切换至 "中华医学电子期刊资源库"

中华介入放射学电子杂志 ›› 2023, Vol. 11 ›› Issue (02) : 123 -127. doi: 10.3877/cma.j.issn.2095-5782.2023.02.005

肿瘤介入

经皮金属多支架置入治疗BismuthⅡ型及以上肝门部胆管癌的临床应用分析
许晨1, 俞靖凡1, 方昌文1, 张志轩1, 徐国雄1,(), 金一琦1   
  1. 1. 215000 江苏苏州,南京医科大学附属苏州医院血管介入科
  • 收稿日期:2022-07-13 出版日期:2023-05-25
  • 通信作者: 徐国雄

Clinical application of percutaneous multi-metal stent insertion for hilar cholangiocarcinoma with Bismuth-Corlette type Ⅱ or above

Chen Xu1, Jingfan Yu1, Changwen Fang1, Zhixuan Zhang1, Guoxiong Xu1,(), Yiqi Jin1   

  1. 1. Department of Vascular Surgery, Suzhou Municipal Hospital Affiliated to Nanjing Medical University, Jiangsu Suzhou 215008, China
  • Received:2022-07-13 Published:2023-05-25
  • Corresponding author: Guoxiong Xu
引用本文:

许晨, 俞靖凡, 方昌文, 张志轩, 徐国雄, 金一琦. 经皮金属多支架置入治疗BismuthⅡ型及以上肝门部胆管癌的临床应用分析[J/OL]. 中华介入放射学电子杂志, 2023, 11(02): 123-127.

Chen Xu, Jingfan Yu, Changwen Fang, Zhixuan Zhang, Guoxiong Xu, Yiqi Jin. Clinical application of percutaneous multi-metal stent insertion for hilar cholangiocarcinoma with Bismuth-Corlette type Ⅱ or above[J/OL]. Chinese Journal of Interventional Radiology(Electronic Edition), 2023, 11(02): 123-127.

目的

应用经皮肝穿刺多支架置入术治疗BismuthⅡ型及以上肝门部胆管癌,评估该方法的有效性及安全性,分析支架通畅期及患者生存期。

方法

回顾性收集2019年1月至2021年9月,于南京医科大学附属苏州医院血管介入科收治并接受多支架置入的Ⅱ型及以上肝门部胆管癌患者的临床资料。分析手术技术成功率、临床成功率、肝功能变化、术后并发症、支架通畅期及患者生存期。

结果

共纳入108例患者,年龄38~92岁,平均(66.8 ± 10.6)岁。手术技术成功率100%,临床成功率84.3%(91/108)。术后血清总胆红素水平由(266.23 ± 108.87)μmol/L降至(153.08 ± 98.63)μmol/L;其余直接胆红素、谷丙转移酶、谷草转氨酶及碱性磷酸酶水平差异均具有统计学意义(P < 0.01),但白蛋白水平未见明显变化(P = 0.252)。术后并发症发生率12.0%,无严重并发症发生。中位支架通畅时间122 d(17~833 d),中位生存时间151 d(17~915 d)。

结论

经皮多支架置入治疗BismuthⅡ型及以上肝门部胆管癌有良好的安全性与有效性,可以一定程度上解决黄疸,恢复患者肝功能。

Objective

To evaluate the efficacy and safety of percutaneous multi-metal stent insertion in the treatment of hilar cholangiocarcinoma with Bismuth-Corlette typeⅡor above, and analyze the stent patency and overall survival.

Methods

During the period from January 2019 to September 2021, the clinical data of patients with Bismuth Ⅱ or above hilar cholangiocarcinoma who treated with multi-metal stent insertion in Department of Vascular Surgery, Suzhou Municipal Hospital Affiliated to Nanjing Medical University were analyzed retrospectively. The technical success, clinical success, complications, stent patency, and overall survival were evaluated.

Results

108 patients were enrolled, aged from 38 to 92, and the average was (66.8 ± 10.6) years old. Technical success was 100%, and successful drainage was achieved in 91 of 108(84.3%) patients. After the procedure, the total bilirubin level decreased from (266.23 ± 108.87) μmol/L to (153.08 ± 98.63) μmol/L. Besides, the level of direct bilirubin, alanine transferase, aspartate aminotransferase and alkaline phosphatase were significantly decreased (P < 0.01), however there was no significant change in albumin level (P = 0.252). Incidence of complications was 12.0%, and no major complications occurred. The median stent patency was 122 days (range, 17~833 days), and the median survival time was 151 days (range, 17~915 days).

Conclusions

Percutaneous multi-metal stent insertion may offer a safe and effective way for patients with BismuthⅡor above hilar cholangiocarcinoma to solve jaundice and recover liver function in a certion extent.

表1 患者基线资料
表2 术后肝功能水平变化
图1 支架通畅期及患者生存期曲线
表3 支架通畅期及生存期
[1]
邢颖, 刘洋, 张洪义. 肝门胆管癌致梗阻性黄疸的处理策略[J]. 中国临床医生杂志, 2020, 48(6): 642-644.
[2]
张凡, 汪学艳, 白琪, 等. 肝门部胆管癌术前评估和处理[J]. 中华肝脏外科手术学电子杂志, 2021, 10(5): 446-448.
[3]
王甄, 周健, 左玉江, 等. 肝门部胆管癌MRI诊断价值分析(附64例报告)[J]. 影像诊断与介入放射学, 2010, 19(1): 36-38.
[4]
郭俊, 赵文军, 吕洋, 等. 肝门部胆管癌高位多支复杂胆道梗阻的介入引流方法探讨[J]. 中华介入放射学电子杂志, 2018, 6(4): 301-305.
[5]
李茂岚, 刘颖斌. 胆道恶性肿瘤临床研究进展与展望[J]. 中国实用外科杂志, 2020, 40(2): 167-170.
[6]
李勇, 毕涛, 郝翠萍, 等. 胆管癌危险因素及其治疗研究进展[J]. 肝胆胰外科杂志, 2014, 26(2): 166-169.
[7]
杨安, 刘玉娥, 申景. 肝门部胆管癌的介入治疗现状及研究进展[J]. 介入放射学杂志, 2021, 30(3): 312-316.
[8]
Li M, Li K, Qi X, et al. Percutaneous transhepatic biliary stent implantation for obstructive jaundice of perihilar cholangiocarcinoma: a prospective study on predictors of stent patency and survival in 92 patients[J]. J Vasc Interv Radiol, 2016, 27: 1047-1055.
[9]
Li M, Bai M, Qi X, et al. Percutaneous transhepatic biliary metal stent for malignant hilar obstruction: results and predictive factors for efficacy in 159 patients from a single center[J]. Cardiovasc Intervent Radiol, 2015, 38(3): 709-721.
[10]
Sugawara S, Arai Y, Sone M, et al. Frequency, severity, and risk factors for acute pancreatitis after percutaneous transhepatic biliary stent placement across the papilla of vater[J]. Cardiovasc Intervent Radiol, 2017, 40: 1904-1910.
[11]
Lee SH. Optimal biliary drainage for inoperable Klatskin's tumor based on Bismuth type[J]. World J Gastroenterol, 2007, 13(29): 3948-3955.
[12]
Cardella J, Kundu S, Miller D. Society of interventional radiology clinical practice guidelines[J]. J Vasc Interv Radiol, 2009,20(7 Suppl.): S189-S191.
[13]
钱震, 刘会春, 庞青, 等. 胆道支架联合125I粒子腔内照射治疗胆管癌的临床疗效及预后因素分析[J]. 中华放射学杂志, 2018, 52(8): 640-643.
[14]
Kubota Y, Nakatani S, Nakahashi Y, et al. Bilateral internal biliary drainage of hilar cholangiocarcinoma with modified Gianturco Z stents inserted via a single percutaneous tract[J]. J Vasc Interv Radiol, 2019, 4(5): 605-610.
[15]
王炜, 刘会春, 庞青, 等. 经皮胆道双金属支架置入治疗恶性高位胆道梗阻的疗效[J]. 介入放射学杂志, 2019, 28(8): 773-777.
[16]
Shim DJ, Gon DI, Han K, et al. Percutaneous metallic stent placement for palliative management of malignant biliary hilar obstruction[J]. Korean J Radiol, 2018, 19(4): 597-605.
[17]
Naitoh I, Hayashi K, Nakazawa T, et al. Side-by-side versus stent-in-stent deployment in bilateral endoscopic metal stenting for malignant hilar biliary obstruction[J]. Dig Dis Sci, 2012, 57(12): 3279-3285.
[18]
徐红豆, 周春高, 施海彬, 等. 两种经皮胆道支架置入技术治疗肝门部恶性胆管梗阻的临床疗效比较[J]. 介入放射学杂志, 2021, 30(4): 403-407.
[19]
Zhang GY, Li WT, Peng WJ, et al. Clinical outcomes and Prediction of survival following Percutaneous biliary drainage for malignant obstructive jaundice[J]. Oncol Lett, 2014, 7(4): 1185-1190.
[20]
Afshar M, Khanom K, Ma YT, et al. Biliary stenting in advanced malignancy: an analysis of Predictive factors for survival[J]. Cancer Manag Res, 2014, 6: 475-479.
[21]
陈伟伟, 黄坤, 刘锐, 等. 经皮肝穿刺胆管引流术联合胆道支架置入术治疗高位恶性梗阻性黄疸的效果及预后影响因素分析[J]. 临床肝胆病杂志, 2019, 35(3): 559-564.
[22]
周猛, 菅志远, 沈先锋, 等. 无法手术切除的肝门部胆管癌患者的预后分析[J]. 肝胆外科杂志, 2011, 19(1): 58- 60.
[1] 谢迎东, 孙帼, 徐超丽, 杨斌, 孙晖, 戴云. 超声造影定量评价不同生存期移植肾血流灌注的临床价值[J/OL]. 中华医学超声杂志(电子版), 2023, 20(07): 749-754.
[2] 丁科, 张亚琼, 刘杰, 邓莉平, 张永喜, 熊勇. 获得性免疫缺陷综合征相关淋巴瘤患者的临床特征及生存状况的变化趋势[J/OL]. 中华实验和临床感染病杂志(电子版), 2024, 18(05): 278-284.
[3] 徐楠, 杨云川, 周迟, 马翔, 鲁正, 崔培元. 脾动脉结扎在肝门胆管癌行大范围肝切除中的临床作用研究[J/OL]. 中华普通外科学文献(电子版), 2024, 18(04): 271-274.
[4] 高彬, 阿曼塔依·努尔塔依, 宁江红, 邵英梅. 胆管癌的光动力治疗[J/OL]. 中华普通外科学文献(电子版), 2024, 18(01): 76-80.
[5] 尚培中, 张润萍, 张伟, 贾国洪, 李晓武, 苗建军, 刘冰. 梗阻性黄疸临床防治新技术单中心应用研究[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(01): 104-107.
[6] 张礼江, 沈玲佳, 施我大. 倾向性评分匹配分析奥希替尼对晚期NSCLC 预后的影响[J/OL]. 中华肺部疾病杂志(电子版), 2024, 17(05): 820-822.
[7] 郭兵, 王万里, 何凯, 黄汉生. 腹腔镜下肝门部胆管癌根治术[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(01): 143-143.
[8] 魏丽霞, 张安澜, 周宝勇, 李明. 腹腔镜下Ⅲb型肝门部胆管癌根治术[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(01): 145-145.
[9] 张润锦, 阳盼, 林燕斯, 刘尊龙, 刘建平, 金小岩. EB病毒相关胆管癌伴多发转移一例及国内文献复习[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 865-869.
[10] 马振威, 宋润夫, 王兵. ERCP胆道内支架与骑跨十二指肠乳头支架置入治疗不可切除肝门部胆管癌疗效的Meta分析[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 807-812.
[11] 林科灿, 罗柳平. 肝胰十二指肠切除术在胆囊癌和胆管癌应用中的关键问题[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 774-778.
[12] 韦德令, 蒋佳君, 徐邦浩, 王继龙, 朱海, 卢婷婷, 张灵, 曾晶晶, 郭雅, 文张. 显微外科肝动脉重建在累及第一肝门胆管癌外科治疗的应用[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(03): 350-356.
[13] 陈明政, 栗玉龙, 唐流康, 谢峰. IDH1突变应用于肝内胆管癌治疗的研究进展[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(01): 103-108.
[14] 张金珠, 梅世文, 孙金峰, 胡刚, 邱文龙, 李国利, 汪欣, 王锡山, 汤坚强. 原发结直肠癌超系膜切除术后患者的生存危险因素分析[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(03): 197-204.
[15] 葛雪梅. SOX与mFOLFOX6化疗方案对晚期胃癌的疗效与安全性[J/OL]. 中华消化病与影像杂志(电子版), 2024, 14(01): 67-71.
阅读次数
全文


摘要