ENBD 与 PTBD 相比，可减少肝门部胆管癌的肿瘤播散。
ENBD is Associated with Decreased Tumor Dissemination Compared to PTBD in Perihilar Cholangiocarcinoma.
机构信息
Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.
Department of Pathology and International Research and Educational Institute for Integrated Medical Sciences, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.
出版信息
J Gastrointest Surg. 2017 Sep;21(9):1506-1514. doi: 10.1007/s11605-017-3492-0. Epub 2017 Jul 18.
BACKGROUND
Little is known regarding the risk of tumor dissemination when percutaneous biliary drainage is used before surgical resection of perihilar cholangiocarcinoma (PHC). We aimed to compare the incidence of tumor dissemination after preoperative endoscopic nasobiliary drainage (ENBD) with that after percutaneous transhepatic biliary drainage (PTBD) for PHC.
METHODS
Data from 208 consecutive patients who underwent PHC resection between 2000 and 2013 were retrospectively analyzed. The influence of drainage type on incidence of tumor dissemination was examined. Seventy-six patients underwent ENBD (37%), 87 underwent PTBD (42%), and 45 underwent surgery without preoperative biliary drainage (WD, 22%).
RESULTS
The respective 2- and 5-year estimated cumulative incidences of tumor dissemination in the ENBD group (11.8/14.6%) were lower than in the PTBD group (28.8/35.9%, p = 0.003) and equivalent to that in the WD group (11.2/15.9%, p = NS). PTBD (hazard ratio [HR] vs. ENBD, 2.80) was an independent risk factor for postoperative tumor dissemination in the multivariate analysis. The 2- and 5-year disease-specific survival rates were higher in the ENBD group (67.6/47.3%) than in the PTBD group (56.6/27.8%, p = 0.032) and equivalent to that in the WD group (64.9/53.8%, p = NS). However, drainage type was not an independent risk factor in multivariate analysis of disease-specific survival.
CONCLUSION
For patients with PHC, the associated risk of postoperative tumor dissemination in the ENBD group was lower than in the PTBD group and equivalent to that in the WD group. Thus, ENBD is the ideal procedure for preoperative biliary drainage.
背景
经皮胆道引流（PTBD）用于肝门部胆管癌（PHC）手术切除前，对肿瘤播散的风险知之甚少。我们旨在比较术前内镜鼻胆管引流（ENBD）与 PTBD 用于 PHC 后肿瘤播散的发生率。
方法
回顾性分析 2000 年至 2013 年间接受 PHC 切除的 208 例连续患者的数据。检查引流类型对肿瘤播散发生率的影响。76 例患者行 ENBD（37%），87 例行 PTBD（42%），45 例患者未行术前胆道引流（WD，22%）。
结果
ENBD 组（11.8%/14.6%）的 2 年和 5 年估计累积肿瘤播散发生率均低于 PTBD 组（28.8%/35.9%，p=0.003），与 WD 组（11.2%/15.9%，p=NS）相当。PTBD（与 ENBD 相比，风险比 [HR] 2.80）是多变量分析中术后肿瘤播散的独立危险因素。ENBD 组的 2 年和 5 年疾病特异性生存率（分别为 67.6%/47.3%）高于 PTBD 组（分别为 56.6%/27.8%，p=0.032），与 WD 组（分别为 64.9%/53.8%，p=NS）相当。然而，在疾病特异性生存的多变量分析中，引流类型不是独立的危险因素。
结论
对于 PHC 患者，ENBD 组术后肿瘤播散的相关风险低于 PTBD 组，与 WD 组相当。因此，ENBD 是术前胆道引流的理想方法。
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