Marchesi Federico, Mita Maria Teresa, Cecchini Stefano, Ziccarelli Antonio, Michieletti Emanuele, Del Rio Paolo, Roncoroni Luigi
Hepatogastroenterology. 2014 Nov-Dec;61(136):2443-7.
BACKGROUND/AIMS: In some cases of bile duct compression by lymph node recurrence of gastric cancer, a second line chemotherapy can lead to prolonged survival; thus, a surgical derivation could represent a reasonable alternative to non surgical drainage, owing to its better long term efficacy. Our study retrospectively compares the surgical approach (SA) and percutaneous transhepatic biliary drainage (PTBD) in this particular oncological condition.
11 patients undergoing biliary-jejunal anastomosis for obstructive jaundice by lymph node recurrence of gastric cancer at our Institution were compared with 10 patients undergoing PTBD. Clinical records and outcome parameters (success rate, complications, survival) were statistically matched in order to assess possible advantages for each technique and to evaluate any particular variable influencing survival.
The SA patients experienced a better jaundice resolution (91% vs 50%, p.0.063), a lower major complication rate (9% vs 30%, p:0.311), and a significantly longer survival (317 days vs 85 days, p:0.001). Procedural success and complication rates were found to be correlated with survival.
According to our experience the SA represents a valid alternative to PTBD in the case of lymph node recurrence of gastric cancer, being favoured for patients with better performance status and longer life expectancy.
背景/目的：在胃癌淋巴结转移导致胆管受压的某些病例中，二线化疗可延长生存期；因此，手术引流因其更好的长期疗效，可能是一种比非手术引流更合理的选择。我们的研究回顾性比较了在这种特殊肿瘤情况下的手术方法（SA）和经皮经肝胆道引流（PTBD）。
将我院11例行胃癌淋巴结转移所致梗阻性黄疸胆肠吻合术的患者与10例行PTBD的患者进行比较。对临床记录和结果参数（成功率、并发症、生存率）进行统计学匹配，以评估每种技术的可能优势，并评估影响生存的任何特定变量。
SA组患者黄疸消退情况更好（91%对50%，p = 0.063），主要并发症发生率更低（9%对30%，p = 0.311），生存期显著更长（317天对85天，p = 0.001）。发现手术成功率和并发症发生率与生存率相关。
根据我们的经验，在胃癌淋巴结转移的情况下，SA是PTBD的有效替代方法，对于身体状况较好、预期寿命较长的患者更有利。
