Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, 65526Asan Medical Center, Seoul, Republic of Korea.
Acta Radiol. 2021 Dec;62(12):1625-1631. doi: 10.1177/0284185120978512. Epub 2020 Dec 13.
To overcome the technical difficulty of bilateral stent-in-stent placement, large cell-type biliary stents have been developed. However, most of the studies using large cell-type stents were conducted with endoscopic method.
To evaluate the efficacy and safety of percutaneous stent placement with a stent-in-stent method using large cell-type stents in patients with malignant hilar biliary obstruction.
From December 2015 and October 2018, 51 patients with malignant hilar biliary obstruction were retrospectively studied. All of the patients underwent bilateral (n=46) or unilateral (n=5) stenting in a T, Y, or X configuration with a stent-in-stent method using large cell-type stents. Technical success, complications, successful internal drainage, stent patency, and patient survival were analyzed.
A total of 118 stents were successfully placed in 51 patients (100.0%). Three patients had minor complications with self-limiting hemobilia. Major complications were not observed in any patient. Successful internal drainage was achieved in 45 patients (88.2%). Clinical follow-up information until death or the end of the study was available for 50 of 51 patients. The median patient survival was 285.5 days (95% confidence interval [CI] 197-374). Stent dysfunction occurred in 16 patients (35.6%) due to tumor ingrowth (n=9) or tumor ingrowth combined with biliary sludge (n=7) among the patients who achieved successful internal drainage. Median stent patency was 179 days (95% CI 104-271).
Percutaneous stent-in-stent placement with large cell-type stents is technically feasible and safe, and can be an effective technique in patients with malignant hilar biliary obstruction.
为了克服双侧支架内支架放置的技术难题，已经开发出大细胞型胆管支架。然而，大多数使用大细胞型支架的研究都是通过内镜方法进行的。
评估使用大细胞型支架进行支架内支架方法经皮支架置入治疗恶性肝门部胆管梗阻的疗效和安全性。
2015 年 12 月至 2018 年 10 月，回顾性研究了 51 例恶性肝门部胆管梗阻患者。所有患者均采用支架内支架方法行双侧（n=46）或单侧（n=5）T、Y 或 X 型支架置入。分析技术成功率、并发症、成功的内引流、支架通畅性和患者生存情况。
51 例患者共成功放置 118 枚支架（100.0%）。3 例患者出现轻微并发症，表现为自限性血胆红素血症。无患者出现严重并发症。45 例（88.2%）患者获得成功的内引流。51 例患者中，有 50 例获得随访至死亡或研究结束。中位患者生存时间为 285.5 天（95%置信区间 197-374）。在成功实现内引流的患者中，16 例（35.6%）因肿瘤生长（n=9）或肿瘤生长合并胆管内淤积（n=7）导致支架功能障碍。中位支架通畅时间为 179 天（95%置信区间 104-271）。
使用大细胞型支架进行经皮支架内支架放置技术上是可行和安全的，可作为恶性肝门部胆管梗阻患者的有效治疗手段。
