金属支架、内涵管治疗恶性胆道梗阻的临床疗效比较(多中心研究)

目的比较金属支架与塑料支架(内涵管)置入术治疗恶性胆道梗阻的临床疗效。方法调查广东省3家医院95例实施经皮穿肝胆总管支架置入术的恶性胆道梗阻患者,其中61例置入自膨式金属支架(支架组),34例置入10F塑料内涵管(内涵管组)。所有患者均回访至死亡或至少术后1年。用Kaplan-Meier方法分析比较两组患者的生存及支架开通率。结果支架组的30 d死亡率(6/61,9.8%)低于内涵管组(9/34,26.5%,P<0.05)。支架组30d再阻塞率(15.0%)和并发症发生率(16.4%)均明显低于内涵管组(分别为32.4%和29.4%,P<0.01)。支架组中位开通期(230 d)和中位生存期(224 d)明显长于内涵管组(分别为90和94d,P<0.01)。结论金属支架置入术治疗恶性胆道梗阻临床疗效优于内涵管。

Comparative assessment of clinical efficacy of percutaneous transhepatic metal versus plastic biliary stent implantation for malignant biliary obstruction: a multi-centered investigation

Objective Tocomparetheclinicalefficacyofmetalversusplasticbiliarystentimplantationfortreatmentofmalignant biliary obstruction. Methods Percutaneous transhepatic implantations of self-expandable metal stent (MS, n=61) or 10F plastic stent (PS, n=34) were performed in 95 patients with malignant biliary obstruction selected from 3 hospitals ofGuangdong Province. All patients were followed up until death or at least one year after the procedure. Kaplan-Meier analysiswas used to compare the patients' survival and stent patency rates. Results The 30-day mortality rate was lower in MS group (6/61, 9.8%) than in PS group (9/34, 26.5%, P<0.05). The 30-day reobstruction rate and incidence of complications were 15.0%, 16.4% in MS group and 32.4%, 29.4% in PS group, respectively (P<0.01). The median patency period of the stents andmedian survival period of the patients were 230 d, 224 d in MS group and 90 d, 94 d in PS group, respectively (P<0.01).Conclusion Metal stent implantation is superior to plastic stent for treatment of malignant biliary obstruction.