Izumi Hideki, Yoshii Hisamichi, Fujino Rika, Takeo Shigeya, Mukai Masaya, Kaneko Junichi, Makuuchi Hiroyasu
Department of Gastrointestinal Surgery, Tokai University Hachioji Hospital, 1838 Ishikawa, Hachioji, Tokyo, 192-0032, Japan.
BMC Gastroenterol. 2025 Mar 31;25(1):211. doi: 10.1186/s12876-025-03767-5.
Percutaneous transhepatic bile duct stent insertion is a useful alternative to the endoscopic approach for malignant biliary strictures. This study retrospectively reviewed the cases of percutaneous metallic stent insertion at our institution to evaluate its safety and usefulness.
The study included cases of percutaneous bile duct stent insertion performed between April 2016 and August 2024. All patients included those with malignant biliary obstruction and those in whom an endoscopic approach was first attempted but could not reach or cannulate the papilla of Vater. Two procedures were used: a two-stage procedure, in which a drain was inserted to create an external or internal fistula, followed by stent insertion, and a one-stage procedure, in which the stent was inserted at the same time as the approach to the bile duct. The causes of biliary strictures and complications were examined.
The study included 14 cases: seven patients had pancreatic head cancer, including biliary tract cancer (n = 4) and postoperative gastric cancer (n = 3); three patients who underwent a one-stage insertion. The number of inserted stents tended to increase in patients with postoperative cholangiocarcinoma recurrence. No complication occurred in any patient. One patient had severe cholangitis, eight had moderate cholangitis, and four had mild cholangitis; two patients who underwent one-stage procedures had moderate cholangitis and one had mild cholangitis. In cases of two-stage expandable metal stent (EMS) insertion, the average time from initial drainage to EMS insertion was 10.5 days (4-25).
The stent can be safely inserted in a one-stage procedure without compromising the patient's quality of life. Therefore, one-stage insertion of EMS for malignant biliary stricture may be performed aggressively unless the patient has severe cholangitis.
经皮经肝胆道支架置入术是治疗恶性胆管狭窄的一种有用的替代内镜治疗的方法。本研究回顾性分析了我院经皮金属支架置入术的病例，以评估其安全性和有效性。
本研究纳入了2016年4月至2024年8月期间行经皮胆管支架置入术的病例。所有患者包括恶性胆管梗阻患者以及首次尝试内镜治疗但未能到达或插管至 Vater 乳头的患者。采用了两种手术方法：两阶段手术，即先插入引流管以形成外瘘或内瘘，然后再置入支架；以及一阶段手术，即在进入胆管的同时置入支架。对胆管狭窄的原因和并发症进行了检查。
本研究共纳入14例患者：7例为胰头癌，包括胆管癌（n = 4）和胃癌术后（n = 3）；3例患者接受了一阶段置入。术后胆管癌复发患者置入的支架数量有增加趋势。所有患者均未发生并发症。1例患者发生严重胆管炎，8例发生中度胆管炎，4例发生轻度胆管炎；接受一阶段手术的2例患者发生中度胆管炎，1例发生轻度胆管炎。在两阶段可扩张金属支架（EMS）置入病例中，从初始引流到EMS置入的平均时间为10.5天（4 - 25天）。
支架可在不影响患者生活质量的情况下安全地进行一阶段置入。因此，除非患者患有严重胆管炎，否则对于恶性胆管狭窄可积极进行EMS一阶段置入。
