经皮肝穿刺胆道引流术可能是肝门部胆管癌首选的术前引流方法。
Percutaneous transhepatic biliary drainage may be the preferred preoperative drainage method in hilar cholangiocarcinoma.
作者信息
Ba Yongjiang, Yue Ping, Leung Joseph W, Wang Haiping, Lin Yanyan, Bai Bing, Zhu Xiaoliang, Zhang Lei, Zhu Kexiang, Wang Wenhui, Meng Wenbo, Zhou Wence, Liu Ying, Li Xun
机构信息
The First Clinical Medical School of Lanzhou University, Lanzhou, China.
Department of Special Minimally Invasive Surgery, The First Hospital of Lanzhou University, Lanzhou, China.
出版信息
Endosc Int Open. 2020 Feb;8(2):E203-E210. doi: 10.1055/a-0990-9114. Epub 2020 Jan 22.
Preoperative biliary drainage of hilar cholangiocarcinoma (HC) is controversial. The goal of this study was to compare the clinical outcome and associated complications for types II, III, and IV HC managed by percutaneous transhepatic biliary drainage (PTBD) and endoscopic retrograde cholangiopancreatography (ERCP). Between January 2011 and June 2017, a total of 180 patients with II, III, and IV HC were enrolled in this retrospective cohort study. According to the drainage method, patients were divided into two groups: PTBD (n = 81) and ERCP (n = 99). This study was registered with ClinicalTrials.gov, NCT03104582, and was completed. Compared with the PTBD group, the ERCP group had a higher incidence of post-procedural cholangitis (37 [37.37 %] vs. 18 [22.22 %], = 0.028) and pancreatitis (17 [17.17 %] vs. 2 [2.47 %], = 0.001); required more salvaged biliary drainage (18 [18.18 %] vs. 5 [6.17 %], = 0.029), and incurred a higher cost ( < 0.05). Patients with type III and IV HC in the ERCP group had more cholangitis than those in the PTBD group (26 [36.62 %] vs. 11 [18.03 %], = 0.018). The rate of cholangitis in patients who received endoscopic bilateral biliary stents insertion was higher than patients with unilateral stenting (23 [50.00 %] vs. 9 [26.47 %], = 0.034), and underwent PTBD internal-external drainage had a higher incidence of cholangitis than those with only external drainage (11 [34.36 %] vs. 7 [14.29 %], = 0.034). No significant difference in the rate of cholangitis was observed between the endoscopic unilateral stenting group and the endoscopic nasobiliary drainage group (9 [26.47 %] vs. 5 [26.32 %], = 0.990). Compared to ERCP, PTBD reduced the rate of cholangitis, pancreatitis, salvage biliary drainage, and decreased hospitalization costs in patients with types II, III, and IV HC. Risk of cholangitis for patients with types III and IV was significantly lower in the PTBD group.
肝门部胆管癌（HC）术前胆道引流存在争议。本研究的目的是比较经皮经肝胆道引流（PTBD）和内镜逆行胰胆管造影（ERCP）治疗II、III和IV型HC的临床结局及相关并发症。2011年1月至2017年6月，共有180例II、III和IV型HC患者纳入本回顾性队列研究。根据引流方法，患者分为两组：PTBD组（n = 81）和ERCP组（n = 99）。本研究已在ClinicalTrials.gov注册，注册号为NCT03104582，且已完成。与PTBD组相比，ERCP组术后胆管炎发生率更高（37例[37.37%] vs. 18例[22.22%]，P = 0.028）、胰腺炎发生率更高（17例[17.17%] vs. 2例[2.47%]，P = 0.001）；需要更多的补救性胆道引流（18例[18.18%] vs. 5例[6.17%]，P = 0.029），且费用更高（P < 0.05）。ERCP组中III型和IV型HC患者的胆管炎比PTBD组更多（26例[36.62%] vs. 11例[18.03%]，P = 0.018）。接受内镜双侧胆管支架置入的患者胆管炎发生率高于单侧支架置入患者（23例[50.00%] vs. 9例[26.47%]，P = 0.034），且接受PTBD内外引流的患者胆管炎发生率高于仅外引流患者（11例[34.36%] vs. 7例[14.29%]，P = 0.034）。内镜单侧支架置入组和内镜鼻胆管引流组之间胆管炎发生率无显著差异（9例[26.47%] vs. 5例[26.32%]，P = 0.990）。与ERCP相比，PTBD降低了II、III和IV型HC患者的胆管炎、胰腺炎、补救性胆道引流发生率，并降低了住院费用。PTBD组中III型和IV型患者的胆管炎风险显著更低。
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