Fukasawa Mitsuharu, Takano Shinichi, Shindo Hiroko, Takahashi Ei, Sato Tadashi, Enomoto Nobuyuki
First Department of Internal Medicine, Faculty of Medicine, University of Yamanashi, 1110, Shimokato, Chuo, Yamanashi, 409-3898, Japan.
Clin J Gastroenterol. 2017 Dec;10(6):485-490. doi: 10.1007/s12328-017-0778-4. Epub 2017 Oct 19.
Palliative drainage is the primary treatment option for unresectable malignant hilar biliary obstruction (UMHBO) to improve the prognosis and quality of life. Currently, endoscopic biliary drainage is considered as a first-line treatment for UMHBO as well as for distal biliary obstruction. Self-expanding metal stents (SEMSs) are preferred over plastic stents (PSs) in patients with life expectancy of >3 months. However, endoscopic treatment of UMHBO is often more challenging and complex than that of distal biliary obstruction. Although no consensus exists on the optimal method for biliary drainage because of the lack of well-designed, large-scale randomized control trials, several essential aspects of various optimal methods have been studied. Presently, technological developments in this field are under way and newly designed or modified stenting devices for UMHBO are being developed. In this review, we assess the optimal stenting strategy for UMHBO based on the previous literature, focusing on the stent type (PS vs SEMS), the liver volume to be drained, unilateral (single) vs bilateral (multiple) stent deployment, and bilateral stenting method (stent-in-stent vs side-by-side).
姑息性引流是不可切除的恶性肝门部胆管梗阻（UMHBO）的主要治疗选择，以改善预后和生活质量。目前，内镜下胆管引流被认为是UMHBO以及远端胆管梗阻的一线治疗方法。对于预期寿命大于3个月的患者，自膨式金属支架（SEMS）比塑料支架（PS）更受青睐。然而，UMHBO的内镜治疗通常比远端胆管梗阻的内镜治疗更具挑战性和复杂性。尽管由于缺乏设计良好的大规模随机对照试验，胆管引流的最佳方法尚无共识，但已经对各种最佳方法的几个重要方面进行了研究。目前，该领域的技术正在发展，新型设计或改良的用于UMHBO的支架装置正在研发中。在这篇综述中，我们根据既往文献评估UMHBO的最佳支架置入策略，重点关注支架类型（PS与SEMS）、需引流的肝体积、单侧（单个）与双侧（多个）支架置入以及双侧支架置入方法（支架套支架与并排）。
