Department of Hepatobiliary Surgery, the First Affiliated Hospital of Bengbu Medical College, 233000, Bengbu, Anhui, China.
Sci Rep. 2019 Aug 5;9(1):11348. doi: 10.1038/s41598-019-47791-4.
We aimed to compare the efficacy of percutaneous transhepatic biliary stenting (PTBS) and PTBS combined with I particles implantation in the treatment of advanced extrahepatic cholangiocarcinoma (EHC). A total of 184 advanced EHC patients, who received PTBS (PTBS group) or PTBS combined with I particles implantation (PTBS + I group) from January 2012 to April 2017 in our department, were retrospectively reviewed. The improvement of jaundice and liver function was observed in both groups. The postoperative complications, risk of biliary re-obstruction, and overall survival (OS) were compared between the two groups. Amongst, 71 cases received PTBS and 113 had the additional implantation of I particles. The jaundice and liver function were significantly improved in all patients, especially in PTBS + I group. There was no significant difference in the risk of postoperative complications between the two groups. However, the risk of biliary re-obstruction significantly reduced in PTBS + I group (19.5% vs. 35.2%, p = 0.017). Kaplan Meier analysis showed that patients in PTBS + I group had a significantly better OS, both for hilar and distal cholangiocarcinoma. Univariate analysis demonstrated that preoperative levels of carbohydrate antigen 19-9 (CA19-9), total bilirubin, neutrophil count, lymphocyte count, and different therapeutic method were significant factors affecting OS. Multivariate analysis further identified the treatment of PTBS combined with I particles implantation as an independent protective prognostic factor (HR = 0.26, 95% CI: 0.17-0.39, p < 0.001). In conclusion, for patients with advanced EHC, PTBS combined with I particles implantation is superior to PTBS alone in improving liver function, inhibiting biliary re-obstruction, and prolonging survival time.
我们旨在比较经皮经肝胆管支架置入术（PTBS）和 PTBS 联合 I 粒子植入治疗晚期肝外胆管癌（EHC）的疗效。回顾性分析 2012 年 1 月至 2017 年 4 月我科收治的 184 例接受 PTBS（PTBS 组）或 PTBS 联合 I 粒子植入（PTBS+I 组）的晚期 EHC 患者。观察两组患者黄疸及肝功能改善情况，比较两组术后并发症、胆道再梗阻风险及总生存期（OS）。其中，71 例行 PTBS，113 例行 I 粒子植入。所有患者黄疸及肝功能均明显改善，PTBS+I 组改善更明显。两组术后并发症风险无显著差异，但 PTBS+I 组胆道再梗阻风险显著降低（19.5%比 35.2%，p=0.017）。Kaplan-Meier 分析显示，PTBS+I 组患者 OS 明显较好，包括肝门部及远端胆管癌。单因素分析显示，术前糖链抗原 19-9（CA19-9）、总胆红素、中性粒细胞计数、淋巴细胞计数及不同治疗方法是影响 OS 的显著因素。多因素分析进一步确定 PTBS 联合 I 粒子植入治疗是独立的保护预后因素（HR=0.26，95%CI：0.17-0.39，p<0.001）。综上所述，对于晚期 EHC 患者，PTBS 联合 I 粒子植入在改善肝功能、抑制胆道再梗阻及延长生存时间方面优于单纯 PTBS。
