Departments of Internal Medicine, Pusan National University Hospital, Busan, South Korea.
Eur J Gastroenterol Hepatol. 2013 Jan;25(1):99-106. doi: 10.1097/MEG.0b013e3283590a2a.
The usefulness of bilateral stent placement for malignant hilar obstruction is still under debate. Nevertheless, many endoscopists advocate the placement of an endoscopic bilateral metal stent using various new devices and techniques.
We compared the technical and clinical efficacy, and the short-term and long-term complications of the 'stent-in-stent' method using a Y-stent for malignant hilar obstruction between the early and the late period of this study.
Ninety-seven patients treated with Y-stent implantation for malignant hilar obstruction were enrolled retrospectively. In 31 patients treated during the early period, bilateral Y-configured metal stents were placed for malignant hilar obstruction using the older designed Y-stent and a closed-cell second stent. The newly designed Y-stent and a slimmer open-cell second stent were introduced in 66 patients treated during the late period. New techniques learned through experience were gradually applied throughout the entire study period.
The rate of successful placement of bilateral stents was significantly higher in patients treated during the late period than those treated during the early period (58.1 vs. 87%; P=0.001). The functional success rate was 97.3%, with no difference between the early and the late periods. Cholangitis occurred as an early complication more frequently during the early period than during the late period (16.1 vs. 1.5%; P=0.012). Cholecystitis as a late complication occurred in 21 of 76 patients (27.6%). The incidence of late complications was similar between the early and the late periods.
With the development of new devices and increased technical experience, there were better outcomes during the late period compared with the early period. Endoscopic bilateral metal stenting using a Y-stent is an attractive option for the palliative treatment of malignant hilar obstruction.
双侧支架置入治疗恶性肝门部梗阻的有效性仍存在争议。然而，许多内镜医生主张使用各种新的设备和技术，通过内镜置入双侧金属支架。
本研究比较了早期和晚期应用 Y 型支架的“支架内支架”方法治疗恶性肝门部梗阻的技术和临床疗效，以及短期和长期并发症。
回顾性纳入 97 例接受 Y 型支架植入术治疗恶性肝门部梗阻的患者。31 例早期患者采用老式 Y 型支架和封闭式第二代支架行双侧 Y 型金属支架置入术治疗恶性肝门部梗阻。66 例晚期患者采用新型 Y 型支架和更薄的开放式第二代支架。在整个研究期间，逐渐应用通过经验获得的新技术。
与早期患者相比，晚期患者双侧支架置入成功率显著提高（58.1%比 87%；P=0.001）。早期和晚期患者的功能成功率均为 97.3%，无显著差异。早期胆管炎发生率高于晚期（16.1%比 1.5%；P=0.012）。76 例患者中有 21 例（27.6%）发生晚期胆囊炎。早期和晚期的晚期并发症发生率相似。
随着新设备的发展和技术经验的增加，晚期患者的治疗效果优于早期。Y 型支架内镜下双侧金属支架置入术是恶性肝门部梗阻姑息治疗的一种有吸引力的选择。
