Shimizu Shuya, Naitoh Itaru, Nakazawa Takahiro, Hayashi Kazuki, Miyabe Katsuyuki, Kondo Hiromu, Yoshida Michihiro, Yamashita Hiroaki, Ohara Hirotaka, Joh Takashi
Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan.
J Hepatobiliary Pancreat Sci. 2014 Mar;21(3):219-25. doi: 10.1002/jhbp.22. Epub 2013 Aug 1.
We aimed to clarify the clinical usefulness of one-step self-expandable metal stent (SEMS) placement for distal malignant biliary obstruction by comparing with two-step SEMS placement.
We retrospectively compared early complications, bilirubin level decreasing rate, and period of hospitalization between 40 patients with one-step SEMS and 52 patients with two-step SEMS. We also evaluated the complications in patients with two-step SEMS by classifying them into first drainage (ERBD or ENBD) and second drainage (SEMS).
The total incidence of early complications was significantly higher in patients with one-step SEMS than the second drainage of two-step SEMS (42.5% [17/40] vs. 13.5% [7/52]; P = 0.004). However, there was no significant difference in the early complications between one-step SEMS and two-step SEMS (total of first and second drainage) (42.5% [17/40] vs. 36.5% [19/52]; P = 0.561). The period required to reach the bilirubin level (<3 mg/dL) after initial drainage was significantly shorter in one-step SEMS than in two-step SEMS (5.7 vs. 10.1 days; P = 0.025). Similar results were observed in the period of hospitalization for patients without chemotherapy (22.2 vs. 37.3 days; P = 0.004).
One-step SEMS placement is the alternative option of drainage method for distal malignant biliary obstruction.
我们旨在通过与两步法自膨式金属支架（SEMS）置入术进行比较，阐明一步法SEMS置入术治疗远端恶性胆管梗阻的临床实用性。
我们回顾性比较了40例行一步法SEMS置入术的患者和52例行两步法SEMS置入术的患者的早期并发症、胆红素水平下降率及住院时间。我们还通过将两步法SEMS置入术患者的并发症分为首次引流（内镜逆行胆管引流术或内镜鼻胆管引流术）和二次引流（SEMS）来进行评估。
一步法SEMS置入术患者的早期并发症总发生率显著高于两步法SEMS置入术的二次引流患者（42.5%[17/40]对13.5%[7/52]；P = 0.004）。然而，一步法SEMS置入术与两步法SEMS置入术（首次和二次引流的总和）的早期并发症无显著差异（42.5%[17/40]对36.5%[19/52]；P = 0.561）。一步法SEMS置入术首次引流后达到胆红素水平（<3mg/dL）所需时间显著短于两步法SEMS置入术（5.7天对10.1天；P = 0.025）。在未接受化疗的患者住院时间方面也观察到类似结果（22.2天对37.3天；P = 0.004）。
一步法SEMS置入术是远端恶性胆管梗阻引流方法的替代选择。
