塑料胆管支架置入方式对不可切除肝门部胆管癌伴梗阻性黄疸治疗效果的影响  

Clinical effect of different plastic biliary stent indwelling methods on managing obstructive jaundice in unresectable hilar cholangiocarcinoma

作　　者：王建 楚江涛 张月明 窦利州 刘勇 柯岩 刘旭东 刘雨蒙 王贵齐 贺舜 Wang Jian;Chu Jiangtao;Zhang Yueming;Dou Lizhou;Liu Yong;Ke Yan;Liu Xudong;Liu Yumeng;Wang Guiqi;He Shu(Department of Colorectal Oncology Surgery,Beijing Shijitan Hospital,Capital Medical University,Beijing 100038,China;National Cancer Center,National Clinical Research Center for Cancer,Department of Endoscopy,Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100021,China)

机构地区：[1]首都医科大学附属北京世纪坛医院结直肠肿瘤外科,北京100038 [2]国家癌症中心,国家肿瘤临床医学研究中心,中国医学科学院北京协和医学院肿瘤医院内镜科,北京100021

出　　处：《中华消化内镜杂志》2022年第6期441-446,共6页Chinese Journal of Digestive Endoscopy

基　　金：国家重点研发计划(2016YFC1302800);深圳市医疗卫生三名工程(SZSM201911008);中国医学科学院医学与健康科技创新工程项目(2016-I2M-1-001);协和青年科研基金(2017320012)。

摘　　要：目的对比塑料胆管支架3种末端开口留置方式在解除不可切除肝门部胆管癌梗阻性黄疸方面的临床应用效果。方法回顾性分析2014年4月—2020年12月在中国医学科学院肿瘤医院内镜科行塑料胆管支架置入减黄治疗的不可切肝门部除胆管癌患者61例,其中胆管支架末端开口胃内留置18例(胃内留置组),十二指肠乳头留置31例(十二指肠乳头留置组),十二指肠水平部留置12例(十二指肠水平部留置组)。对随访2周发热率、围手术期死亡率、术后90 d支架梗阻率、支架中位通畅时间进行分析。结果胃内留置组、十二指肠乳头留置组和十二指肠水平部留置组3组患者术后2周内发热率比较[66.7%(12/18),58.1%(18/31)和16.7%(2/12),χ^(2)=7.30,P=0.026]差异有统计学意义,围手术期死亡率[0(0/16),3.2%(1/31)和0(0/10),χ^(2)=1.09,P=1.000]、术后90 d内支架梗阻率[52.9%(9/17),48.3%(14/29)和40.0%(4/10),χ^(2)=1.91,P=0.589]和支架中位通畅时间(66.0 d,91.5 d和94.0 d,Z=4.96,P=0.084)比较差异无统计学意义。结论与胆管支架末端开口胃内留置和十二指肠乳头留置比较,十二指肠水平部留置术后2周发热率低,但支架中位通畅时间、术后90 d支架梗阻率及围手术期死亡率相似。支架末端开口留置于十二指肠水平部可作为首选置入方式。Objective To compare the clinical effect of three indwelling methods of plastic biliary stent on relieving obstructive jaundice caused by unresectable hilar cholangiocarcinoma.Methods A retrospective study was performed on data of 61 patients with obstructive jaundice caused by unresectable hilar cholangiocarcinoma from April 2014 to December 2020 in Cancer Hospital,Chinese Academy of Medical Sciences.Plastic biliary stent placement was used to relieve jaundice,including 18 cases of intragastric indwelling at the end of biliary stent,31 cases of duodenal papilla indwelling at the end of biliary stent,and 12 cases of horizontal portion of duodenum indwelling at the end of biliary stent.Incidence of fever within 2 weeks,perioperative mortality,90-day obstruction rate,and median stent patency period were followed up and the results were analyzed.Results The incidence of fever within 2 weeks of the three groups were significantly different[66.7%(12/18),58.1%(18/31)and 16.7%(2/12),χ^(2)=7.30,P=0.026].There were no statistically differences in the perioperative mortality[0(0/16),3.2%(1/31)and 0(0/10),χ^(2)=1.09,P=1.000],90-day obstruction rate[52.9%(9/17),48.3%(14/29)and 40.0%(4/10),χ^(2)=1.91,P=0.589],or median stent patency period(66.0 d,91.5 d and 94.0 d,Z=4.96,P=0.084)among three groups.Conclusion Patients with biliary plastic stents with ends placed at the horizontal portion of the duodenum show lower incidence of fever within two weeks after implantation,and similar median stent patency period,90-day obstruction rate and perioperative mortality compared with intragastric indwelling and duodenal papilla indwelling groups.Therefore,biliary plastic stents with ends placed at the horizontal portion of the duodenum should be recommended as the preferred procedure.

关 键 词：十二指肠水平部 十二指肠乳头 肝门部胆管癌 胆管支架 梗阻性黄疸 不可切除 内支架 留置术 

分 类 号：R735.8[医药卫生—肿瘤] R575[医药卫生—临床医学]