Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea.
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kyung Hee University Hospital, Seoul, Republic of Korea.
PLoS One. 2021 Mar 29;16(3):e0249096. doi: 10.1371/journal.pone.0249096. eCollection 2021.
For unresectable hilar obstruction, restoring and maintaining biliary ductal patency are crucial for improved survival and quality of life. The endoscopic placement of stents is now a mainstay of its treatment, and bilateral stenting is effective for biliary decompression. This study aimed to determine the clinical outcomes of bilateral metal stent placement using large cell-type stents and the clinical predictors of stent dysfunction in patients with malignant hilar obstruction.
We performed a retrospective analysis of patients who underwent bilateral metal stent placement using two large cell-type stents at two academic teaching hospitals between September 2017 and February 2019. The primary outcome was stent dysfunction. Secondary outcomes included predictors related to stent dysfunction and overall survival.
The study included 87 patients who underwent bilateral metal stent placement for malignant hilar obstruction. Technical success and clinical success were achieved in 80 patients (92.0%) and 83 patients (95.4%), respectively. During the follow-up period (median: 201, range: 18-671 days), stent dysfunction occurred in 42 patients (48.3%), and the median stent patency was 199 days (95% confidence interval [CI]: 181-262). In univariate analysis, age, cholangitis before stent insertion, and subsequent chemotherapy were found to be associated with the cumulative risk of stent dysfunction. In multivariate analysis, cholangitis before stent insertion (hazards ratio [HR]: 2.26, 95% CI: 1.216-4.209, P = 0.010) and subsequent chemotherapy (HR: 0.250, 95% CI: 0.130-0.482, P<0.001) remained as statically significant factors associated with the cumulative risk of stent dysfunction. The median overall survival was 288 days (95% CI: 230-327).
The bilateral placement of large cell-type stents for malignant hilar obstruction was effective with high technical and clinical success rates and acceptable patency. Cholangitis before stent insertion was associated with shorter patency, and subsequent chemotherapy was associated with longer stent patency.
对于不可切除的肝门部梗阻，恢复和维持胆管通畅对于提高生存率和生活质量至关重要。内镜下支架置入术现在是其治疗的主要方法，双侧支架置入术可有效进行胆道减压。本研究旨在确定使用大细胞型支架进行双侧金属支架置入术的临床结果，并确定恶性肝门部梗阻患者支架功能障碍的临床预测因素。
我们对 2017 年 9 月至 2019 年 2 月在两所学术教学医院接受双侧金属支架置入术的 87 例患者进行了回顾性分析。主要结局是支架功能障碍。次要结局包括与支架功能障碍和总生存相关的预测因素。
研究纳入 87 例因恶性肝门部梗阻行双侧金属支架置入术的患者。80 例（92.0%）和 83 例（95.4%）患者分别达到技术成功和临床成功。在随访期间（中位数：201 天，范围：18-671 天），42 例（48.3%）发生支架功能障碍，中位支架通畅时间为 199 天（95%置信区间[CI]：181-262）。单因素分析显示，支架置入前胆管炎、年龄和随后的化疗与支架功能障碍的累积风险相关。多因素分析显示，支架置入前胆管炎（风险比[HR]：2.26，95%CI：1.216-4.209，P=0.010）和随后的化疗（HR：0.250，95%CI：0.130-0.482，P<0.001）是与支架功能障碍累积风险相关的统计学显著因素。中位总生存时间为 288 天（95%CI：230-327）。
对于恶性肝门部梗阻，使用大细胞型支架进行双侧支架置入术是有效且安全的，具有较高的技术和临床成功率以及可接受的通畅率。支架置入前胆管炎与较短的通畅时间相关，而随后的化疗与较长的支架通畅时间相关。
