Deviere J, Baize M, de Toeuf J, Cremer M
Department of Gastroenterology, Hôpital Erasme, Free University of Brussels, Belgium.
Gastrointest Endosc. 1988 Mar-Apr;34(2):95-101. doi: 10.1016/s0016-5107(88)71271-7.
Seventy patients with biliary obstruction secondary to hilar tumors underwent attempted endoscopic internal biliary drainage using large transpapillary stents between December 1981 and March 1986. Placement of one or more stents was successful in 68. The type of stricture and mode of treatment were more important in determining subsequent survival than the type of tumor. In type II and III malignant strictures of the bifurcation of the common hepatic duct and the main hepatic duct, use of two or more stents to achieve complete drainage of the biliary system improves survival compared to incomplete drainage (176 vs. 119 days) and reduces procedure-related mortality and the incidence of early and late cholangitis. Patients with hilar tumors causing type II and III strictures treated with placement of multiple stents have at least as good a prognosis as patients with tumor involving only the common hepatic duct treated with use of a single stent. Once ERCP is performed and palliative endoscopic management of bifurcation tumors is begun, it must completed as soon as possible.
1981年12月至1986年3月期间，70例因肝门部肿瘤继发胆道梗阻的患者尝试使用大型经乳头支架进行内镜下胆道内引流。68例成功置入一个或多个支架。在决定后续生存期方面，狭窄类型和治疗方式比肿瘤类型更为重要。在肝总管分叉部和肝主管道的II型和III型恶性狭窄中，与引流不完全相比，使用两个或更多支架实现胆道系统完全引流可提高生存率（176天对119天），并降低手术相关死亡率以及早期和晚期胆管炎的发生率。通过置入多个支架治疗导致II型和III型狭窄的肝门部肿瘤患者，其预后至少与仅累及肝总管的肿瘤患者使用单个支架治疗的预后一样好。一旦进行了内镜逆行胰胆管造影（ERCP）并开始对分叉部肿瘤进行姑息性内镜治疗，就必须尽快完成。
