| Shujuan Jang,Zhongyin Zhou. Application of endoscopic nasobiliary cutting in the treatment of hilar cholangiocarcinoma. Oncol Transl Med, 2021, 7: 76-82. |
| 经内镜鼻胆管剪断术在肝门部胆管癌治疗中的应用分析 |
| Application of endoscopic nasobiliary cutting in the treatment of hilar cholangiocarcinoma |
| Received:October 13, 2020 Revised:April 02, 2021 |
| DOI：10.1007/s10330-020-0461-1 |
| 中文关键词: 肝门部胆管癌；内镜下鼻胆管引流术；内镜下鼻胆管剪断术；内镜下塑料胆管支架置入术；胆管支架 |
| 英文关键词: hilar cholangiocarcinoma (HC); endoscopic nasobiliary drainage; endoscopic nasobiliary cutting; endoscopic retrograde biliary drainage (ERBD); biliary stent |
| 基金项目: |
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| 中文摘要: |
| 【摘要】目的 研究经内镜剪断鼻胆管留置其残余段充当胆管支架用于治疗肝门部胆管癌的临床疗效及预后。方法 回顾性分析2017年8月至2019年8月于我院消化内镜中心接受经内镜胆道引流术治疗的55例肝门部胆管癌患者的临床资料，按不同引流方案分为鼻胆管剪断术组（n=26）及塑料胆管支架置入术组（n=29），比较两组患者术后肝功能指标、术后相关并发症发生率、支架中位通畅期及患者中位生存期。结果 55例患者术后1周肝功能指标（TBIL、DBIL、ALT、AST、ALP、GGT）均显著降低(P<0.05)，鼻胆管剪断术组术后1周肝功能指标下降均较塑料胆管支架置入术组显著(P<0.05)；鼻胆管剪断术组胆道感染发生率15.40%显著低于塑料胆管支架置入术组41.40%，差异有统计学意义（P<0.05）；鼻胆管剪断术亚组中胃窦部剪断组（n=21）、十二指肠乳头处剪断组（n=5）分别有1 例、3例出现胆道感染，分别有0例、2例出现移位，二者比较差异均有统计学意义（P<0.05）；鼻胆管剪断术组支架中位通畅期（190d）、中位生存期（230d）高于塑料胆管支架置入术组支架中位通畅期（169d）、中位生存期（202d），但相比均无统计学差异（P>0.05）；结论 Ⅰ期于ERCP下行ENBD，经鼻胆管充分引流胆汁后Ⅱ期于内镜下利用内镜剪刀剪断鼻胆管，其残余段仍可达到支撑胆管、引流胆汁的效果，减黄、肝酶恢复显著，胆道感染发生率较低；于十二指肠乳头处剪断鼻胆管胆道感染发生率较高，鼻胆管残余段支架更易移位；经内镜鼻胆管剪断术引流方案用于肝门部胆管癌的姑息性治疗的一种有效、简便、安全的减黄方案。 |
| 英文摘要: |
| Objective The aim of the study was to study the clinical efficacy and prognosis of endoscopically
cutting the nasobiliary duct and leaving its residual segment as a biliary stent in the treatment of hilar
cholangiocarcinoma (HC).
Methods The clinical data of 55 patients with HC treated by endoscopic biliary drainage at the
Gastrointestinal Endoscopy Center of our hospital (Renmin Hospital of Wuhan University, China) from
August 2017 to August 2019 were retrospectively analyzed. According to different drainage schemes,
patients were divided into the endoscopic nasobiliary cutting group (n = 26) and the endoscopic retrograde
biliary drainage (ERBD) group (n = 29). The postoperative liver function indexes, incidence of postoperative
complications, median patency period of stents, and median survival time of patients were compared
between the two groups.
Results Liver function indexes (total bilirubin, direct bilirubin, alanine aminotransferase, aspartate
aminotransferase, alkaline phosphatase, gamma-glutamyl transpeptidase) were significantly decreased in
55 patients a week postoperaticely (P < 0.05), and decreases in liver function indexes in the endoscopic
nasobiliary cutting group were more significant than those in the ERBD group (P < 0.05). The incidence
of biliary tract infection in the endoscopic nasobiliary cutting group was significantly lower than that in the
ERBD group (15.40% vs. 41.4%, P < 0.05). In the endoscopic nasobiliary cutting subgroups, there were 1
and 3 cases of biliary tract infection in the gastric antrum cutting group (n = 21) and duodenal papilla cutting
group (n = 5), respectively, and 0 cases and 2 cases of displacement, respectively; there was a statistically
significant difference in terms of complications between the two subgroups (P < 0.05). The median patency
period (190 days) and median survival time (230 days) in the nasobiliary duct cutting group were higher
than those (169 days and 202 days) in the ERBD group, but there was no significant difference (P > 0.05).
Conclusion The nasobiliary duct was cut by using endoscopic scissors in Stage II after the bile was fully
drained through the nasobiliary duct. The residual segment could still support the bile duct and drain bile.
The reduction of jaundice and the recovery of liver enzymes were significant, and the incidence of biliary
tract infection was low. Cutting off the nasobiliary duct at the duodenal papilla results in a higher incidence
of biliary tract infection, and the residual segment of the nasobiliary duct is more likely to be displaced.
Endoscopic nasobiliary-cutting drainage is an effective, simple, and safe method to reduce jaundice in the
palliative treatment of HC. |
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