Yoshinari Motohiro, Hijioka Susumu, Nagashio Yoshikuni, Maruki Yuta, Ohba Akihiro, Kawasaki Yuki, Takeshita Kotaro, Morizane Chigusa, Tanaka Yasuhito, Okusaka Takuji
National Cancer Center Hospital, Department of Hepatobiliary and Pancreatic Oncology, Tokyo, Japan.
Kumamoto University, Department of Gastroenterology and Hepatology, Faculty of Life Sciences, Kumamoto, Japan.
Endosc Int Open. 2023 Mar 23;11(3):E276-E283. doi: 10.1055/a-2039-3936. eCollection 2023 Mar.
The clinical outcome of the new hybrid drainage method for unresectable malignant hilar biliary obstruction (UMHBO) has not yet been compared with that of the partial stent-in-stent (PSIS) method with three or more stents. Patients with UMHBO underwent drainage of three segments using the hybrid or PSIS method. The clinical outcomes of both methods were compared retrospectively. Overall, 54 patients underwent the hybrid (n = 31) or PSIS (n = 23) method of drainage with three or more stents for UMHBO. There were no significant differences in the technical success rate (hybrid vs. PSIS, 87.1 % vs. 87 %), clinical success rate according to per-protocol analysis (81.5 % vs. 70 %), early adverse events rate (14.8 % vs. 10%), late adverse events rate (7.4 % vs. 0 %), and technical success rate of the endoscopic transpapillary reintervention (90.9 % vs. 100 %). Time to recurrent biliary obstruction (TRBO) of the hybrid and PSIS methods was 178 and 231 days, respectively, with no significant difference ( = 0.354). The choice between the two methods should be made at the physician's discretion.
新型混合引流方法用于不可切除的恶性肝门部胆管梗阻（UMHBO）的临床疗效尚未与使用三个或更多支架的部分支架套叠（PSIS）方法进行比较。UMHBO患者采用混合或PSIS方法对三个节段进行引流。对两种方法的临床疗效进行回顾性比较。总体而言，54例患者采用混合（n = 31）或PSIS（n = 23）方法对UMHBO进行三个或更多支架的引流。技术成功率（混合与PSIS，87.1%对87%）、根据方案分析的临床成功率（81.5%对70%）、早期不良事件发生率（14.8%对10%）、晚期不良事件发生率（7.4%对0%）以及内镜经乳头再次干预的技术成功率（90.9%对100%）方面均无显著差异。混合和PSIS方法的复发性胆管梗阻时间（TRBO）分别为178天和231天，无显著差异（P = 0.354）。两种方法的选择应由医生自行决定。
