超细推送系统金属支架在肝门胆管恶性狭窄中的应用

Application of ultra?fine metal stents to malignant hilar biliary strictures

摘要:

目的 探讨超细金属支架治疗肝门胆管恶性狭窄的可行性、有效性和安全性。方法 2014年1月—2021年6月在东方肝胆外科医院消化内科根据影像学或组织学和（或）细胞学诊断为Bismuth Ⅱ型以上肝门胆管恶性狭窄的30例患者，使用超细推送系统金属支架，采用同步并行置入法置入胆管双侧金属支架。分析其技术成功率、临床疗效及并发症发生率。结果 技术成功率为100.0%（30/30），临床成功率为93.3%（28/30），操作时间（55.7±20.7）min， 金属支架置入时间（28.3±18.2） min。早期不良事件包括轻度急性胰腺炎2例和胆管炎5例。支架半数通畅时间为243 d （95%CI： 186.6~299.4 d），患者半数生存期为237 d （95%CI：149.0~325.0 d）。晚期胆管炎发生率为36.7% （11/30）。14例患者出现支架失效，其中5例接受内镜下再介入。双侧金属支架腔内再置入支架技术成功率为4/5，操作时间为（49.8±6.9）min。结论 内镜下同步并行放置双侧超细金属支架治疗肝门胆管恶性狭窄是安全、可行、有效的。 结果 技术成功率100%（30/30例），临床成功率93.3%(28/30例)，操作时间55.7±20.7分, 金属支架置入时间28.3±18.2分。早期不良事件包括轻度急性胰腺炎2例和胆管炎5例。支架中位通畅时间为243 d (95% CI 186.6-299.4 d)，中位生存期为237 d (95% CI 149.0-325.0 d)。晚期胆管炎发生率为36.7% (11/30)。14例患者出现支架失效，其中5例受内镜下再介入。双侧金属支架腔内再置入支架技术成功率为80%（4/5），操作时间为49.8±6.9分。 结论 内镜下同步并行放置双侧超细推送系统金属支架治疗肝门胆管恶性狭窄是安全、可行、有效的。

Abstract:

Objective To evaluate the feasibility, efficacy, and safety of ultra?fine metal stents for malignant hilar biliary strictures (MHBS). Methods Ultra?fine metal stents were simultaneously placed into the intrahepatic duct of 30 patients with unresectable malignant hilar biliary strictures of Bismuth type Ⅱ or higher (based on imaging or histological and/or cytological findings) by using the stent?by?stent mode from January 2014 to June 2021 at the Department of Gastroenterology, Eastern Hepatobiliary Surgical Hospital. The technical success rate, clinical efficacy and incidence of complications were observed. Results The technical success rate was 100.0% (30/30), and the clinical success was achieved in 28 patients (93.3%) . The mean procedure time was 55.7±20.7 min and the placement time was 28.3±18.2 min. Early adverse events included mild acute pancreatitis (n=2) and cholangitis (n=5). The median stent patency and the median overall survival were 243 days (95%CI: 186.6?299.4 days) and 237 days (95%CI: 149.0- 325.0 days), respectively. The incidence of late cholangitis was 36.7% (11/30). Stent malfunction occurred in 14 of the 30 patients, and 5 of them received endoscopic reintervention. The technical success rate for the reintervention was 4/5 with the mean procedure time of 49.8±6.9 min. Conclusion Malignant hilar biliary obstruction endoscopic palliation with ultra-fine metal stents using the stent-by-stent mode is safe, feasible and effective.