Department of Radiology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; Faculty of Medicine, University of Coimbra, Coimbra, Portugal.
Faculty of Medicine, University of Coimbra, Coimbra, Portugal.
J Vasc Interv Radiol. 2023 Aug;34(8):1400-1408. doi: 10.1016/j.jvir.2023.03.031. Epub 2023 Apr 5.
To compare the effectiveness, adverse events (AEs), stent patency, and patient survival with suprapapillary and transpapillary uncovered self-expandable metallic stent placement for perihilar cholangiocarcinoma.
A single-center retrospective study of 54 patients with inoperable perihilar cholangiocarcinoma who underwent percutaneous transhepatic biliary stent placement between January 1, 2019, and August 31, 2021, was conducted. According to stent location, the patients were classified into 2 groups: suprapapillary (S) and transpapillary (T). Demographic data, Bismuth-Corlette classification, type and location of the stent, laboratory data, postprocedural AEs, procedural success, stent occlusion, reintervention rate, and mortality were compared between the groups.
Stent placement was suprapapillary in 13 (24.1%) patients and transpapillary in 41 (75.9%) patients. Mean age was higher in Group T (78 vs 70.5 years; P = .046). Stent occlusion rates were similar in the 2 groups (Group S, 23.8%; Group T, 19.5%), as were AE rates, the most common being cholangitis (Group S, 23.1%; Group T, 24.4%). There were no significant differences in revision rate (Group S, 7.7%; Group T, 12.2%) and 30-day mortality rate (Group S, 15.4%; Group T, 19.5%). Ninety-day mortality rate was statistically significantly higher in Group T (46.3% vs 15.4%; P = .046). Preprocedural bilirubin level was higher in Group T, as were postprocedural leukocyte and C-reactive protein (CRP) levels.
Suprapapillary and transpapillary stent placement procedures were similar in terms of procedural success, occlusion rate, revision rate, postprocedural AEs, and 30-day mortality. Ninety-day mortality rate and postprocedural leukocyte and CRP levels were higher in Group T, although these patients were also older and had higher preprocedural bilirubin levels.
比较经皮经肝胆道支架置入术治疗高位和低位肝外胆管癌的疗效、不良事件（AEs）、支架通畅率和患者生存率。
回顾性分析 2019 年 1 月 1 日至 2021 年 8 月 31 日期间 54 例无法手术的高位肝外胆管癌患者的临床资料，所有患者均行经皮经肝胆道支架置入术。根据支架位置将患者分为高位（S）和低位（T）两组。比较两组患者的一般资料、Bismuth-Corlette 分型、支架类型和位置、实验室数据、术后 AEs、操作成功率、支架闭塞、再干预率和死亡率。
13 例（24.1%）患者采用高位支架置入，41 例（75.9%）患者采用低位支架置入。T 组患者的平均年龄高于 S 组（78 岁比 70.5 岁；P=0.046）。两组支架闭塞率相似（S 组为 23.8%，T 组为 19.5%），AEs 发生率也相似，最常见的是胆管炎（S 组为 23.1%，T 组为 24.4%）。两组再干预率（S 组为 7.7%，T 组为 12.2%）和 30 天死亡率（S 组为 15.4%，T 组为 19.5%）无显著差异。T 组 90 天死亡率显著高于 S 组（46.3%比 15.4%；P=0.046）。T 组患者的术前胆红素水平较高，术后白细胞和 C 反应蛋白（CRP）水平也较高。
高位和低位支架置入术在操作成功率、支架闭塞率、再干预率、术后 AEs 和 30 天死亡率方面相似。T 组患者的 90 天死亡率以及术后白细胞和 CRP 水平较高，尽管这些患者年龄较大，术前胆红素水平较高。
