Chen Wangyang, Huang Peiyao, Gu Xinyi, Liu Xiaodie, Ying Xiuzhiye, Yang Jianfeng
Department of Gastroenterology, Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China.
Key Laboratory of Integrated Traditional Chinese and Western Medicine for Biliary and Pancreatic Diseases of Zhejiang Province, Hangzhou, Zhejiang Province, China.
Therap Adv Gastroenterol. 2025 Feb 17;18:17562848251319809. doi: 10.1177/17562848251319809. eCollection 2025.
The rising incidence of hilar malignant bile duct strictures poses challenges for diagnosis and treatment. While endoscopic treatment is essential for relieving obstruction, it carries a high risk of postoperative cholangitis. Sequential cutting of nasobiliary tubes as an alternative to stent placement after nasobiliary drainage may emerge as an effective strategy to mitigate these complications.
This study aimed to evaluate the efficacy and safety of nasobiliary tube cutting after nasobiliary drainage versus conventional stent placement in reducing postoperative cholangitis in patients with hilar malignant biliary strictures.
A retrospective cohort study.
From 2015 to 2023, 208 patients were divided into two groups: nasobiliary tube cutting group ( = 103) and conventional stent group ( = 105). The primary outcome was postoperative cholangitis, with secondary outcomes including drainage success, bilirubin reduction, re-interventions, complications, and hospital stay.
Cholangitis occurred in 11.7% of the nasobiliary tube cutting group and 26.7% of the conventional stent group ( = 0.006). Successful drainage was achieved in 84 patients (81.6%) in the nasobiliary tube cutting group and 78 patients (74.3%) in the conventional stent group, with no statistically significant difference ( = 0.207). Patients whose total bilirubin reduction >50% within 7 days were significantly higher in the nasobiliary tube cutting group (48.5% vs 27.6%, = 0.002). There were no significant differences between the groups in the number of endoscopic retrograde cholangiopancreatography procedures or re-interventions required ( > 0.05). Except for postoperative cholangitis, other postoperative complications were comparable between the groups ( > 0.05). The postoperative hospital stay was significantly longer in the nasobiliary tube cutting group, with a median duration of 10.0 (7.0, 14.0) days compared to 7.0 (5.5, 12.5) days in the conventional stent group ( = 0.024). Bismuth-Corlette Type IV was identified as an independent risk factor for cholangitis (OR = 3.207, 95%CI: 1.253-8.210, = 0.015).
For patients with hilar malignant biliary stricture, sequential cutting of nasobiliary tubes as an alternative to stent placement after nasobiliary drainage may reduce the incidence of postoperative cholangitis and achieve early successful drainage, but it may result in a prolonged postoperative hospital stay. Bismuth-Corlette Type IV is an independent risk factor for the development of postoperative cholangitis.
肝门部恶性胆管狭窄的发病率不断上升，给诊断和治疗带来了挑战。虽然内镜治疗对于缓解梗阻至关重要，但术后胆管炎的风险很高。鼻胆管序贯切割作为鼻胆管引流后置入支架的替代方法，可能成为减轻这些并发症的有效策略。
本研究旨在评估鼻胆管引流后鼻胆管切割与传统支架置入在降低肝门部恶性胆管狭窄患者术后胆管炎发生率方面的疗效和安全性。
一项回顾性队列研究。
2015年至2023年，208例患者分为两组：鼻胆管切割组（n = 103）和传统支架组（n = 105）。主要结局是术后胆管炎，次要结局包括引流成功、胆红素降低、再次干预、并发症和住院时间。
鼻胆管切割组胆管炎发生率为11.7%，传统支架组为26.7%（P = 0.006）。鼻胆管切割组84例患者（81.6%）引流成功，传统支架组78例患者（74.3%）引流成功，差异无统计学意义（P = 0.207）。鼻胆管切割组7天内总胆红素降低>50%的患者明显更多（48.5%对27.6%，P = 0.002）。两组在内镜逆行胰胆管造影术操作次数或所需再次干预次数方面无显著差异（P>0.05）。除术后胆管炎外，两组其他术后并发症相当（P>0.05）。鼻胆管切割组术后住院时间明显更长，中位时间为10.0（7.0，14.0）天，而传统支架组为7.0（5.5，12.5）天（P = 0.024）。Bismuth-Corlette IV型被确定为胆管炎的独立危险因素（OR = 3.207，95%CI：1.253 - 8.210，P = 0.015）。
对于肝门部恶性胆管狭窄患者而言，鼻胆管引流后鼻胆管序贯切割作为支架置入的替代方法，可能降低术后胆管炎的发生率并实现早期成功引流，但可能导致术后住院时间延长。Bismuth-Corlette IV型是术后胆管炎发生的独立危险因素。
