Lee T H, Lee S J, Moon J H, Park S H
Division of Gastroenterology Department of Internal Medicine Soonchunhyang University School of Medicine Cheonan Hospital, Cheonan and Bucheon Hospital, Bucheon, Republic of Korea -
Minerva Gastroenterol Dietol. 2014 Jun;60(2):135-49.
In patients with inoperable hilar cholangiocarcinoma (HCCA), palliative endoscopic or percutaneous drainage provides benefits in terms of symptomatic improvement and quality of life. Endoscopic biliary stent placement is considered the gold standard, with metal stents preferred over plastic stents in patients with more than three months of life expectancy. However, the endoscopic management of advanced hilar obstruction is often more challenging and complex than distal malignant biliary obstructions. Recently, the Asia-Pacific working group on hepatobiliary cancers produced consensus recommendations on the use of endoscopic vs. percutaneous drainage and unilateral vs. bilateral drainage in the management of HCCA. However, these guidelines must be weighed against context-specific information, such as the volume of liver drainage required, life expectancy of the patient, and the available expertise. In this literature review, we describe the issues commonly encountered during endoscopic biliary stenting for malignant hilar obstruction and provide technical guidance to improve success rates and patient outcomes.
对于无法手术切除的肝门部胆管癌（HCCA）患者，姑息性内镜或经皮引流在改善症状和提高生活质量方面具有益处。内镜下胆管支架置入被视为金标准，对于预期寿命超过三个月的患者，金属支架优于塑料支架。然而，晚期肝门部梗阻的内镜治疗通常比远端恶性胆管梗阻更具挑战性和复杂性。最近，亚太地区肝胆癌工作组就HCCA治疗中内镜引流与经皮引流以及单侧引流与双侧引流的使用制定了共识性建议。然而，这些指南必须结合具体情况的信息进行权衡，例如所需的肝引流量、患者的预期寿命以及现有的专业技术。在这篇文献综述中，我们描述了恶性肝门部梗阻内镜胆管支架置入过程中常见的问题，并提供技术指导以提高成功率和改善患者预后。
