Shabunin A V, Bedin V V, Tavobilov M M, Chechenin G M, Lebedev S S, Ivanova N A
Chair of Surgery of the Russian Medical Academy of Continuing Professional Education of Healthcare Ministry of Russia, Moscow, Russia; Botkin Municipal Clinical Hospital, Moscow, Russia.
Botkin Municipal Clinical Hospital, Moscow, Russia.
Khirurgiia (Mosk). 2018(11):20-23. doi: 10.17116/hirurgia201811120.
In the time period from 2009 to 2017 in Botkin Hospital (Moscow) bilateral biliary stenting was performed in 43 patients with malignant common hepatic duct stricture. Patients were divided into 2 statistically homogeneous groups: 'side-by-side' stenting in 28 patients and percutaneous 'Y'-biliary stent placement in 15 patients. The causes of malignant obstruction were as follows: in the 1 group 13 (46.4%) patients with extrahepatic cholangiocarcinoma (46.4%), 8 (28.6%) patients with intrahepatic cholangiocarcinoma, 4 (14.3%) patients with gallbladder cancer, 3 (10.7%) patients with metastatic cancer. In the 2 group 6 (40%) patients with extrahepatic cholangiocarcinoma, 4 (26.6%) patients with intrahepatic cholangiocarcinoma, 2 (13.3%) patients with gallbladder cancer, 3 (20%) patients with metastatic cancer. Characteristics of patients: age - 1 group 71.2±5.1 years, 2 group 74.3±5.5 years; sex - (m/f) 1 group 18/10, 2 group 9/6; location of stricture - 1 group Bismuth IIIa/IIIb 17/11, 2 group Bismuth IIIa/IIIb 11/4; mean level of bilirubin - 1 group 284±8.2 μmol/l; 2 group 311±7.4 μmol/l. Technically all procedures were successful (100%). No complications and mortality associated with the procedure was recorded. Clinically significant results were achieved in 26 (92.8%) patients in Group 1 and in 13 (86.7%) patients in Group 2 (p=0.043). Following stenting procedures, 23 (82.1%) patients in Group 1 and 11 (68.8%) patients in the Group 2 had chemotherapy (p=0.047). 19 patients from the 1 group and 10 patients from the 2 group died due to tumor progression of the underlying disease, other patients are under care of a physician. Median survival rate: 1 group (12 patients - 50 days, 7 patients - 100 days, 9 patients are alive at the time of writing); 2 group (7 patients - 50 days, 4 patients - 100 days, 4 patients are alive at the time of writing). The results of this study showed that 6 (21.4%) patients from the 1 group and 4 (26.7%) patients from the 2 group had biliary stent occlusion (p=0.041). The average period of stent function in the 1 group was 78±4.5 days, and 63±4.8 days in the 2 group (p=0.036). Based on the obtained results, it is recommended to use the 'side-by-side' method of bilobar biliary stenting in patients with malignant common hepatic duct strictures.
2009年至2017年期间，在莫斯科博特金医院，对43例肝总管恶性狭窄患者进行了双侧胆管支架置入术。患者被分为2个统计学上同质的组：28例患者采用“并排”支架置入术，15例患者采用经皮“Y”形胆管支架置入术。恶性梗阻的原因如下：第1组中，13例（46.4%）肝外胆管癌患者，8例（28.6%）肝内胆管癌患者，4例（14.3%）胆囊癌患者，3例（10.7%）转移性癌患者。第2组中，6例（40%）肝外胆管癌患者，4例（26.6%）肝内胆管癌患者，2例（13.3%）胆囊癌患者，3例（20%）转移性癌患者。患者特征：年龄——第1组71.2±5.1岁，第2组74.3±5.5岁；性别——（男/女）第1组18/10，第2组9/6；狭窄部位——第1组Bismuth IIIa/IIIb 17/11，第2组Bismuth IIIa/IIIb 11/4；平均胆红素水平——第1组284±8.2 μmol/l，第2组311±7.4 μmol/l。从技术角度看，所有手术均成功（100%）。未记录到与手术相关的并发症和死亡率。第1组26例（92.8%）患者和第2组13例（86.7%）患者取得了临床显著效果（p=0.043）。支架置入术后，第1组23例（82.1%）患者和第2组11例（68.8%）患者接受了化疗（p=0.047）。第1组19例患者和第2组10例患者因基础疾病的肿瘤进展死亡，其他患者由医生照料。中位生存期：第1组（12例患者——50天，7例患者——100天，撰写本文时9例患者存活）；第2组（7例患者——50天，4例患者——100天，撰写本文时4例患者存活）。本研究结果显示，第1组6例（21.4%）患者和第2组4例（26.7%）患者出现胆管支架堵塞（p=0.041）。第1组支架功能的平均时长为78±4.5天，第2组为63±4.8天（p=0.036）。基于所获结果，建议对肝总管恶性狭窄患者采用双侧胆管“并排”支架置入法。
