两种经皮胆道支架植入技术治疗肝门部恶性胆管梗阻的临床疗效比较

Clinical efficacy comparison of two percutaneous biliary stent implantation techniques in treating malignant hilar biliary obstruction

目的比较分析Y型并排式支架与Y型嵌合内支架技术治疗肝门部恶性胆管阻塞的安全性和有效性。方法回顾性分析2012年8月至2019年3月64例采用Y型并排式支架或Y型嵌合内支架治疗肝门部恶性胆管梗阻患者的临床资料。其中38例患者采用Y型并排式支架技术进行支架植入(并排组),26例采用Y型嵌合内支架技术(嵌合组)。评估两组间临床成功率(术后1周和1个月总胆红素下降率)、技术成功率、支架通畅时间、患者生存期及术后并发症等。结果两组病例均取得了技术成功。两组间术后1周黄疸改善率有显著差异[并排组89.5%(34/38),嵌合组65.4%(17/26),χ^(2)=5.53,P=0.02]。并排组、嵌合组患者术后1个月黄疸改善率分别为92%(35/38)和88.5%(23/26)(χ^(2)=0.24),患者中位总生存期分别为155 d和143 d(χ^(2)=0.04,P均>0.05)均无明显差异。两组间支架中位通畅时间有统计学意义(并排组149 d,嵌合组75d,χ^(2)=4.60,P=0.03)。尽管两组术后总并发症的发生率没有明显差异,但在嵌合组中胆管炎的发生率更高(嵌合组27%(8/26),并排组8.9%(3/38),χ^(2)=5.30,P=0.04),两组间有统计学差异。结论经皮经肝双侧支架植入治疗肝门部恶性胆管阻塞采用Y型并排式支架或Y型嵌合内支架均安全、有效。且采用Y型并排式支架技术比Y型嵌合内支架技术能获得更长支架通畅时间,同时可在早期改善术后黄疸情况和降低胆管炎的发生率。

Objective To compare the safety and effectiveness of Y-shaped side-by-side(SBS)stent with those of Y-shaped stent-in-stent(SIS)stent in treating malignant hilar biliary obstruction.Methods The clinical data of 64 patients with malignant hilar biliary obstruction,who received biliary stent implantation using Y-shaped SBS stent or Y-shaped SIS stent during the period from August 2012 to March 2019,were retrospectively analyzed.Y-shaped SBS stent was adopted in 38 patients(SBS group)and Y-shaped SIS stent was employed in 26 patients(SIS group).The clinical success rate(assessed by postoperative one-week and one-month total bilirubin dropping rate),technical success rate,stent patency time,overall survival and complications were compared between the two groups.Results Technical success was achieved in all patients of the two groups.The postoperative one-week serum bilirubin levels in SBS group and SIS group were 89.5%(34/38)and 65.4%(17/26)respectively(χ^(2)=5.53,P=0.02)with obvious improvement of jaundice.The postoperative one-month jaundice improvement rates in SBS group and SIS group were 92%(35/38)and 88.5%(23/26)respectively(χ^(2)=0.24,P>0.05).The median survival time in SBS group and SIS group was 155 days and 143 days respectively,and the difference between the two groups was not statistically significant(χ^(2)=0.04,P>0.05).The median stent patency time in SBS group and SIS group was 149 days and 75 days respectively,and the difference between the two groups was statistically significant(χ^(2)=4.60,P=0.03).Although no statistically significant difference in the incidence of total postoperative complications existed between the two groups,the incidence of cholangitis in SIS group was up to 27%(8/26),which was much higher than 8.9%(3/38)in SBS group,the difference between the two groups was statistically significant(χ^(2)=5.30,P=0.04).Conclusion For the treatment of malignant hilar biliary obstruction,percutaneous transhepatic biliary stent implantation,regardless of using Y-shaped SBS stent or using Y-shaped SIS stent,are safe and effective.Compared with Yshaped SIS stent,Y-shaped SBS stent can obtain longer stent patency time,improve postoperative jaundice earlier and reduce the incidence of cholangitis.