Mao Xiao-Nan, Lu Zai-Ming, Wen Feng, Liang Hong-Yuan, Guo Qi-Yong
Department of Radiology, Shengjing Hospital, China Medical University, Shenyang, Liaoning, China.
Medicine (Baltimore). 2017 Nov;96(45):e7475. doi: 10.1097/MD.0000000000007475.
This study explored the effect of the implant position of stents across the Vater's ampulla on treatment outcomes in patients with lower bile duct obstruction.In the retrospective study, 41 patients with malignant obstruction of the lower bile duct and obstructive jaundice received percutaneous transhepatic biliary placement of bare-metal stents. Basic demographic data on patients, such as sex, age, and primary diseases, and follow-up data, including postoperative complications and jaundice-free survival, were recorded. The follow-up data on patients with an involved ampulla, patients with an uninvolved ampulla, patients with a stent across the ampulla, and patients with a stent at a site other than the ampulla were compared. Furthermore, prognostic factors for jaundice- free survival were investigated using Cox proportional hazards regression analysis.Among the 41 patients, 38 patients experienced subsiding of jaundice, whereas 3 cases had unsuccessful stent patency. Whether or not the ampulla was involved did not influence the incidence rates of postoperative complications and the jaundice-free survival time. Notably, when stents were placed across the ampulla, the jaundice-free survival time was significantly longer than when stents were placed at sites other than across the ampulla (P < .05). Furthermore, placement of the stent across the ampulla or at other sites was an independent prognostic factor (hazard ratio = 0.154, 95% confidence interval 0.042-0.560, P = .005) for jaundice-free survival of patients.The current study revealed that the implant position of a stent across the ampulla resulted in maintenance of stent patency and prolongation of the jaundice-free survival time.
本研究探讨了横跨壶腹放置支架的位置对低位胆管梗阻患者治疗效果的影响。在这项回顾性研究中，41例低位胆管恶性梗阻并伴有梗阻性黄疸的患者接受了经皮经肝胆道裸金属支架置入术。记录了患者的基本人口统计学数据，如性别、年龄和原发疾病，以及随访数据，包括术后并发症和无黄疸生存期。比较了壶腹受累患者、壶腹未受累患者、横跨壶腹放置支架的患者以及在壶腹以外部位放置支架的患者的随访数据。此外，使用Cox比例风险回归分析研究了无黄疸生存期的预后因素。41例患者中，38例黄疸消退，3例支架通畅失败。壶腹是否受累不影响术后并发症的发生率和无黄疸生存期。值得注意的是，当支架横跨壶腹放置时，无黄疸生存期明显长于在壶腹以外部位放置支架时（P<0.05）。此外，横跨壶腹或在其他部位放置支架是患者无黄疸生存期的独立预后因素（风险比=0.154，95%置信区间0.042-0.560，P=0.005）。本研究表明，横跨壶腹放置支架的位置可维持支架通畅并延长无黄疸生存期。
