Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan.
Department of Internal Medicine, Fukuyama City Hospital, Fukuyama, Japan.
BMC Gastroenterol. 2021 Jan 13;21(1):28. doi: 10.1186/s12876-020-01594-4.
Only a few reports have assessed the effectiveness of endoscopic biliary drainage (EBD) in hepatocellular carcinoma (HCC) patients with obstructive jaundice and liver dysfunction.
This was a retrospective study based on the clinical databases from the Okayama University Hospital and 10 affiliated hospitals. All patients received EBD for jaundice or liver dysfunction. The indication for EBD was aggravation of jaundice or liver dysfunction with intrahepatic bile duct (IHBD) dilation. The technical and clinical success rate, complications, factors associated with clinical failure, and survival duration were evaluated.
A total of 107 patients were enrolled in this study. Technical success was achieved in 105 of 107 patients (98.1%). Clinical success was achieved in 85 of 105 patients (81%). Complications related to endoscopic retrograde cholangiography (ERC) occurred in 3 (2.8%) patients. Child-Pugh class C (odds ratio 3.90, 95% confidence interval [CI] 1.47-10.4, p = 0.0046) was the only factor associated with clinical failure, irrespective of successful drainage. The median survival duration was significantly longer in patients with clinical success than in those without clinical success (5.0 months vs. 0.93 months; hazard ratio [HR] 3.2, 95% CI 1.87-5.37). HCC Stage I/II/III (HR 0.57, CI 0.34-0.95, p = 0.032), absence of portal thrombosis (HR 0.52, CI 0.32-0.85, p = 0.0099), and clinical success (HR 0.39, CI 0.21-0.70, p = 0.0018) were significant factors associated with a long survival.
EBD for obstructive jaundice and liver dysfunction in patients with HCC can be performed safely with a high technical success rate. Clinical success can improve the survival duration, even in patients expected to have a poor prognosis.
Retrospectively registered.
仅有少数研究评估了内镜下胆道引流（EBD）对合并梗阻性黄疸和肝功能障碍的肝细胞癌（HCC）患者的疗效。
这是一项基于冈山大学医院和 10 家附属医院临床数据库的回顾性研究。所有患者均因黄疸或肝功能障碍而行 EBD。EBD 的适应证为肝内胆管（IHBD）扩张导致黄疸或肝功能障碍加重。评估了技术和临床成功率、并发症、与临床失败相关的因素以及生存时间。
共纳入 107 例患者。107 例患者中，技术成功率为 105 例（98.1%）。85 例（81%）患者达到临床成功。3 例（2.8%）患者发生与内镜逆行胰胆管造影（ERC）相关的并发症。Child-Pugh 分级为 C（比值比 3.90，95%置信区间 [CI] 1.47-10.4，p=0.0046）是与临床失败相关的唯一因素，与引流是否成功无关。临床成功患者的中位生存时间明显长于临床失败患者（5.0 个月 vs. 0.93 个月；风险比 [HR] 3.2，95%CI 1.87-5.37）。HCC 分期 I/II/III 期（HR 0.57，CI 0.34-0.95，p=0.032）、无门静脉血栓形成（HR 0.52，CI 0.32-0.85，p=0.0099）和临床成功（HR 0.39，CI 0.21-0.70，p=0.0018）是与长期生存相关的显著因素。
EBD 治疗 HCC 合并梗阻性黄疸和肝功能障碍可安全进行，技术成功率高。临床成功可改善生存时间，即使在预后较差的患者中也是如此。
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