Gastroenterology, Hepatology, and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Division of Digestive Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA.
Dig Dis Sci. 2019 Feb;64(2):561-569. doi: 10.1007/s10620-018-5277-z. Epub 2018 Sep 20.
The complex biliary strictures of perihilar cholangiocarcinoma present significant challenges for providing adequate and long-lasting biliary drainage. The best approach to relieve obstruction remains controversial. The purpose of this study was to assess stenting outcomes in perihilar cholangiocarcinoma.
This study was approved by the center's institutional review board. Subjects with a diagnosis of perihilar cholangiocarcinoma who underwent endoscopic retrograde cholangiopancreatography (ERCP) were identified from endoscopic and pathologic databases from 1997 to 2014. Patient characteristics, endoscopic data, and follow-up evaluation data were retrospectively collected via review of available medical records.
A total of 199 patients with perihilar cholangiocarcinoma who underwent a total of 504 ERCPs were included in the study. Nine of 504 (1.8%) procedures were technical failures. Among the 495 technically successful procedures, 347 (70.1%) procedures were clinical successes. Clinical success was significantly associated with longer overall survival (HR 0.57; p = 0.002). A higher proportion of patients with bilateral drainage had clinical success, compared with those with unilateral drainage. Cholangitis was not more common in the bilateral group compared to the unilateral group except in the group where a segment was not drained (1.9% vs 1.6% vs 7.1%, respectively). Patients with metal stents were 3.8 times more likely to have clinical success than those with plastic stents.
In conclusion, adequate biliary drainage improves overall survival. Bilateral stenting if anatomy permits with self-expanding metal stents rather than plastic stents appears to provide the optimal chance of clinical success.
肝门部胆管癌的复杂胆管狭窄对提供充分和持久的胆道引流提出了重大挑战。缓解梗阻的最佳方法仍存在争议。本研究旨在评估肝门部胆管癌支架置入的效果。
本研究得到了中心机构审查委员会的批准。本研究通过内镜和病理数据库，从 1997 年至 2014 年，确定了诊断为肝门部胆管癌并接受内镜逆行胰胆管造影术（ERCP）的患者。通过回顾现有病历，收集了患者特征、内镜数据和随访评估数据。
本研究共纳入 199 例肝门部胆管癌患者，共进行了 504 次 ERCP。504 次 ERCP 中有 9 次（1.8%）为技术失败。在 495 次技术成功的 ERCP 中，347 次（70.1%）为临床成功。临床成功与总生存期显著相关（HR 0.57；p=0.002）。与单侧引流相比，双侧引流的患者有更高的临床成功率。除未引流段（分别为 1.9%、1.6%和 7.1%）外，双侧引流组的胆管炎发生率并不高于单侧引流组。与塑料支架相比，金属支架患者的临床成功率高 3.8 倍。
总之，充分的胆道引流可提高总生存期。如果解剖允许，双侧支架置入术（采用自膨式金属支架而非塑料支架）似乎可提供最佳的临床成功率。
