Faculty of Medical Sciences, Second Department of Internal Medicine, Fukui University, Fukui, Japan.
J Dig Dis. 2018 Oct;19(10):626-634. doi: 10.1111/1751-2980.12656. Epub 2018 Sep 30.
To evaluate the long-term outcomes of complete common bile duct (CBD) stone removal and biliary stenting in elderly patients (≥85 years) with CBD stones.
We retrospectively examined 65 patients who underwent complete CBD stone removal (the duct clearance group) and 40 patients who underwent biliary stenting (the biliary stenting group) between July 2006 and March 2016. To reduce selection bias, we also conducted a propensity score matching analysis and generated 30 pairs of patients. Cholangitis recurrence-free survival and overall survival were compared between the two groups and independent prognostic factors of survival were identified by univariate and multivariate analyses.
Cholangitis recurrence-free survival was significantly better in the duct clearance group than in the biliary stenting group (P < 0.001). Their overall survival did not significantly differ after propensity score matching (P = 0.388). In all cohorts, univariate analysis demonstrated that poor performance status and biliary stenting were factors of poor prognosis, and in multivariate analysis only performance status remained associated with poor prognosis for survival. Similarly, in the propensity score-matched cohort, only performance status independently predicted poorer survival (hazard ratio [HR] 2.726, 95% confidence interval [CI] 1.105-6.675, P = 0.029). The choice of endoscopic treatment was not a significant factor associated with prognosis (HR 1.354, 95% CI 0.678-2.701, P = 0.391).
Biliary stenting was similar to complete stone removal in terms of prognosis for long-term survival. Biliary stenting for CBD stones could be an effective therapeutic tool in high-risk elderly patients.
评估高龄（≥85 岁）胆总管结石患者行胆总管（CBD）结石完全清除和胆道支架置入的长期疗效。
回顾性分析 2006 年 7 月至 2016 年 3 月期间行完全 CBD 结石清除术（胆管清除组）的 65 例和行胆道支架置入术（胆道支架组）的 40 例患者。为了减少选择偏倚，我们还进行了倾向评分匹配分析，生成了 30 对患者。比较两组患者的胆管炎无复发生存和总生存，并通过单因素和多因素分析确定生存的独立预后因素。
胆管清除组的胆管炎无复发生存显著优于胆道支架组（P＜0.001）。但在倾向评分匹配后，两组患者的总生存无显著差异（P=0.388）。在所有队列中，单因素分析表明，一般状况较差和胆道支架置入是预后不良的因素，而多因素分析仅表明一般状况与生存预后不良相关。同样，在倾向评分匹配队列中，仅一般状况独立预测生存预后较差（风险比[HR] 2.726，95%置信区间[CI] 1.105-6.675，P=0.029）。内镜治疗的选择不是与预后相关的显著因素（HR 1.354，95%CI 0.678-2.701，P=0.391）。
胆道支架置入与完全清除结石在长期生存预后方面相似。对于高危老年患者，胆总管结石的胆道支架置入可能是一种有效的治疗手段。
