活体肝移植术后吻合口狭窄的最佳引流。
Optimal drainage of anastomosis stricture after living donor liver transplantation.
机构信息
Division of Gastroenterology, Department of Internal Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
Division of Gastroenterology, Department of Internal Medicine CHA Bundang Medical Center, CHA University, Gyeonggi-do, Republic of Korea.
出版信息
Surg Endosc. 2021 Nov;35(11):6307-6317. doi: 10.1007/s00464-021-08456-4. Epub 2021 Apr 1.
BACKGROUND
Endoscopic biliary stenting (EBS) with a fully covered, self-expandable metallic stent (FC-SEMS) and plastic stent (PS) is safe and efficient for biliary anastomotic strictures (ASs) after a deceased donor liver transplantation. Limited studies have investigated the use of FC-SEMSs for biliary strictures post-living donor liver transplantation (LDLT). We compared the resolution rate of biliary ASs post-LDLT and the 12-month recurrence rates post-stent removal between EBS with an FC-SEMS, PS, and percutaneous transhepatic biliary drainage (PTBD).
METHODS
Patients with biliary ASs after an LDLT (mean age: 57.3 years, 76.1% men) hospitalized between 2014 and 2017 were enrolled. Endoscopic retrograde cholangiopancreatography (ERCP) was repeated every 3-4 months. Patients were followed-up for at least 1-year post-stent removal.
RESULTS
Of the 75 patients enrolled, 16, 20, and 39 underwent EBS with an FC-SEMS, PS, and PTBD, respectively. Median follow-up period was 39.2 months. Fewer ERCP procedures were needed in the FC-SEMS group than in the PS group (median, 2 vs. 3; P = 0.20). Median stent indwelling periods were 4.7, 9.3, and 5.4 months in the FC-SEMS, PS, and PTBD groups, respectively (P = 0.006). The functional resolution rate was lower in the PS group (16/20) than in the FC-SEMS (16/16) or PTBD (39/39) group (P = 0.005). The radiologic resolution rate was higher in the FC-SEMS group (16/16) than in the PS group (14/20) (P = 0.07). The 12-month recurrence rates showed no significant differences (FC-SEMS, 4/16; PS, 3/16; PTBD, 6/39; P = 0.66). The rates of complications during treatment differed significantly between the groups (P = 0.04). Stent migration occurred in 1 (6.3%) and 5 (25.0%) patients in the FC-SEMS and PS groups, respectively (P = 0.59).
CONCLUSIONS
EBS with an FC-SEMS is comparable with EBS with a PS or PTBD in terms of biliary stricture resolution and 12-month recurrence rates. The use of FC-SEMSs is potentially effective and safe for biliary AS resolution after LDLT.
背景
对于接受过尸体供肝肝移植的患者，内镜下胆道支架置入术（EBS）联合全覆膜自膨式金属支架（FC-SEMS）和塑料支架（PS）用于治疗胆道吻合口狭窄（AS）是安全有效的。目前，仅有少量研究调查了 FC-SEMS 治疗活体供肝肝移植（LDLT）后胆道狭窄的效果。我们比较了 EBS 联合 FC-SEMS、PS 和经皮经肝胆道引流（PTBD）治疗 LDLT 后胆道 AS 的缓解率和支架取出后 12 个月的复发率。
方法
纳入了 2014 年至 2017 年期间接受 LDLT 并患有胆道 AS 的患者（平均年龄：57.3 岁，76.1%为男性）。每隔 3-4 个月进行一次内镜逆行胰胆管造影术（ERCP）检查。所有患者在支架取出后至少随访 1 年。
结果
共有 75 名患者接受了 EBS 治疗，其中 16 名、20 名和 39 名患者分别接受了 FC-SEMS、PS 和 PTBD 治疗。中位随访时间为 39.2 个月。与 PS 组相比，FC-SEMS 组需要进行的 ERCP 次数更少（中位数：2 次 vs. 3 次；P=0.20）。FC-SEMS、PS 和 PTBD 组的中位支架留置时间分别为 4.7、9.3 和 5.4 个月（P=0.006）。PS 组的功能缓解率（16/20）低于 FC-SEMS 组（16/16）或 PTBD 组（39/39）（P=0.005）。FC-SEMS 组的影像学缓解率（16/16）高于 PS 组（14/20）（P=0.07）。12 个月的复发率无显著差异（FC-SEMS 组：4/16；PS 组：3/16；PTBD 组：6/39；P=0.66）。各组间治疗期间并发症发生率差异有统计学意义（P=0.04）。FC-SEMS 组和 PS 组各有 1 例（6.3%）和 5 例（25.0%）患者出现支架移位（P=0.59）。
结论
EBS 联合 FC-SEMS 与 EBS 联合 PS 或 PTBD 在胆道狭窄缓解率和 12 个月复发率方面相似。对于 LDLT 后胆道 AS 的缓解，使用 FC-SEMS 可能是有效且安全的。
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