Division of Gastroenterology-Hepatology, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA.
Surg Endosc. 2011 Jul;25(7):2364-7. doi: 10.1007/s00464-010-1552-6. Epub 2011 Mar 4.
It is unclear whether plastic or metal stents are more suitable for preoperative biliary decompression in pancreatic cancer. The objective of this study was to compare the rate of endoscopic reinterventions in patients with pancreatic cancer undergoing plastic or self-expandable metal stent (SEMS) placements for preoperative biliary decompression.
This was a retrospective study of all patients with obstructive jaundice secondary to pancreatic head cancer who underwent their index endoscopic retrograde cholangiopancreatography (ERCP) and all follow-up biliary stent placements at our center before undergoing pancreaticoduodenectomy. Plastic or SEMS were placed at ERCP for biliary decompression. The main outcome measure was to compare the rate of endoscopic reinterventions between the plastic and SEMS cohorts.
29 patients who underwent pancreaticoduodenectomy had preoperative biliary stent placement (18 plastic, 11 SEMS) at our center. Whereas none of the 11 patients who underwent SEMS placement had stent dysfunction, 7 of 18 (39%) patients with plastic stents required endoscopic reintervention before surgery (P=0.02). Reinterventions were due to cholangitis (n=1) or persistent elevation in serum bilirubin levels (n=6). Two patients with SEMS underwent EUS-guided fine-needle aspiration after ERCP, which yielded a positive diagnosis of cancer in all cases; SEMS did not impair visualization of the tumor mass at EUS. Pancreaticoduodenectomy was undertaken successfully in all 29 patients and the presence of a SEMS did not interfere with biliary anastomosis. On univariate logistic regression, only SEMS placement was associated with less need for endoscopic reintervention (P=0.02).
SEMS are superior to plastic stents for preoperative biliary decompression in pancreatic cancer.
在胰腺癌术前胆道减压中，塑料支架和金属支架哪种更适用仍不明确。本研究旨在比较行胰十二指肠切除术的胰腺癌患者中，术前胆道减压采用塑料支架和自膨式金属支架（SEMS）的内镜再干预率。
这是一项回顾性研究，纳入所有因胰头癌所致梗阻性黄疸并在本中心行首次内镜逆行胰胆管造影（ERCP）及所有后续胆道支架置入以行胰十二指肠切除术的患者。ERCP 时采用塑料或 SEMS 行胆道减压。主要观察指标为比较塑料支架和 SEMS 两组间内镜再干预率。
本中心 29 例行胰十二指肠切除术的患者行术前胆道支架置入（18 例塑料支架，11 例 SEMS）。11 例行 SEMS 置入的患者中无一例支架功能不良，而 18 例行塑料支架置入的患者中有 7 例（39%）在术前需要内镜再干预（P=0.02）。再干预的原因是胆管炎（n=1）或血清胆红素水平持续升高（n=6）。2 例 SEMS 患者在 ERCP 后行超声内镜引导下细针抽吸活检，所有病例均获得阳性癌症诊断；SEMS 并未影响超声内镜对肿瘤团块的观察。所有 29 例患者均成功行胰十二指肠切除术，SEMS 的存在并未干扰胆道吻合。单因素逻辑回归分析显示，仅 SEMS 置入与内镜再干预需求减少相关（P=0.02）。
SEMS 优于塑料支架，可作为胰腺癌术前胆道减压的首选。
