Jha Ashish Kumar, Jha Praveen, Jha Sharad Kumar, Keshari Ravi
Department of Gastroenterology, Indira Gandhi Institute of Medical Sciences, Patna, India.
Ann Gastroenterol. 2021;34(1):12-19. doi: 10.20524/aog.2020.0548. Epub 2020 Oct 12.
In unresectable malignant hilar obstruction, adequate biliary drainage can be achieved with endoscopic placement of plastic or metal stents. Stent patency and patient survival may differ, depending on the primary disease, disease progression and stent type. Metal and plastic stents were compared in patients with malignant hilar strictures in several studies, but these studies mainly included patients who had cholangiocarcinoma, without taking into consideration potential differences in the invasion properties of tumor cells, histological differentiation and the biological behavior of different tumors. Gallbladder cancer (GBC) is the most common malignancy of the biliary tract, especially in the Indian subcontinent and Latin America. About half the patients with GBC present with jaundice, which usually means the tumor is inoperable. Palliative endoscopic stenting remains the first-line treatment of unresectable GBC with biliary obstruction. Primary disease progression is faster in GBC compared to cholangiocarcinoma. There is a paucity of data on the selection of stents for inoperable GBC with hilar biliary obstruction. This review focuses on the published literature related to the selection of stents for unresectable GBC with hilar obstruction.
在无法切除的恶性肝门梗阻中，通过内镜放置塑料或金属支架可实现充分的胆道引流。支架通畅情况和患者生存率可能因原发疾病、疾病进展和支架类型而异。在多项研究中，对恶性肝门狭窄患者的金属支架和塑料支架进行了比较，但这些研究主要纳入了胆管癌患者，未考虑肿瘤细胞侵袭特性、组织学分化及不同肿瘤生物学行为的潜在差异。胆囊癌（GBC）是胆道最常见的恶性肿瘤，尤其在印度次大陆和拉丁美洲。约一半的GBC患者会出现黄疸，这通常意味着肿瘤无法手术切除。姑息性内镜支架置入术仍是无法切除的伴有胆道梗阻的GBC的一线治疗方法。与胆管癌相比，GBC的原发疾病进展更快。关于无法手术切除的伴有肝门部胆道梗阻的GBC患者支架选择的数据较少。本综述聚焦于已发表的有关无法切除的伴有肝门梗阻的GBC患者支架选择的文献。
