Department of Radiology, University of California, San Francisco, San Francisco, CA 94143, USA.
J Vasc Interv Radiol. 2013 Jul;24(7):1003-10. doi: 10.1016/j.jvir.2013.03.020.
To assess clinical outcomes of metal stent insertion in patients with bilobar bile duct obstruction by malignant tumors.
Records of 120 consecutive patients who underwent placement of metallic stents for palliation of malignant bilobar biliary obstruction between 1995 and 2010 were retrospectively reviewed. Single-duct stent insertion was performed in 44 patients with one liver lobe that accounted for more than 70% of total liver volume or only one patent lobar portal vein (group 1). Bilobar stent insertion was performed in 60 patients with approximately equal lobe sizes, patent lobar portal veins, or cholangitis at presentation (group 2). In 16 patients with discontiguous right anterior and posterior segmental ducts (group 3), three stents were deployed in the left lobar and right anterior and posterior segmental ducts. Overall survival, primary patency, and patient morbidity rates following stent insertion were assessed.
No significant differences in mean overall survival (group 1, 7.3 mo; group 2, 10.3 mo; group 3, 6.5 mo; P = .21) or mean primary stent patency (group 1, 4.2 mo; group 2, 5.9 mo; group 3, 3.5 mo; P = .17) were demonstrated. However, patients in group 3 were significantly more likely to require hospitalizations for cholangitis and additional invasive procedures for recurrent biliary obstruction than patients in groups 1 and 2.
Unilobar and bilobar metal stent insertion led to similar outcomes when treatment decision was based on relative liver lobe volumes, lobar portal vein patency, and presence of cholangitis on presentation.
评估金属支架置入治疗双侧恶性肿瘤所致胆管梗阻的临床疗效。
回顾性分析 1995 年至 2010 年间 120 例接受金属支架置入姑息治疗双侧恶性胆管梗阻患者的临床资料。120 例患者中，44 例单侧肝叶（占总肝体积的 70%以上）或单一肝叶门静脉通畅（组 1）行单支胆管支架置入术，60 例双侧肝叶大小基本相同、门静脉通畅或胆管炎患者（组 2）行双侧胆管支架置入术，16 例右前、后段胆管不连续患者（组 3）行左叶胆管和右前、后段胆管共 3 支支架置入术。评估支架置入后的总生存率、初次通畅率和患者发病率。
组 1 平均总生存时间为 7.3 个月，组 2 为 10.3 个月，组 3 为 6.5 个月，差异无统计学意义（P =.21）；组 1 平均初次通畅时间为 4.2 个月，组 2 为 5.9 个月，组 3 为 3.5 个月，差异亦无统计学意义（P =.17）。然而，与组 1 和组 2 相比，组 3 患者因胆管炎需住院治疗和因复发性胆道梗阻需进一步侵入性治疗的比例显著更高。
根据相对肝叶体积、肝叶门静脉通畅性和胆管炎的存在，单侧和双侧金属支架置入治疗双侧恶性肿瘤所致胆管梗阻的疗效相似。
