内镜下双侧金属支架与单侧金属支架治疗不能手术切除肝门胆管恶性梗阻的比较:一项大型回顾性研究  

Endoscopic bilateral metallic stenting versus unilateral metallic stenting for unresectable malignant hilar biliary obstruction:a large-scale retrospective study

作　　者：夏明星 高道键 吴军 王田田 叶馨 赵毅 胡冰 Xia Mingxing;Gao Daojian;Wu Jun;Wang Tiantian;Ye Xin;Zhao Yi;Hu Bing(Department of Endoscopy,Oriental Hepatobiliary Surgery Hospital Affiliated to Naval Military Medical University,Shanghai 200438,China)

机构地区：[1]海军军医大学附属东方肝胆外科医院内镜科,上海200438

出　　处：《中华消化内镜杂志》2021年第1期43-47,共5页Chinese Journal of Digestive Endoscopy

基　　金：上海市医学领军人才项目(2015-83)。

摘　　要：目的比较内镜下双侧金属支架和单侧金属支架治疗不能手术切除肝门胆管恶性梗阻的疗效优劣。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内镜下金属支架治疗的300例肝门胆管恶性狭窄(BismuthⅡ~Ⅳ型)患者资料,通过倾向性评分匹配法,94例双侧金属支架患者(双侧金属支架组)和94例单侧金属支架患者(单侧金属支架组)进行匹配。比较两组临床成功率、总干预次数、支架通畅期和生存期。结果双侧金属支架组的临床成功率高于单侧金属支架组[98.9%(93/94)比78.7%(74/94),χ^2=19.352,P<0.001],平均总干预次数少于单侧金属支架组[(1.2±0.5)次比(1.7±0.9)次,t=-4.345,P<0.001],支架通畅期长于单侧金属支架组[10.0(8.0,12.1)个月比5.7(5.2,6.3)个月,χ^2=19.789,P<0.001]。双侧金属支架组患者的中位生存时间在数值上大于单侧金属支架组,但是差异无统计学意义[7.6(6.3,8.9)个月比4.6(3.7,5.7)个月,χ^2=3.628,P=0.057]。结论对于无法手术切除的肝门胆管恶性梗阻,双侧金属支架引流的临床疗效优于单侧金属支架引流。Objective To compare the efficacy of bilateral and unilateral metallic stenting in the treatment of unresectable malignant hilar biliary obstruction.Methods From January 2012 to December 2018,a total of 300 patients with malignant hilar biliary obstruction(Bismuth typeⅡ-Ⅳ)were treated with endoscopic metallic stenting in Oriental Hepatobiliary Surgery Hospital.Ninety-four patients with bilateral metallic stenting(bilateral metallic stent group)and 94 patients with unilateral metallic stenting(unilateral metallic stent group)were matched and analyzed by propensity score matching.The clinical success rate,the total number of interventions,the stent patency and overall survival time were compared between the two groups.Results The clinical success rate in the bilateral metallic stent group was significantly higher than that of the unilateral metallic stent group[98.9%(93/94)VS 78.7%(74/94),χ^2=19.352,P<0.001],and the mean number of intervention in the bilateral metallic stent group was significantly less than that of the unilateral metallic stent group(1.2±0.5 times VS 1.7±0.9 times,t=-4.345,P<0.001).The stent patency time in the bilateral metallic stent group was significantly longer than that of the other group[10.0(8.0,12.1)months VS 5.7(5.2,6.3)months,χ^2=19.789,P<0.001].The median survival time of patients in the bilateral group was numerically longer than that in the unilateral group,but did not reach statistical significance[7.6(6.3,8.9)months VS 4.6(3.7,5.7)months,χ^2=3.628,P=0.057].Conclusion Endoscopic bilateral metallic stenting is superior to unilateral metallic stenting in the clinical management of malignant hilar biliary obstruction unsuitable for surgery.

关 键 词：胰胆管造影术 内窥镜逆行 肝门胆管恶性梗阻 金属支架 通畅期 生存时间 倾向性评分匹配 

分 类 号：R735.8[医药卫生—肿瘤]