Department of Gastroenterology and Hepatology, Kinki University Faculty of Medicine, 377-2 Ohno-Higashi, Osaka-Sayama, Osaka, Japan.
Dig Dis. 2012;30(6):592-7. doi: 10.1159/000343087. Epub 2012 Dec 13.
Among patients with later stage hepatocellular carcinoma (HCC), only 1-12% manifest obstructive jaundice as the initial complaint. Endoscopic retrograde biliary drainage (ERBD) and percutaneous transhepatic biliary drainage (PTBD) are the two main non-surgical treatment options for obstructive jaundice in patients with HCC. ERBD is usually the first-line treatment because of its low hemorrhage risk. Some have reported that the successful drainage rate ranges from 72 to 100%. Mean stent patency time and mean survival range from 1.0 to 15.9 and 2.8 to 12.3 months, respectively. PTBD is often an important second-line treatment when ERBD is impossible. With regard to materials, metallic stents offer the benefit of longer patency than plastic stents. The dominant effect of biliary drainage suggests that successful jaundice therapy could enhance anti-cancer treatment by increasing life expectancy, decreasing mortality, or both. We present an overview of the efficacy of endoscopic and percutaneous drainage for obstructive jaundice in patients with HCC who are not candidates for surgical resection and summarize the current indications and outcomes of reported clinical use.
在晚期肝细胞癌（HCC）患者中，仅有 1-12%以梗阻性黄疸为首发症状。内镜逆行胰胆管引流术（ERBD）和经皮经肝胆管引流术（PTBD）是 HCC 患者梗阻性黄疸的两种主要非手术治疗选择。由于 ERBD 出血风险低，通常是一线治疗。一些人报告称，其成功引流率范围为 72%至 100%。支架通畅时间和平均生存时间分别为 1.0 至 15.9 个月和 2.8 至 12.3 个月。当 ERBD 不可行时，PTBD 通常是重要的二线治疗。在材料方面，金属支架比塑料支架具有更长的通畅时间优势。胆道引流的主要作用表明，成功的黄疸治疗可以通过延长预期寿命、降低死亡率或两者兼而有之，来增强抗癌治疗效果。我们对不能手术切除的 HCC 患者内镜和经皮引流治疗梗阻性黄疸的疗效进行了综述，并总结了目前报告的临床应用的适应证和结果。
