Chung Kwang Hyun, Lee Sang Hyub, Park Jin Myung, Lee Jae Min, Ahn Dong-Won, Ryu Ji Kon, Kim Yong-Tae
Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea.
Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Republic of Korea.
Endoscopy. 2015 Jun;47(6):508-16. doi: 10.1055/s-0034-1391304. Epub 2015 Jan 15.
The patency of self-expandable metallic stents (SEMS) is known to be better than plastic stents in the palliation of malignant biliary obstruction. However, data are scarce for obstructive jaundice caused by hepatocellular carcinoma (HCC). This study aimed to compare SEMSs and plastic stents for the palliation of obstructive jaundice in unresectable HCC.
A total of 96 patients who underwent endoscopic retrograde biliary drainage with SEMSs or plastic stents were included in this retrospective analysis. The rate of successful biliary drainage, adverse events, stent patency duration, and patient survival were compared between the SEMS (n = 36) and plastic stent (n = 60) groups.
The rate of successful biliary drainage was similar between the SEMS and plastic stent groups (25/36 [69.4 %] vs. 39/60 [65.0 %]; P = 0.655). Adverse events occurred in 6 patients (16.7 %) in the SEMS group and 13 patients (21.7 %) in the plastic stent group (P = 0.552). The median patency duration was also similar between the two groups (60 vs. 68 days; P = 0.396). The median patient survival was longer in the plastic stent group than in the SEMS group (123 vs. 48 days; P = 0.005).
SEMSs were not superior to plastic stents for the palliation of malignant biliary obstruction in HCC with regard to successful drainage, stent patency, and adverse events. Patient survival was better in the plastic stent group. Given the lower cost, plastic stents could be a favorable option for malignant biliary obstruction caused by HCC.
在恶性胆道梗阻的姑息治疗中，自膨式金属支架（SEMS）的通畅性优于塑料支架。然而，关于肝细胞癌（HCC）所致梗阻性黄疸的数据较少。本研究旨在比较SEMS和塑料支架在不可切除HCC所致梗阻性黄疸姑息治疗中的效果。
本回顾性分析纳入了96例行内镜逆行胆道引流并置入SEMS或塑料支架的患者。比较了SEMS组（n = 36）和塑料支架组（n = 60）的胆道引流成功率、不良事件、支架通畅持续时间和患者生存率。
SEMS组和塑料支架组的胆道引流成功率相似（25/36 [69.4%] 对39/60 [65.0%]；P = 0.655）。SEMS组6例患者（16.7%）发生不良事件，塑料支架组13例患者（21.7%）发生不良事件（P = 0.552）。两组的中位通畅持续时间也相似（60天对68天；P = 0.396）。塑料支架组的中位患者生存期长于SEMS组（123天对48天；P = 0.005）。
在成功引流、支架通畅性和不良事件方面，SEMS在HCC所致恶性胆道梗阻的姑息治疗中并不优于塑料支架。塑料支架组的患者生存率更高。鉴于成本较低，塑料支架可能是HCC所致恶性胆道梗阻的一个有利选择。
