支架置入与引流管置入治疗恶性胆肠吻合口狭窄的对比研究

Comparative study of stent placement and drainage tube placement for malignant bilioenteric anastomotic stricture

目的比较自膨胀金属支架(SEMS)置入与引流管置入治疗恶性胆肠吻合口狭窄(BAS)的疗效和安全性。方法回顾性分析2016年3月至2019年6月期间接受治疗的33例恶性BAS患者。其中19例患者接受了SEMS(支架组)治疗,其余14名患者接受了引流管置入治疗(引流管组)。技术成功定义为将支架或引流管成功放置在适当的位置;临床成功定义为术后1周内血清胆红素与基线水平相比降低20%。比较两种治疗方法的并发症,支架或引流管的通畅时间和总体存活率。结果两组患者均取得了技术成功。在支架组中,15名患者放置了1个支架,另外4名患者放置了2个支架。两组的临床成功率相似,支架组94.7%(18/19),引流管组92.9%(13/14)。两组均没有严重并发症。支架/引流管的中位通畅时间支架组(130 d)显著长于引流管组(61 d,P=0.001)。支架组(159 d)的中位生存期也明显长于引流管组(65 d,P=0.003)。结论支架置入治疗恶性BAS支架通畅时间和患者存活期显著长于引流管置入治疗恶性BAS,SEMS放置可能优于引流管置入。

Objective To compare efficacy and safety of self-expandable metallic stent(SEMS)placement and catheter drainage for malignant bilioenteric anastomotic stricture(BAS).Methods This study included 33 patients with malignant BAS treated from March 2016 to June 2019.Nineteen patients underwent insertion of SEMS(Stent group);the remaining fourteen patients underwent catheter drainage(Catheter group).Technical success was defined as successful placement of stent or drainage catheter in the appropriate position;clinical success was defined as 20%reduction in serum bilirubin within 1 week after the procedure,compared with baseline.Complications,duration to stent/catheter malfunction,and overall survival were evaluated.Results Technical success was achieved in all patients in both groups.In the Stent group,15 patients received one stent and the other 4 patients required two stents.Clinical success rates were similar between the groups[Stent group,94.7%(18/19);Catheter group,92.9%(13/14)].There were no major complications.The median duration to stent/catheter malfunction was significantly longer in the Stent group(130 days)than that in the control group(61 days;P=0.001).The median overall survival was also significantly longer in the Stent group(159 days)than that in the Control group(65 days;P=0.003).Conclusions SEMS placement may be better than drainage catheter insertion for malignant BAS in terms of the duration before stent/catheter malfunction and patient survival.