经皮肝穿刺胆道支架植入治疗恶性梗阻性黄疸的早期疗效
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摘要
目的研究"一步法"和"两步法"经皮肝穿刺胆道支架植入术治疗恶性梗阻性黄疸的早期疗效。方法收集111例诊断为恶性梗阻性黄疸且接受过经皮肝穿刺胆道支架植入术治疗患者的临床资料进行回顾性分析。结果两种方法均能使患者黄疸减轻,肝功能好转,"一步法"和"两步法"有效引流率分别为64.8%和80%,早期并发症发生率分别为34.1%和30%,早期不良事件发生率分别为35.2%和30%,平均住院时间分别为(19.8±7.2)d和(24.6±10.5)d,平均住院费用分别为(72 916±21 137)元和(88 010±19 843)元。结论 "一步法"和"两步法"经皮肝穿刺胆道支架植入术都是治疗恶性梗阻性黄疸的有效方法,早期疗效相当,但"一步法"住院时间和费用较"两步法"少,既可减轻患者经济负担,又能提高医疗资源利用效率,在临床治疗中值得优先选择。
Objective To evaluate the early efficacy and safety of one-step and two-step percutaneous transhepatic biliary stenting on malignant obstructive jaundice. Methods Clinical data of 111 patients with malignant obstructive jaundice who received percutaneous transhepatic biliary stenting between January 2013 and July 2007 in our institute was collected. Results Both of the two methods effectively reduced jaundice and improved liver function. The effective drainage rate was 64.8% in the one-step group and 80% in the two-step group. The rates of early complications were 34.1% and 30%, respectively. The of early adverse event rates were 35.2% and 30%, respectively. The hospital stays were 19.8 days and 24.6 days, respectively. The costs were 72 916 RMB and 88 010 RMB, respectively. Conclusion Both one-step and two-step percutaneous transhepatic biliary stenting are effective on malignant obstructive jaundice. The early efficacy and safety of two methods are similar. However, compared with two-step method, one-step is more cost-effective with shorter hospital stay.
Objective To evaluate the early efficacy and safety of one-step and two-step percutaneous transhepatic biliary stenting on malignant obstructive jaundice. Methods Clinical data of 111 patients with malignant obstructive jaundice who received percutaneous transhepatic biliary stenting between January 2013 and July 2007 in our institute was collected. Results Both of the two methods effectively reduced jaundice and improved liver function. The effective drainage rate was 64.8% in the one-step group and 80% in the two-step group. The rates of early complications were 34.1% and 30%, respectively. The of early adverse event rates were 35.2% and 30%, respectively. The hospital stays were 19.8 days and 24.6 days, respectively. The costs were 72 916 RMB and 88 010 RMB, respectively. Conclusion Both one-step and two-step percutaneous transhepatic biliary stenting are effective on malignant obstructive jaundice. The early efficacy and safety of two methods are similar. However, compared with two-step method, one-step is more cost-effective with shorter hospital stay.
引文
[1] 马少军,翟仁友,赵峰.恶性梗阻性黄疸的介入治疗进展[J/CD].中华介入放射学电子杂志,2016,4(2):119-123.
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[6] Bae JI,Park AW,Choi SJ,et al.Crisscross-configured dual stent placement for trisectoral drainage in patients with advanced biliary hilar malignancies[J].J Vasc Interv Radiol,2008,19(11):1614-1619.
[7] Duan F,Cui L,Bai Y,et al.Comparison of efficacy and complications of endoscopic and percutaneous biliary drainage in malignant obstructive jaundice:a systematic review and meta-analysis[J].Cancer Imaging,2017,17(1):27-35.
[8] Xu C,Lv PH,Huang XE,et al.Analysis of different ways of drainage for obstructive jaundice caused by hilar cholangiocarcinoma[J].Asian Pac J Cancer Prev,2014,15(14):5617-5620.
[9] Sangchan A,Kongkasame W,Pugkhem A,et al.Efficacy of metal and plastic stentsin unresectable complex hilarcholangiocarcinoma:a randomized controlled trial[J].Gastrointest Endosc,2012,76(1):93-99.
[10] Mukai T,Yasuda I,Nakashima M,et al.Metallic stents are more efficacious thanplastic stents in unresectable malignant hilar biliary strictures:a randomized controlled Trial[J].J Hepatobiliary Pancreat Sci,2013,20(2):214-222.
[11] Chatzis N,Pfiffner R,Glenck M,et al.Comparing percutaneous primary and secondary biliary stenting for malignant biliary obstruction:A retrospective clinical analysis[J].Indian J Radiol Imaging,2013,23(1):38-45.
[12] 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.
[13] Inal M,Aksungur E,Akgul E,et al.Percutaneous placement of metallic stents in malignant biliary obstruction:one-stage or two-stage procedure?Pre-dilate or not?[J].Cardiovasc Intervent Radiol,2003,26(1):40-45.
[14] Krokidis M,Fanelli F,Orgera G,et al.Percutaneous treatment of malignant jaundice due to extrahepatic Cholangiocarcinoma:Covered Viabil stent versus uncovered Wallstents[J].Cardiovasc Intervent Radiol,2010,33(1):97-106.
[2] Itoi T,Sofuni A,Itokawa F,et al.Current status and issues regarding biliary stenting in unresectable biliary obstruction[J].Dig Endosc,2013,25(Suppl 2):63-70.
[3] Yoshida H,Mamada Y,Taniai N,et al.One-step palliative treatment method for obstructive jaundice caused byunresectable malignancies by percutaneous transhepatic insertion of an expandable metallic stent[J].World J Gastroenterol,2006,12(15):2423-2426.
[4] Akamatsu N,Sugawara Y,Shin N,et al.One-step percutaneous transhepatic insertion of a balloon-expanding metallic stent for obstructive jaundice[J].J Gastroenterol Hepatol,2011,26(12):1795-1803.
[5] Gwon DI,Ko GY,Kim JH,et al.Percutaneous bilateral metallic stent placement using a stentin-stent deployment technique in patients with malignant hilar biliary obstruction[J].AJR Am J Roentgenol,2013,200(4):909-914.
[6] Bae JI,Park AW,Choi SJ,et al.Crisscross-configured dual stent placement for trisectoral drainage in patients with advanced biliary hilar malignancies[J].J Vasc Interv Radiol,2008,19(11):1614-1619.
[7] Duan F,Cui L,Bai Y,et al.Comparison of efficacy and complications of endoscopic and percutaneous biliary drainage in malignant obstructive jaundice:a systematic review and meta-analysis[J].Cancer Imaging,2017,17(1):27-35.
[8] Xu C,Lv PH,Huang XE,et al.Analysis of different ways of drainage for obstructive jaundice caused by hilar cholangiocarcinoma[J].Asian Pac J Cancer Prev,2014,15(14):5617-5620.
[9] Sangchan A,Kongkasame W,Pugkhem A,et al.Efficacy of metal and plastic stentsin unresectable complex hilarcholangiocarcinoma:a randomized controlled trial[J].Gastrointest Endosc,2012,76(1):93-99.
[10] Mukai T,Yasuda I,Nakashima M,et al.Metallic stents are more efficacious thanplastic stents in unresectable malignant hilar biliary strictures:a randomized controlled Trial[J].J Hepatobiliary Pancreat Sci,2013,20(2):214-222.
[11] Chatzis N,Pfiffner R,Glenck M,et al.Comparing percutaneous primary and secondary biliary stenting for malignant biliary obstruction:A retrospective clinical analysis[J].Indian J Radiol Imaging,2013,23(1):38-45.
[12] 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.
[13] Inal M,Aksungur E,Akgul E,et al.Percutaneous placement of metallic stents in malignant biliary obstruction:one-stage or two-stage procedure?Pre-dilate or not?[J].Cardiovasc Intervent Radiol,2003,26(1):40-45.
[14] Krokidis M,Fanelli F,Orgera G,et al.Percutaneous treatment of malignant jaundice due to extrahepatic Cholangiocarcinoma:Covered Viabil stent versus uncovered Wallstents[J].Cardiovasc Intervent Radiol,2010,33(1):97-106.