Tomooka Fumimasa, Kitagawa Koh, Mitoro Akira, Fujinaga Yukihisa, Nishimura Norihisa, Namisaki Tadashi, Akahane Takemi, Kaji Kosuke, Asada Shohei, Sato Shinya, Hanatani Jun-Ichi, Mori Hitoshi, Motokawa Yuki, Iwata Tomihiro, Kachi Hiroki, Osaki Yui, Yoshiji Hitoshi
Department of Gastroenterology Nara Medical University Nara Japan.
Division of Endoscopy Nara Medical University Nara Japan.
DEN Open. 2024 Jul 15;5(1):e404. doi: 10.1002/deo2.404. eCollection 2025 Apr.
To evaluate the results of inside stent therapy for unresectable malignant hilar biliary obstruction and identify factors related to stent patency duration.
Of 44 patients who underwent initial inside-stent placement above the sphincter of Oddi from April 2017 to December 2022, 42 with the resolution of jaundice (clinical success rate, 95.5%) were retrospectively analyzed. Univariate and multivariate logistic regression analysis identified factors associated with stent patency duration.
Univariate analysis revealed significant differences in the drainage method (406 days for unilateral drainage vs. 305 days for bilateral drainage of the right and left liver lobes, = 0.022) with or without chemotherapy (406 days with vs. 154 days without, = 0.038). Multivariate analysis (Cox proportional hazards analysis) revealed similar results, with unilateral drainage ( = 0.031) and chemotherapy ( = 0.048) identified as independent factors associated with prolonged stent patency. Early adverse events were observed in two patients (4.8%; one cholangitis, one pancreatitis).
Inside-stent therapy was safely performed in patients with malignant hilar biliary obstruction. Simple unilateral drainage and chemotherapy may prolong stent patency.
评估不可切除的恶性肝门部胆管梗阻的内支架治疗效果，并确定与支架通畅持续时间相关的因素。
回顾性分析2017年4月至2022年12月期间在Oddi括约肌上方首次置入内支架的44例患者，其中42例黄疸消退（临床成功率95.5%）。单因素和多因素逻辑回归分析确定与支架通畅持续时间相关的因素。
单因素分析显示，引流方式（左、右肝叶单侧引流406天，双侧引流305天，P = 0.022）以及是否进行化疗（进行化疗的为406天，未进行化疗的为154天，P = 0.038）存在显著差异。多因素分析（Cox比例风险分析）显示了类似结果，单侧引流（P = 0.031）和化疗（P = 0.048）被确定为与支架通畅时间延长相关的独立因素。两名患者（4.8%）出现早期不良事件（1例胆管炎，1例胰腺炎）。
恶性肝门部胆管梗阻患者接受内支架治疗安全可行。单纯单侧引流和化疗可能会延长支架通畅时间。
