Department of Interventional Vascular Surgery, Binzhou People's Hospital, 7 Huang-he Road, Binzhou, 256600, China.
Department of Interventional Radiology, Xuzhou Central Hospital, 199 South Jie-fang Road, Xuzhou, 221009, China.
Abdom Radiol (NY). 2017 Nov;42(11):2745-2751. doi: 10.1007/s00261-017-1174-8.
To determine the clinical efficiency and long-term outcomes between unilateral and bilateral stent insertion in patients with malignant hilar biliary obstruction.
From August 2012 to February 2016, 63 consecutive patients with malignant hilar biliary obstruction were treated with unilateral or bilateral stent insertion at our center. The bilateral stents were inserted using the side-by-side technique. The clinical efficiency and long-term outcomes were compared between the two groups.
Unilateral and bilateral stent insertions were successfully performed in 31 of 33 and 27 of 30 patients, respectively (P = 0.912). No procedure-related complication occurred. Clinical success was achieved in 29 of 31 patients in the unilateral stent group and in 26 of 27 patients in the bilateral stent group (P = 0.637). During the follow-up, re-obstruction of stent occurred in five patients in the unilateral stent group and in three patients in the bilateral stent group (P = 0.58). The significant differences were not observed in the stent patency time (368 vs. 387 days, P = 0.685) and survival (200 vs. 198 days, P = 0.751) between two groups. Based on the univariate and multivariate analyses, the independent risk factors for decreasing the survival time included higher Eastern Cooperative Oncology Group performance status (P = 0.018), higher alanine aminotransferase level (P = 0.009), and absence of anticancer treatment after stent insertion (P = 0.002).
Compared to bilateral stent insertion for malignant hilar biliary obstruction, unilateral stent insertion can provide comparable clinical efficiency and long-term outcomes.
比较单侧和双侧支架置入治疗恶性肝门部胆管梗阻患者的临床疗效和长期预后。
2012 年 8 月至 2016 年 2 月，本中心连续收治 63 例恶性肝门部胆管梗阻患者，采用单侧或双侧支架置入治疗。双侧支架采用侧-侧技术置入。比较两组患者的临床疗效和长期预后。
33 例患者中，31 例成功实施单侧支架置入，27 例成功实施双侧支架置入（P=0.912）。无手术相关并发症发生。单侧支架组 29 例和双侧支架组 26 例患者获得临床成功（P=0.637）。随访期间，单侧支架组 5 例和双侧支架组 3 例患者支架再梗阻（P=0.58）。两组患者支架通畅时间（368 天 vs. 387 天，P=0.685）和生存时间（200 天 vs. 198 天，P=0.751）差异均无统计学意义。单因素和多因素分析结果显示，影响生存时间的独立危险因素包括较高的东部肿瘤协作组体能状态评分（P=0.018）、较高的丙氨酸氨基转移酶水平（P=0.009）和支架置入后未接受抗癌治疗（P=0.002）。
与双侧支架置入相比，单侧支架置入治疗恶性肝门部胆管梗阻可获得相似的临床疗效和长期预后。
