跨越十二指肠主乳头平行放置双侧金属支架治疗肝门部胆管恶性狭窄的临床研究（含视频）

A clinical study of endoscopic transpapillary parallel-style bilateral metal stenting for malignant hilar biliary stricture (with video)

摘要:

目的探讨内镜下跨越十二指肠主乳头平行放置双侧胆管金属支架治疗肝门部胆管恶性狭窄的成功率和疗效。方法回顾性纳入2012年1月—2018年12月在上海东方肝胆外科医院内镜中心采用改良内镜引流技术（内镜下跨越十二指肠主乳头平行放置双侧金属支架）治疗的肝门部胆管恶性狭窄（Bismuth Ⅱ~Ⅳ型）患者共55例，分析技术成功率、临床成功率、并发症发生率、内镜下双侧胆管再干预成功率、支架通畅期和生存时间。结果内镜下跨越十二指肠主乳头平行放置双侧金属支架技术成功率为96.4%（53/55），临床成功率为96.2%（51/53），早期并发症发生率为13.2%（7/53），支架中位通畅期为9.2个月（95%CI：8.0~10.3个月），双侧胆道系统的内镜再干预成功率为92.3%（12/13），患者的中位生存时间为6.7个月（95%CI：4.7~8.8个月）。结论改良的双侧金属支架置入法治疗无法手术的肝门部胆管恶性狭窄是安全和有效的。

Abstract:

ObjectiveTo investigate the feasibility and efficacy of endoscopic placement of transpapillary parallel-style bilateral metal stents for malignant hilar biliary stricture. MethodsA total of 55 patients with malignant hilar biliary stricture (Bismuth Ⅱ-Ⅳ) were treated with an improved endoscopic drainage technique (endoscopic transpapillary parallel-style bilateral metal stenting) from January 2012 to December 2018 in Shanghai Oriental Hepatobiliary Surgery Hospital. The technical success rate, clinical success rate, incidence of complications, success rate of endoscopic re-intervention, stent patency and overall survival were analyzed. ResultsThe technical success rate of endoscopic placement of bilateral metal stents was 96.4% (53/55), the clinical success rate was 96.2% (51/53), and the early complication incidence was 13.2% (7/53). The median stent patency was 9.2 months (95%CI: 8.0-10.3 months), the success rate of endoscopic re-intervention of bilateral biliary systems was 92.3% (12/13), and the median overall survival was 6.7 months (95%CI: 4.7-8.8 months). ConclusionThis modified technique of bilateral metal stent placement is safe and effective for malignant hilar biliary stricture that is unsuitable for surgery.