Percutaneous transhepatic hybrid biliary endoprostheses using both plastic and metallic stents for palliative treatment of malignant common bile duct obstruction

To evaluate clinical safety and efficacy of percutaneous transhepatic hybrid biliary prostheses for palliative treatment in patients with common bile duct obstruction caused by advanced malignancies. A total of 13 consecutive patients was treated with percutaneous transhepatic biliary endoprostheses concurrently using both plastic and metallic stents. Serum total bilirubin levels before and after stent placement were evaluated. The technical success rate, the period with no obstructive jaundice, patient survival and complications were also assessed. Median bilirubin levels decreased from 3.8 mg/dL before to 1.2 mg/dL after stent placement, and this difference was statistically significant. The median no‐jaundice period after bile duct stent placement was 6.0 months (range: 2–11 months), and overall survival time was 7.0 months. Of the 13 patients, nine did not have recurrent jaundice by the time of death, whereas four (31%) had recurrent jaundice. A second intervention was performed in these four patients. A new plastic stent was placed and jaundice did not recur up to the time of death. No serious complications such as cholangitis, pancreatitis or bile duct perforation developed. Percutaneous transhepatic hybrid biliary endoprostheses using both plastic and metallic stents can be useful as non‐invasive palliative treatment to relieve jaundice in patients with malignant obstructive jaundice.     

恶性梗阻性黄疸的介入治疗

目的 :探讨介入治疗恶性梗阻性黄疸的临床价值。方法 :31例恶性梗阻性黄疸患者先行PTCD( 17例 )及金属支架置入术 ( 14例 ) ,1周后行肝动脉灌注化疗或栓塞治疗。结果 :31例PTCD或胆道内支架置入后 ,血清总胆红素下降。 2例患者 2个月内死于与本治疗无关的原因。 2例支架再狭窄。所有病例均获随访 ,平均生存 9个月 ,最长 2 6个月。结论 :介入治疗恶性梗阻性黄疸是一种有效的方法 ;介入治疗可以延长恶性梗阻性黄疸患者的生存时间。     

经皮胆道内支架置入术姑息性治疗恶性梗阻性黄疸临床观察

目的研究经皮胆道内支架置入术姑息性治疗恶性梗阻性黄疸的临床价值。方法28例恶性梗阻性黄疸接受经皮经肝胆道内支架置入术,男18例,女10例。胆管癌13例,胰头癌4例,胆囊癌3例,肝门区转移癌8例。共置入胆道内28枚金属内支架。结果28例采用经皮经肝穿刺置入胆道内支架均获得成功。结论经皮胆道内支架置入术是姑息治疗手术不能切除的恶性梗阻性黄疸的有效方法,配合动脉内灌注化疗可提高恶性阻塞患者的生存率。     

金属胆道支架植入联合介入化疗治疗恶性梗阻性黄疸的疗效

目的评价金属胆道支架植入联合介入化疗治疗恶性梗阻性黄疸的疗效。方法对20例接受金属胆道支架植入联合介入化疗治疗的恶性梗阻性黄疸患者,回顾性分析血清总胆红素和谷丙转氨酶的变化,以及联合介入化疗后的生存时间和生存率。结果术后两周,血清总胆红素和谷丙转氨酶较术前明显下降,术后四周,9例患者的血清总胆红素和谷丙转氨酶恢复正常。本组病例的中位生存时间为6个月,半年及一年生存率分别为60%及35%。结论对于无法外科手术治疗的恶性梗阻性黄疸患者,金属胆道支架植入联合介入化疗能明显提高其生活质量及生存率。     

胆管支架治疗恶性梗阻性黄疸５３例分析

目的　观察经皮肝穿刺肝胆管支架治疗恶性梗阻性黄疸的疗效及不良反应。方法　５３例恶性胆道梗阻患者采用经皮肝穿刺置入胆管支架治疗,术前及术后１周复查血清总胆红素、直接胆红素。２２例患者行肝动脉栓塞化疗（ＴＡＣＥ）。结果　共置入５５枚镍钛形状记忆合金内支架,其中２例各置入２枚胆道支架,技术操作成功率１００％。术前及术后１周血清总胆红素、直接胆红素均有显著差异（Ｐ＝０.０２１,Ｐ＝０.０１８）,支架置入后行ＴＡＣＥ者中位生存期（３９.２周）明显高于未行ＴＡＣＥ组（１７.３周）,术中及术后的并发症经及时处理后均能缓解。结论　对梗阻性黄疸患者经皮肝穿刺支架治疗对解除胆道梗阻是一种安全、有效的方法。术后行肝动脉栓塞化疗者能明显延长患者生存。     

恶性梗阻性黄疸胆道内涵管置人术28例

［目的］探讨经皮肝胆道内涵管置入治疗梗阻性黄疸的疗效及并发症。［方法］对４８例梗阻性黄疸患者分为两组,２８ 例为内涵管组,行经皮肝穿胆道内涵管置入术;２０例为对照组,用一般内科治疗（利胆、护肝等对症处理）。其中内涵管组２８例随 访 ３５至 ３５６天,观察近中期疗效和并发症。［结果］内涵管组：经皮肝胆道内涵管置入术技术成功率为 １００％。置入后血清总胆红 素水平较置入前明显下降（Ｐ＜０．０５）。对照组：随时间的延长血清总胆红素水平较治疗前明显上升（Ｐ＜０．００１）。开通时间平均为 ９８天,半年开通率为５３．５７％。内涵管组：并发症发生率２４．９５％,主要为胰腺炎和逆行胆道感染等,对照组：井发症发生率３０％（Ｐ ＜０．０５）［结论］经皮肝胆道内涵管置入术疗效可靠、安全,可作为胆管阻塞介入治疗的另一种选择。     

Internal-External Percutaneous Transhepatic Biliary Drainage for Patients with Malignant Obstructive Jaundice

Purpose: To evaluate the effect of internal-external percutaneous transhepatic biliary drainage (IEPTBD)for patients with malignant obstructive jaundice. Methods: During the period of January 2008 and July 2013,internal-external drainage was performed in 42 patients with malignant obstructive jaundice. During theprocedure, if the guide wire could pass through the occlusion and into the duodenum, IEPTBD was performed.External drainage biliary catheter was placed if the occlusion was not crossed. Newly onset of infection, degreeof bilirubin decrease and the survival time of patients were selected as parameters to evaluate the effect ofIEPTBD. Results: Twenty newly onset of infection were recorded after procedure and new infectious rate was47.6%. Sixteen patients with infection (3 before, 13 after drainage) were uncontrolled after procedure, 12 ofthem (3 before, 9 after drainage) died within 1 month. The mean TBIL levels declined from 299.53 umol/L beforedrainage to 257.62 umol/L after drainage, while uninfected group decline from 274.86 umol/L to 132.34 umol/Lp(P < 0.5). The median survival time for uninfected group was 107 days, and for infection group was 43 days (P< 0.05). Conclusions: The IEPTBD drainage may increase the chance of biliary infection, reduce bile drainageefficiency and decrease the long-term prognosis, and the external drainage is a better choice for patients withmalignant obstructive jaundice need to biliary drainage.     

胆管引流术与胆管支架置入术治疗恶性阻塞性黄疸的临床疗效比较

目的 比较经皮经肝胆管引流术(PTBD)和经皮经肝胆管支架置入术(PTBS)治疗恶性阻塞性黄疸的疗效.方法 210例阻塞性黄疸患者中,161例行PTBD,49例行PTBS.收集患者的临床资料,并通过电话随访或从患者复检记录中获取随访资料.结果 技术成功率为100%.术后3～5 d,PTBS组(15例)血清总胆红素(TB)下降了(178.04±42.32)μmol/L,血清直接胆红素(DB)下降了(83.97±23.63)μmol/L;PTBD组(28例)血清TB下降了(95.67±34.28)μmol/L,血清DB下降了(49.84±28.21)μmol/L,两组差异有统计学意义(P=0.017,P=0.035).术后6～9 d,PTBS组(28例)血清TB下降了(188.22±79.90)μmol/L,PTBD组(126例)下降了(141.39±65.32)μmol/L,两组差异有统计学意义(P=0.014);两组血清DB下降值差异无统计学意义(P=0.567).PTBD组和PTBS组的中位通畅期分别为60和197 d,中位生存期分别为148和245 d,两组比较差异均有统计学意义(均P<0.01).结论 FIBS治疗恶性阻塞性黄疽的近期和远期疗效均优于PTBD.     

Analysis of Different Ways of Drainage for Obstructive Jaundice Caused by Hilar Cholangiocarcinoma

Objective: To evaluate the prognosis of different ways of drainage for patients with obstructive jaundicecaused by hilar cholangiocarcinoma. Materials and Methods: During the period of January 2006- March 2012,percutaneous transhepatic catheter drainage (PTCD)/ percutaneous transhepatic biliary stenting (PTBS) wereperformed for 89 patients. According to percutaneous transhepatic cholangiography (PTC), external drainagewas selected if the region of obstruction could not be passed by guide wire or a metallic stent was inserted if itcould. External drainage was the first choice if infection was diagnosed before the procedure, and a metallicstent was inserted in one week after the infection was under control. Selection by new infections, the degree ofbilirubin decrease, the change of ALT, the time of recurrence of obstruction, and the survival time of patients asthe parameters was conducted to evaluate the methods of different interventional treatments regarding prognosisof patients with hilar obstruction caused by hilar cholangiocarcinoma. Results: PTCD was conducted in 6 patientsand PTBS in 7 (p<0.05). Reduction of bilirubin levels and ALT levels was obvious after the procedures (p<0.05).The average survival time with PTCD was 161 days and with PTBS was 243 days (p<0.05). Conclusions: Withboth drainage procedures for obstructive jaundice caused by hilar cholangiocarcinoma improvement in liverfunction was obvious. PTBS was found to be better than PTCD for prolonging the patient survival.     

Drainage Alone or Combined with Anti-tumor Therapy for Treatment of Obstructive Jaundice Caused by Recurrence and Metastasis after Primary Tumor Resection

Aim: To compare drainage alone or combined with anti-tumor therapy for treatment of obstructive jaundicecaused by recurrence and metastasis after primary tumor resection. Materials and Methods: We collect 42 patientswith obstructive jaundice caused by recurrence and metastasis after tumor resection from January 2008 - August2012, for which percutaneous transhepatic catheter drainage (pTCD)/ percutaneous transhepatic biliary stenting(pTBS) were performed. In 25 patients drainage was combined with anti-tumor treatment, antineoplastic therapyincluding intra/postprodure local treatment and postoperative systemic chemotherapy, the other 17 undergoingdrainage only. We assessed the two kinds of treatment with regard to patient prognosis. Results: Both treatmentsdemonstrated good effects in reducing bilirubin levels in the short term and promoting liver function. The timeto reobstruction was 125 days in the combined group and 89 days in the drainage only group; the mean survivaltimes were 185 and 128 days, the differences being significant. Conclusions: Interventional drainage in thetreatment of the obstructive jaundice caused by recurrence and metastasis after tumor resection can decreasebilirubin level quickly in a short term and promote the liver function recovery. Combined treatment prolongsthe survival time and period before reobstruction as compared to drainage only.     

Role of interventional radiography in the treatment of the hepato-pancreato-duodenal area,complicated by obstructive jaundice

We assessed the role of interventional radiological procedures used in the treatment of patients with hepatopancreatobiliary cancer complicated by obstructive jaundice. Between 1990 and 2000, 71 patients underwent percutaneous transhepatic biliary drainage (PTBD): external drainage--18 (group A); external-internal drainage or stenting (group B), and external-internal drainage or stenting plus chemoinfusion or chemoembolization of the hepatic artery--15 (group C). Mean survival (M(SD) calculated for patients who died was 2.1(0.5 mo for group A; (pb,c(0.01), 7.9(6.7 mo (group B), and 16.6(14.8 mo for group C (NS with B). The actual one-year survival was 10, 25, and 45%, respectively. External-internal PTBD and stenting are safe effective palliative procedures for patients with malignant obstructive jaundice. Survival in patients with hepatopancreatobiliary cancer doubled after chemoinfusion or chemoembolization, without grave complications or lethality.     

PTC下胆道活检诊断恶性阻塞性黄疸的临床应用

目的　探索PTC下胆道活检的可行性和敏感性 ,获取病变胆管的组织病理学 ,指导临床治疗。方法　 19例恶性阻塞性黄疸 ,在行PTCD(经皮经肝穿刺胆道内外引流术 )减黄术中 ,PTC下胆道活检 ,进行组织病理学检查。结果　 19例患者中有 18例获得组织病理学诊断 (敏感性 ,94 74% )。病理报告为胆管癌n =13 ,胰腺癌n =2 ,转移瘤n =2 ,肝细胞癌n =1,阴性结果n =1,阳性结果率为 94 74%。结论　PTC胆道活检是一种准确可靠的获取组织病理学检查途径     

Multicenter retrospective analysis of systemic chemotherapy for advanced neuroendocrine carcinoma of the digestive system

This study analyzed outcomes of systemic chemotherapy for advanced neuroendocrine carcinoma (NEC) of the digestive system. Clinical data from 258 patients with unresectable or recurrent NEC of the gastrointestinal tract (GI) or hepato‐biliary‐pancreatic system (HBP), who received chemotherapy, were collected from 23 Japanese institutions and analyzed retrospectively. Patients had primary sites in the esophagus (n = 85), stomach (n = 70), small bowel (n = 6), colorectum (n = 31), hepato‐biliary system (n = 31) and pancreas (n = 31). Median overall survival (OS) was 13.4 months the esophagus, 13.3 months for the stomach, 29.7 months for the small bowel, 7.6 months for the colorectum, 7.9 months for the hepato‐biliary system and 8.5 months for the pancreas. Irinotecan plus cisplatin (IP) and etoposide plus cisplatin (EP) were most commonly selected for GI‐NEC and HBP‐NEC. For patients treated with IP/EP (n = 160/46), the response rate was 50/28% and median OS was 13.0/7.3 months. Multivariate analysis among patients treated with IP or EP showed that the primary site (GI vs HBP; hazard ratio [HR] 0.58, 95% confidence interval [CI] 0.35–0.97) and baseline serum lactate dehydrogenase levels (not elevated vs elevated; HR 0.65, 95% CI 0.46–0.94) were independent prognostic factors for OS, while the efficacy of IP was slightly better than for EP (HR 0.80, 95% CI 0.48–1.33; P = 0.389). IP and EP are the most common treatment regimens for NEC of the digestive system. HBP primary sites and elevated lactate dehydrogenase levels are unfavorable prognostic factors for survival. A randomized controlled trial is required to establish the appropriate chemotherapy regimen for advanced NEC of the digestive system. This study was registered at UMIN as trial number 000005176.     

胆道支架联合125I 粒子腔内治疗胆管癌恶性黄疸的疗效评价*

目的:探讨经皮金属胆道支架和支架联合125I 粒子腔内照射治疗对胆管癌引起的恶性梗阻性黄疸的临床疗效差异。方法:选择2012年10月至2014年10月无法根治手术的胆管癌引起的恶性梗阻性黄疸患者52例,先行支架置入,根据是否置入125I 粒子分为治疗组（26例）与对照组（26例）。 对比两组治疗前后生化常规、瘤体最大径、最小径、再出现黄疸时间、生存时间等是否存在统计学差异。结果:经治疗1 、3 、6 个月后两组肝功能较术前均明显改善,差异有统计学意义（P < 0.05）;比较两组术后1 个月胆红素降低值,差异无统计学意义（P < 0.05）;比较两组术后3 、6 个月与术前,术后3 个月与1 个月,术后6 个月与3 个月胆红素降低值,差异有统计学意义（P < 0.05）;经治疗后治疗组瘤体明显减小,对照组明显增大,差异有统计学意义（P < 0.05）。 治疗组平均生存时间为（12.83± 1.57）个月,24个月总生存率为38.46% ;对照组为（8.89± 1.0）个月,24个月总生存率为11.54% ,差异有统计学意义（P < 0.05）。 结论:经皮金属胆道支架联合125I 粒子腔内照射治疗较单纯支架置入治疗,在具有相同减黄效果同时,亦可有效抑制胆管肿瘤生长、延长患者生存期及支架通畅时间。同时内装施源式有利于更方便观察疗效、调整粒子位置、追加治疗剂量及放射材料的回收。      

表阿霉素在恶性梗阻性黄疸治疗中的应用

目的 探讨表阿霉素治疗恶性梗阻性黄疸（MOJ）的安全性和可行性。方法39例MOJ患者接受胆道支架置放术或经皮穿肝胆道引流术（PTBD）后,血清胆红素未降至正常水平即接受动脉化疗栓塞术（TACE）。TACE方案：法玛新30mg／m^2和超液化碘油混合成乳剂。参照WHO抗癌药物毒性分级标准观察毒性反应,Child-Putgh分级观察肝脏损害。随访患者黄疸复发时间和生存期。结果39例MOJ患者TACE术前血清总胆红素浓度为52．1-91．4μmol／L,中位值72．7μmol／L。表阿霉素总量40-60mg,中位值55．0mg,超液化碘油2～25ml。白细胞计数下降：Ⅰ度41．0％,Ⅱ度35．9％,Ⅲ-Ⅳ度15．4％;恶心呕吐：Ⅲ～Ⅳ度100％。肝脏Child-Pugh分级：8例由A级升至B级,1例由A级升至C级,3例由B级升至C级。全部患者未出现心脏毒性。39例患者的生存期为2～72个月,中位值6．0个月。19例黄疸复发,复发率48．7％,黄疸复发时间2～20个月,中位值9．0个月。结论MOJ患者行有效引流后,即使胆红素未降至正常水平,用30mg／m^2表阿霉素和超液化碘油乳剂进行单纯化疗栓塞治疗原发病灶是安全和有效的。     

Percutaneous Transhepatic Biliary Drainage for the Treatment of Obstructive Jaundice Caused by Metastases from Nonbiliary and Nonpancreatic Cancers

The usefulness of percutaneous transhepatic biliary drainage(PTBD) in the treatment of obstructive jaundice caused by metastasesfrom nonbiliary and nonpancreatic cancers was evaluated. Eighteenpatients underwent PTBD during a 3-year period. The primarycancers were located in the stomach (nine cases), colon (four),lung (three), uterus (one), and breast (one). The causes ofobstructive jaundice and bile duct strictures were investigatedusing both abdominal computed tomography and abdominal ultrasonography.The causes of obstructive jaundice, the usefulness of PTBD interms of the relief of symptoms and laboratory data, survivalafter PTBD, and the relationship between patient characteristicsand survival were evaluated. Obstructive jaundice was most oftenattributable to metastases to the lymph nodes (17 of 18 cases).One case was attributed to metastasis to the liver. PTBD decreasedthe jaundice and relieved the symptoms caused by biliary tractobstruction. Median survival after PTBD was 59 days. Patientswhose performance status was 2 or less survived longer thanthose with a performance status of 3 or more (P = 0.018). Furthermore,patients aged less than 60 years tended to survive longer thanthose aged 60 or over (P = 0.057). Our results suggest thatPTBD is useful for relief of symptoms caused by obstructivejaundice in patients with nonbiliary and nonpancreatic cancers.     

经皮肝穿胆道支架置入治疗恶性胆道梗阻的临床研究

目的：总结经皮肝穿刺胆道金属内支架植入治疗恶性胆道梗阻的临床疗效及经验。方法：92例恶性胆道梗阻性黄疸患者,采用经皮肝穿刺肝胆管支架置入术。根据胆道梗阻狭窄的不同部位和狭窄的程度采用相应的放置方式。结果：92例患者中,91例胆道支架成功放置,其中12例放置双支架,支架扩张良好,引流通畅,血清胆红素下降明显。术后死亡2例,胆道出血3例,腹水渗漏6例,胆漏2例,支架移位1例,胆管炎9例,胆道再阻塞11例。结论对不能手术的恶性胆道梗阻性黄疸患者,经皮肝穿刺胆道内支架植入术创伤小,可提高患者的生存质量,延长生存期,是一种较为安全、有效的方法。     

Long noncoding RNA actin filament‐associated protein 1 antisense RNA 1 promotes malignant phenotype through binding with lysine‐specific demethylase 1 and repressing HMG box‐containing protein 1 in non‐small‐cell lung cancer

The number of documented long noncoding RNAs (lncRNAs) has dramatically increased, and their biological functions and underlying mechanisms in pathological processes, especially cancer, remain to be elucidated. Actin filament‐associated protein 1 antisense RNA 1 (AFAP1‐AS1) is a 6810‐nt lncRNA located on chromosome 4p16.1 that was first reported to be upregulated in esophageal adenocarcinoma tissues and cell lines. Here we reported that AFAP1‐AS1, recruiting and binding to lysine‐specific demethylase 1 (LSD1), was generally overexpressed in human non‐small‐cell lung cancer (NSCLC) tissues using quantitative real‐time PCR. Higher AFAP1‐AS1 expression was significantly correlated with larger tumor size (P = .008), lymph node metastasis (P = .025), higher TNM stage (P = .024), and worse overall survival in NSCLC patients. In vitro experiments revealed that AFAP1‐AS1 downregulation inhibited cell migration and induced apoptosis; AFAP1‐AS1 knockdown also hindered tumorigenesis in vivo. Moreover, mechanistic investigations including RNA immunoprecipitation and ChIP assays validated that AFAP1‐AS1 repressed HMG box‐containing protein 1 (HBP1) expression by recruiting LSD1 to the HBP1 promoter regions in PC‐9 and H1975 cells. Furthermore, HBP1 functions as a tumor suppressor, and its ectopic expression hindered cell proliferation. Rescue assays determined that the oncogenic effect of AFAP1‐AS1 is partially dependent on the epigenetic silencing of HBP1. In conclusion, our results indicate that AFAP1‐AS1 is carcinogenic and that the AFAP1‐AS1/LSD1/HBP1 axis could constitute a new therapeutic direction for NSCLC.     

The palliative role of percutaneous endoscopic gastrostomy with jejunal extension (PEG-J) in an advanced pancreatic cancer patient with duodenal stenosis--a case report

Although a 64-year-old man with pancreatic cancer was referred to our hospital due to difficulty in the bile drainage, he was initially planned to have an operation at another hospital after relief of obstructive jaundice. Laboratory tests on admission revealed obstructive jaundice, pancreatitis and malnutrition (T-Bil 12.1 mg/dL, AMY 1170 IU/L, Alb 2.0 g/dL). Abdominal computed tomography (CT) detected a pancreas tumor and multiple liver metastases. Then, we determined to carry out palliative therapy. Percutaneous transhepatic cholangiography (PTC) showed a common bile duct obstruction, and a biliary metallic stent was placed. Endoscopic examination revealed a tumorous duodenal stenosis. We performed percutaneous endoscopic gastrostomy with jejunal extension (PEG-J), which was used for both transintestinal nutrition and decompression gastrostomy. After these therapies, the patient's condition improved better in 2 weeks as such that he could have stayed away from our hospital for several days. PEG-J was useful to improve a quality of life in pancreatic cancer patient with duodenal stenosis.     

三维适形放疗治疗胃肠道恶性肿瘤转移引起的梗阻性黄疸疗效观察

目的探讨三维适形放疗（3DCRT）治疗胃肠道恶性肿瘤转移引起的梗阻性黄疸的疗效。方法 28例胃肠道恶性肿瘤转移引起梗阻性黄疸患者采用3DCRT技术放疗,必要时行经皮肝穿刺外引流术或胆道内支架植入术完成后续放疗,分割剂量为2.5Gy/次,5次/周,总剂量55～65Gy。结果 28例患者中,8例完全缓解（CR）,13例部分缓解（PR）,2例稳定（NC）,3例进展（PD）。2例放弃治疗。总有效率（CR＋PR）75.0%（21/28）。黄疸、上腹部疼痛、腹部包块、白陶土样大便缓解率分别为64.3%、89.4%、81.8%和75.0%。0.5,1,2年生存率分别为82.1%（23/28）、53.6%（15/28）和14.3%（4/28）。结论 3DCRT治疗胃肠道恶性肿瘤转移引起的梗阻性黄疸是一种安全、有效的治疗方法,近期疗效好,症状改善满意,远期疗效有待进一步探讨。