肝胃吻合术与胆总管十二指肠吻合术：关于其长期通畅性的一项国际多中心研究。
Hepaticogastrostomy choledochoduodenostomy: An international multicenter study on their long-term patency.
作者信息
Tyberg Amy, Napoleon Bertrand, Robles-Medranda Carlos, Shah Janak N, Bories Erwan, Kumta Nikhil A, Yague Andres Sanchez, Vazquez-Sequeiros Enrique, Lakhtakia Sundeep, El Chafic Abdul Hamid, Shah Shawn L, Sameera Sohini, Tawadros Augustine, Ardengh Jose Celso, Kedia Prashant, Gaidhane Monica, Giovannini Marc, Kahaleh Michel
机构信息
Rutgers Robert Wood Johnson Medical Hospital, New Brunswick, New Jersey, USA.
Jean Mermoz Private hospital, Lyon, France.
出版信息
Endosc Ultrasound. 2022 Jan-Feb;11(1):38-43. doi: 10.4103/EUS-D-21-00006.
BACKGROUND AND OBJECTIVES
EUS-guided biliary drainage (EUS-BD) offers minimally invasive decompression when conventional endoscopic retrograde cholangiopancreatography fails. Stents can be placed from the intrahepatic ducts into the stomach (hepaticogastrostomy [HG]) or from the extrahepatic bile duct into the small intestine (choledochoduodenostomy [CCD]). Long-term patency of these stents is unknown. In this study, we aim to compare long-term patency of CCD versus HG.
METHODS
Consecutive patients from 12 centers were included in a registry over 14 years. Demographics, procedure info, adverse events, and follow-up data were collected. Student's t-test, Chi-square, and logistic regression analyses were conducted. Only patients with at least 6-month follow-up or who died within 6-month postprocedure were included.
RESULTS
One-hundred and eighty-two patients were included (93% male; mean age: 70; HG n = 95, CCD n = 87). No significant difference in indication, diagnosis, dissection instrument, or stent type was seen between the two groups. Technical success was 92% in both groups. Clinical success was achieved in 75/87 (86%) in the HG group and 80/80 (100%) in the CCD group. A trend toward higher adverse events was seen in the CCD group. A total of 25 patients out of 87 needed stent revision in the HG group (success rate 71%), while eight out of 80 were revised in the CCD group (success rate 90%). Chi square shows CCD success higher than HG (90% vs. 71%, P = 0.010). After adjusting for diagnosis, jaundice or cholangitis presentation, instrument used for dissection, and gender, CCD was 4.5 times more likely than HG to achieve longer stent patency or manage obstruction (odds ratio 4.5; 95% 1.1548-17.6500, P = 0.0302).
CONCLUSION
CCD is associated with superior long-term patency than HG but with a trend toward higher adverse events. This is particularly important in patients with increased survival. Additional studies are required before recommending a change in practice.
背景与目的
当传统内镜逆行胰胆管造影失败时，超声内镜引导下胆道引流（EUS-BD）可提供微创减压。支架可从肝内胆管置入胃内（肝胃吻合术[HG]）或从肝外胆管置入小肠（胆总管十二指肠吻合术[CCD]）。这些支架的长期通畅性尚不清楚。在本研究中，我们旨在比较CCD与HG的长期通畅性。
方法
连续纳入来自12个中心的患者，进行为期14年的登记。收集人口统计学、手术信息、不良事件和随访数据。进行了学生t检验、卡方检验和逻辑回归分析。仅纳入随访至少6个月或术后6个月内死亡的患者。
结果
共纳入182例患者（93%为男性；平均年龄：70岁；HG组95例，CCD组87例）。两组在适应证、诊断、解剖器械或支架类型方面无显著差异。两组的技术成功率均为92%。HG组75/87例（86%）和CCD组80/80例（100%）取得临床成功。CCD组不良事件有增加趋势。HG组87例中有25例需要支架翻修（成功率71%），而CCD组80例中有8例进行了翻修（成功率90%）。卡方检验显示CCD的成功率高于HG（90%对71%，P = 0.010）。在调整诊断、黄疸或胆管炎表现、用于解剖的器械和性别后，CCD实现更长支架通畅或处理梗阻的可能性是HG的4.5倍（比值比4.5；95% 1.1548 - 17.6500，P = 0.0302）。
结论
与HG相比，CCD具有更好的长期通畅性，但不良事件有增加趋势。这在生存期延长的患者中尤为重要。在建议改变实践之前，还需要进一步研究。
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