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

doi:10.3877/cma.j.issn.2095-5782.2023.02.005

Abstract

Abstract:

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.

Key words: Multi-metal stent, Hilar cholangiocarcinoma, Stent patency, Survival

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]. Chinese Journal of Interventional Radiology(Electronic Edition), 2023, 11(02): 123-127.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhjrfsxdzzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2095-5782.2023.02.005

https://zhjrfsxdzzz.cma-cmc.com.cn/EN/Y2023/V11/I02/123

Figures/Tables 4

References 22

[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．

类别	n（%）
年龄（岁）	38~92（66.8±10.6）
性别（男/女）	67（62.04）/41（37.96）
Bismuth-Corlett分型
Ⅱ型	59（54.63）
Ⅲa型	15（13.89）
Ⅲb型	18（16.67）
Ⅳ型	16（14.81）
基础疾病
高血压	52（48.15）
糖尿病	31（28.70）
冠心病或心功能不全
脑梗个人史	14（12.96）
肾功能不全	9（8.33）
ECOG评分	5（4.63）
1	4（15.38）
2	15（57.70）
3	7（26.92）
术前胆道感染（是/否）	75/33（69.44/30.56）
支架置入
2	74（68.52）
3	23（21.30）
4	11（10.18）

类别	n（%）
年龄（岁）	38~92（66.8±10.6）
性别（男/女）	67（62.04）/41（37.96）
Bismuth-Corlett分型
Ⅱ型	59（54.63）
Ⅲa型	15（13.89）
Ⅲb型	18（16.67）
Ⅳ型	16（14.81）
基础疾病
高血压	52（48.15）
糖尿病	31（28.70）
冠心病或心功能不全
脑梗个人史	14（12.96）
肾功能不全	9（8.33）
ECOG评分	5（4.63）
1	4（15.38）
2	15（57.70）
3	7（26.92）
术前胆道感染（是/否）	75/33（69.44/30.56）
支架置入
2	74（68.52）
3	23（21.30）
4	11（10.18）

类别	术前	术后	t/Z值	P值
TBIL（μmol/L）	266.23 ± 108.87	153.08 ± 98.63	-9.021	< 0.001
DBIL（μmol/L）	174.80 ± 72.74	91.56 ± 35.05	19.828	< 0.001
ALT（U/L）	116.34 ± 74.94	56.45 ± 33.90	-8.914	< 0.001
AST（U/L）	121.50 ± 75.26	64.46 ± 39.48	-8.632	< 0.001
ALP（U/L）	548.06 ± 421.30	371.76 ± 323.44	-8.810	< 0.001
ALB（U/L）	28.68 ± 3.95	29.19 ± 4.84	-1.145	0.252

类别	术前	术后	t/Z值	P值
TBIL（μmol/L）	266.23 ± 108.87	153.08 ± 98.63	-9.021	< 0.001
DBIL（μmol/L）	174.80 ± 72.74	91.56 ± 35.05	19.828	< 0.001
ALT（U/L）	116.34 ± 74.94	56.45 ± 33.90	-8.914	< 0.001
AST（U/L）	121.50 ± 75.26	64.46 ± 39.48	-8.632	< 0.001
ALP（U/L）	548.06 ± 421.30	371.76 ± 323.44	-8.810	< 0.001
ALB（U/L）	28.68 ± 3.95	29.19 ± 4.84	-1.145	0.252

时间（d）	90	180	360	720
支架通畅率（%）	71.83	40.57	16.17	2.73
生存率（%）	75.39	48.25	19.18	4.10

Please choose a citation manager

Content to export