使用自膨式金属支架进行内镜胆管减压可减少化疗胰腺癌患者的支架并发症。
Use of self-expandable metallic stents for endoscopic biliary decompression decreases stent complications in pancreatic cancer patients receiving chemotherapy.
机构信息
Department of Gastrointestinal Surgery, Helsinki University Hospital, Helsinki, Finland.
Translational Cancer Medicine Research Program, University of Helsinki, Helsinki, Finland.
出版信息
Surg Endosc. 2022 Jan;36(1):614-620. doi: 10.1007/s00464-021-08327-y. Epub 2021 Feb 3.
BACKGROUND
Both plastic stents and self-expandable metallic stents (SEMSes) are used for endoscopic biliary decompression (BD) among patients with pancreatic cancer (PAC). Cholangitis or stent occlusion often interrupts or ends chemotherapy. We investigated cholangitis, stent occlusion, and chemotherapy interruption rates for SEMSes and plastic stents among patients receiving chemotherapy for PAC.
MATERIALS AND METHODS
We retrospectively analyzed data for 293 PAC patients who received a biliary stent at Helsinki University Hospital during 2000-2017. Patients received chemotherapy as palliative treatment (PT: n = 187) or neoadjuvant treatment (NAT: n = 106). Among participants, 229 had a plastic stent (PT: n = 138, NAT: n = 91) and 64 had a SEMS (PT: n = 49, NAT: n = 15).
RESULTS
Overall, 15.6% (n = 10) of patients with SEMSes (PT: 20.4%, n = 10, NAT: 0%) and 53.0% (n = 121) of patients with plastic stents (PT: 69.3%, n = 95, NAT: 28.5%, n = 26) experienced one or more stent complications (p < 0.001). Cholangitis developed in 6.3% (n = 8) of PT patients with SEMSes. No patients with SEMSes receiving NAT (n = 15) experienced cholangitis. However, 31.9% (PT: 42.8%, n = 59, p = 0.001; NAT: 15.4%, n = 14, p = 0.211) of patients with plastic stents developed cholangitis. Among all patients receiving NAT or PT, cholangitis interrupted chemotherapy 6 times (9.4%) in SEMS patients and 61 times (26.6%) in plastic stent patients (p = 0.004). Stent occlusion without cholangitis interrupted NAT or PT 2 times (2.1%) in SEMS patients and 31 times (13.5%) in plastic stent patients (p = 0.023).
CONCLUSIONS
SEMS is recommended for BD among patients with PAC receiving chemotherapy. Among both PT and NAT patients, patients with SEMS experience a lower stent failure rate, lower rate of cholangitis, and fewer chemotherapy interruptions than patients with plastic stents.
背景
在胰腺癌（PAC）患者中，塑料支架和自膨式金属支架（SEMS）均用于内镜下胆管减压（BD）。胆管炎或支架阻塞常导致化疗中断或终止。我们研究了接受 PAC 化疗的患者中 SEMS 和塑料支架的胆管炎、支架阻塞和化疗中断率。
材料和方法
我们回顾性分析了 2000 年至 2017 年期间在赫尔辛基大学医院接受胆道支架治疗的 293 例 PAC 患者的数据。患者接受化疗作为姑息治疗（PT：n=187）或新辅助治疗（NAT：n=106）。在参与者中，229 例患者使用塑料支架（PT：n=138，NAT：n=91），64 例患者使用 SEMS（PT：n=49，NAT：n=15）。
结果
总体而言，SEMS 组患者中有 15.6%（n=10）（PT：20.4%，n=10，NAT：0%）和塑料支架组患者中有 53.0%（n=121）（PT：69.3%，n=95，NAT：28.5%，n=26）经历了一次或多次支架并发症（p<0.001）。SEMS 组 PT 患者中有 6.3%（n=8）发生胆管炎。接受 NAT 的 SEMS 组患者无一例发生胆管炎（n=15）。然而，塑料支架组患者中有 31.9%（PT：42.8%，n=59，p<0.001；NAT：15.4%，n=14，p=0.211）发生胆管炎。在接受 NAT 或 PT 的所有患者中，胆管炎导致 SEMS 组患者的化疗中断 6 次（9.4%），而塑料支架组患者的化疗中断 61 次（26.6%）（p=0.004）。无胆管炎的支架阻塞导致 SEMS 组患者的 NAT 或 PT 中断 2 次（2.1%），而塑料支架组患者的 NAT 或 PT 中断 31 次（13.5%）（p=0.023）。
结论
建议对接受化疗的 PAC 患者使用 SEMS 进行 BD。在 PT 和 NAT 患者中，与塑料支架相比，SEMS 组患者的支架失败率更低、胆管炎发生率更低、化疗中断率更低。
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