳入了30例连续的不可切除恶性肝门部狭窄患者，我们打算使用胆道Y形支架进行内镜下双侧支架套入术。将Y形支架跨过肝门部狭窄置入后，以Y形配置插入一个传统的胆道金属支架，使其穿过Y形支架网孔较宽的中央部分进入对侧肝叶。
30例患者中有26例（86.7%）成功进行了使用Y形支架的双侧金属支架置入术，所有26例患者（100%）均成功实现引流。3例患者出现早期并发症（胆管炎1例；胆囊炎2例），无手术相关死亡。作为随访期间的晚期并发症（中位时间为176天；范围为70 - 473天），26例患者中有10例（38.5%）发生支架闭塞。4例患者通过闭塞的金属支架插入塑料支架进行处理，其余患者接受经皮胆道引流治疗。中位生存期和支架通畅时间分别为176天和140天。
使用Y形支架进行Y形内镜下双侧支架置入术似乎是一种可行且有效的方法，对于不可切除的恶性肝门部胆管梗阻的姑息治疗具有较高的技术成功率和较低的支架相关并发症。
