Endoscopic stenting for hilar cholangiocarcinoma: efficacy of unilateral and bilateral placement of plastic and metal stents in a retrospective review of 480 patients.
Endoscopic stenting for hilar cholangiocarcinoma: efficacy of unilateral and bilateral placement of plastic and metal stents in a retrospective review of 480 patients.
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DOI：
10.1186/1471-230x-12-103
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发表时间：
2012-08-09
影响因子：
2.4
通讯作者：
Canena JM
中科院分区：
文献类型：
--
作者：
Liberato MJ;Canena JM
肝门部胆管癌的内镜胆管引流术对于支架的最佳类型和引流范围存在争议。本研究评估了使用自膨胀金属支架 (SEMS) 和塑料支架 (PS) 对肝门部胆管癌患者进行内镜姑息治疗。我们还根据 Bismuth 分类比较了单侧和双侧支架置入情况。回顾性分析 1995 年 9 月至 2010 年 12 月期间接受内镜下胆道引流治疗肝门部胆管癌的 480 例患者的数据，以评估以下结果参数：技术成功（TS）、功能成功（FS）、早期和晚期并发症、支架通畅性和生存率。从支架插入开始对患者进行随访，直至死亡或支架闭塞。根据Bismuth分类将患者分为3组（第1组，I型；第2组，II型；第3组， > III型）。 450 名患者 (93.8%) 首次支架置入成功。 204 名 (88.3%) 接受 PS 治疗的患者实现了 TS，246 名 (98.8%) 接受 SEMS 缓解的患者达到了 TS (p<0.001)。在意向治疗 (ITT) 分析中，SEMS 治疗患者的 FS (97.9%) 显着高于 PS 治疗患者 (84.8%) (p<0.001)。 115 名 (56.4%) 接受 PS 治疗的患者和 60 名 (24.4%) 接受 SEMS 治疗的患者出现晚期并发症 (p<0.001)。支架通畅的中位持续时间（周）如下：接受 PS 缓解的患者为 20 周，接受 SEMS 治疗的患者为 27 周（p<<0.0001）。在第 2 组中，单侧和双侧放置的 PS 通畅中位持续时间分别为 17 周和 18 周 (p = 0.0004)；单侧和双侧放置的 SEMS 通畅时间中位数分别为 24 周和 29 周 (p<0.0001)。使用泊松回归的多变量分析显示，SEMS 放置 (B = 0.48；P < 0.01) 和双侧展开 (B = 0.24；P < 0.01) 是与支架通畅相关的唯一独立预后因素。在所有 Bismuth 分类中，与 PS 置入相比，SEMS 置入用于姑息治疗肝门部胆管癌，在 ITT 分析中提供了更高的技术和临床成功率，以及更低的并发症发生率和优异的累积支架通畅率。 Bismuth II 患者双侧 SEMS 或 PS 支架的累积通畅率显着高于单侧 SEMS 或 PS 支架，且闭塞率较低。
Endoscopic biliary drainage of hilar cholangiocarcinoma is controversial with respect to the optimal types of stents and the extent of drainage. This study evaluated endoscopic palliation in patients with hilar cholangiocarcinoma using self-expandable metallic stents (SEMS) and plastic stents (PS).We also compared unilateral and bilateral stent placement according to the Bismuth classification. Data on 480 patients receiving endoscopic biliary drainage for hilar cholangiocarcinoma between September 1995 and December 2010 were retrospectively reviewed to evaluate the following outcome parameters: technical success (TS), functional success (FS), early and late complications, stent patency and survival. Patients were followed from stent insertion until death or stent occlusion. Patients were divided into 3 groups according to the Bismuth classification (Group 1, type I; Group 2, type II; Group 3, type > III). The initial stent insertion was successful in 450 (93.8%) patients. TS was achieved in 204 (88.3%) patients treated with PS and in 246 (98.8%) patients palliated with SEMS (p < 0.001). In the intention-to-treat (ITT) analysis, the FS in patients treated with SEMS (97.9%) was significantly higher than in patients treated with PS (84.8%) (p < 0.001). Late complications occurred in 115 (56.4%) patients treated with PS and 60 (24.4%) patients treated with SEMS (p < 0.001). The median duration of stent patency in weeks (w) were as follows: 20 w in patients palliated with PS and 27 w in patients treated with SEMS (p < 0.0001). In Group 2, the median duration of PS patency was 17 w and 18 w for unilateral and bilateral placement, respectively (p = 0.0004); the median duration of SEMS patency was 24 w and 29 w for unilateral and bilateral placement, respectively (p < 0.0001). Multivariate analysis using the Poisson regression showed that SEMS placement (B = 0.48; P < 0.01) and bilateral deployment (B = 0.24; P < 0.01) were the only independent prognostic factors associated with stent patency. SEMS insertion for the palliation of hilar cholangiocarcinoma offers higher technical and clinical success rates in the ITT analysis as well as lower complication rates and a superior cumulative stent patency when compared with PS placement in all Bismuth classifications. The cumulative patency of bilateral SEMS or PS stents was significantly higher than that of unilateral SEMS or PS stents, with lower occlusion rates in Bismuth II patients.