使用自膨式金属支架的内镜下三分支以上部分支架置入术在不可切除肝门部胆管癌患者中的疗效
Efficacy of Endoscopic Over 3-branched Partial Stent-in-Stent Drainage Using Self-expandable Metallic Stents in Patients With Unresectable Hilar Biliary Carcinoma.
作者信息
Uchida Daisuke, Kato Hironari, Muro Shinichiro, Noma Yasuhiro, Yamamoto Naoki, Horiguchi Shigeru, Harada Ryo, Tsutsumi Koichiro, Kawamoto Hirofumi, Okada Hiroyuki, Yamamoto Kazuhide
机构信息
*Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences †Department of General Internal Medicine 2, Kawasaki Hospital, Kawasaki Medical School ‡Department of Endoscopy, Okayama University Hospital, Okayama, Japan.
出版信息
J Clin Gastroenterol. 2015 Jul;49(6):529-36. doi: 10.1097/MCG.0000000000000213.
BACKGROUND
The treatment of biliary stricture is crucially important for continuing stable chemotherapy for unresectable biliary carcinoma; however, there is no consensus regarding the use of hilar biliary drainage. In this study, we examined the efficacy of endoscopic over 3-branched biliary drainage using self-expandable metallic stents (SEMSs) in patients with unresectable malignant hilar biliary stricture (HBS).
METHODS
A total of 77 patients with unresectable HBS treated with a SEMS and chemotherapy were retrospectively reviewed. There were 59 patients with cholangiocarcinoma and 18 patients with gallbladder carcinoma. The patients were divided into 2 groups (4- or 3-branched group and 2- or 1-branched group) and compared with respect to the duration of stent patency and overall survival.
RESULTS
A comparison of the patients' baseline characteristics showed no significant differences between the 4- or 3-branched group and the 2- or 1-branched group. Neither the duration of patency nor survival time exhibited significant differences between the 2 groups, although, among the patients achieving disease control , the duration of patency period and survival time of the 4- or 3-branched group were significantly higher than those observed in the 2- or 1-branched group (P=0.0231 and 0.0466).
CONCLUSIONS
The use of endoscopic over 3-branched biliary drainage with a SEMS may improve the duration of patency in patients with HBS.
背景
胆管狭窄的治疗对于不可切除的胆管癌持续稳定地进行化疗至关重要；然而，关于肝门部胆管引流的应用尚无共识。在本研究中，我们探讨了使用自膨式金属支架（SEMS）进行内镜下超过三支胆管引流在不可切除的恶性肝门部胆管狭窄（HBS）患者中的疗效。
方法
回顾性分析了77例接受SEMS及化疗治疗的不可切除HBS患者。其中胆管癌患者59例，胆囊癌患者18例。将患者分为两组（四支或三支组和两支或一支组），比较支架通畅时间和总生存期。
结果
患者基线特征比较显示，四支或三支组与两支或一支组之间无显著差异。两组的通畅时间和生存时间均无显著差异，尽管在病情得到控制的患者中，四支或三支组的通畅期和生存时间显著高于两支或一支组（P = 0.0231和0.0466）。
结论
使用SEMS进行内镜下超过三支胆管引流可能会延长HBS患者的支架通畅时间。
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