Jo Jung Hyun, Chung Moon Jae, Han Dai Hoon, Park Jeong Youp, Bang Seungmin, Park Seung Woo, Song Si Young, Chung Jae Bock
Division of Gastroenterology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Korea.
Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
Surg Endosc. 2017 Jan;31(1):422-429. doi: 10.1007/s00464-016-4993-8. Epub 2016 Jun 10.
Operative treatment combined with PBD has been established as a safe management strategy for Klatskin tumors. However, controversy exists regarding the preferred technique for PBD among percutaneous transhepatic biliary drainage (PTBD), endoscopic biliary stenting (EBS), and endoscopic nasobiliary drainage (ENBD). This study aimed to identify the best technique for preoperative biliary drainage (PBD) in Klatskin tumor patients.
This study evaluated 98 Klatskin tumor patients who underwent PBD prior to operation with a curative aim between 2005 and 2012. The PTBD, EBS, and ENBD groups included 43, 42, and 13 patients, respectively. Baseline characteristics, technical success rate, complications of PBD, and surgical outcomes were compared.
Initial technical success rates (97.3 %, PTBD; 90.2 %, endoscopic methods, including EBS and ENBD) and mean duration until biliary decompression (31.0, PTBD; 28.7, EBS; 35.8 days, ENBD) were not significantly different between the groups. Total frequency of complications did not significantly differ between the EBS group (42.9 %) and the PTBD (27.9 %, p = 0.149) and ENBD (15.4 %, p = 0.072) groups. The ENBD group showed a significantly higher rate of conversion to other methods (76.9 %) than the PTBD (4.7 %, p < 0.0001) and EBS (35.7 %, p = 0.009) groups.
PTBD, EBS, and ENBD showed comparable results regarding initial technical success rates, complication rates, and surgical outcomes. As Klatskin tumor patients must undergo PBD prior to 3 weeks before surgery, PTBD and ENBD are uncomfortable and disadvantageous in terms of compliance. EBS was the most suitable method for initial PBD in terms of compliance among Klatskin tumor patients.
手术治疗联合术前胆道引流已被确立为一种治疗肝门部胆管癌的安全管理策略。然而，在经皮经肝胆道引流（PTBD）、内镜下胆道支架置入术（EBS）和内镜鼻胆管引流（ENBD）这几种术前胆道引流（PBD）的首选技术方面仍存在争议。本研究旨在确定肝门部胆管癌患者术前胆道引流（PBD）的最佳技术。
本研究评估了2005年至2012年间98例以根治为目的在手术前行PBD的肝门部胆管癌患者。PTBD组、EBS组和ENBD组分别有43例、42例和13例患者。比较了基线特征、PBD的技术成功率、并发症及手术结果。
各组间初始技术成功率（PTBD组为97.3%；内镜方法组，包括EBS和ENBD为90.2%）以及直至胆道减压的平均时间（PTBD组为31.0天；EBS组为28.7天；ENBD组为35.8天）无显著差异。EBS组（42.9%）与PTBD组（27.9%，p = 0.149）和ENBD组（15.4%，p = 0.072）的并发症总发生率无显著差异。ENBD组转为其他方法的比例（76.9%）显著高于PTBD组（4.7%，p < 0.0001）和EBS组（35.7%，p = 0.009）。
PTBD、EBS和ENBD在初始技术成功率、并发症发生率和手术结果方面显示出可比的结果。由于肝门部胆管癌患者必须在手术前3周内行PBD，PTBD和ENBD在依从性方面既不舒服也不利。就肝门部胆管癌患者的依从性而言，EBS是初始PBD最合适的方法。
