Compative Study of Biliary Metallic Stent Implantation Via ERCP and PTCD Approaches in Treatment of Malignant Obstructive Jaundice_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 CHENBao-yin , PANGLin-yuan

Department of Gastroenterology, The 3201 th Hospital of AVIC, Hanzhong 723000, Shaanxi Province, China;

Corresponding?author：

CHENBao-yin, Email: 13891620778@163.com

Keywords：

Malignant obstructive jaundice; Biliary metallic stent; Endoscopic retrograde cholangiopancreatography; Percutaneous transhepatic cholangial drainage; Clinical curative effect

DOI：

10.7507/1007-9424.20160253

Video：

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Objective To compare clinical effect of biliary metallic stent implantation via endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous transhepatic cholangial drainage (PTCD) approaches in treatment of malignant obstructive jaundice. Methods One hundred and thirty-six patients with malignant obstructive jaundice who received the biliary metallic stent implantation from June 2010 to June 2015 in this hospital were selected. There were 53 cases via ERCP approach (ERCP group), in which 44 patients with low malignant obstructive jaundice, 9 patients with high malignant obstructive jaundice. There were 83 cases via PTCD approach (PTCD group), in which 24 patients with low malignant obstructive jaundice, 59 patients with malignant obstructive jaundice. The surgical success rate, effective rate, incidence of postoperative complications, hospital stay, and hospitalization expenses were compared in these two groups. Results ① The total surgical success rate had no significant difference between the ERCP group and the PTCD group (P > 0.05). The surgical success rate of the patients with low malignant obstructive jaundice had no significant difference between the ERCP group and PTCD group (P > 0.05), which of the patients with high malignant obstructive jaundice in the ERCP group was significantly lower than that in the PTCD group (P < 0.05). ② The total effective rate had no significant difference between the ERCP group and PTCD group (P > 0.05), which of the patients with low malignant obstructive jaundice in the ERCP group was significantly higher than that in the PTCD group (P < 0.05), which of the patients with high malignant obstructive jaundice in the ERCP group was significantly lower than that in the PTCD group (P < 0.05). ③ The hospital stay of the ERCP group was significantly shorter than that in the PTCD group (P < 0.05). The hospitalization expenses had no significant difference between the ERCP group and PTCD group (P > 0.05). ④ The total incidence of complications in the ERCP group was significantly lower than that in the PTCD group (P < 0.05), which of the patients with low malignant obstructive jaundice in the ERCP group was significantly lower than that in the PTCD group (P < 0.05), which of the patients with high malignant obstructive jaundice in the ERCP group was significantly higher than that in the PTCD group (P < 0.05). Conclusions The biliary metallic stent implantation via ERCP and PTCD approaches in treatment of malignant obstructive jaundice could all obtain a better clinical efficacy. It has more advantages in patients with low malignant obstructive jaundice via ERCP approach and in the patients with high malignant obstructive jaundice via PTCD approach.

Citation： CHENBao-yin, PANGLin-yuan. Compative Study of Biliary Metallic Stent Implantation Via ERCP and PTCD Approaches in Treatment of Malignant Obstructive Jaundice. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2016, 23(8): 967-971. doi: 10.7507/1007-9424.20160253 Copy

1.	Yamamoto R, Takahashi M, Osafune Y, et al. Comparison of endoscopic stenting for malignant biliary obstruction:A single-center study. World J Gastrointest Endosc, 2015, 7(9):889-894.
2.	Chung KH, Lee SH, Park JM, et al. Self-expandable metallic stents vs. plastic stents for endoscopic biliary drainage in hepatocellular carcinoma. Endoscopy, 2015, 47(6):508-516.
3.	Alekseev KI, Maady AS, Osipov AS, et al. The experience of biliary self-expendable nitinol stents for malignant jaundice. Eksp Klin Gastroenterol, 2014, (3):81-87.
4.	張誠, 楊玉龍, 吳萍, 等.全覆膜自膨式可回收金屬支架治療惡性梗阻性黃疸的并發癥及防治策略.中華醫學雜志, 2015, 95(6):416-419.
5.	姚紅響, 陳根生, 葉冠雄, 等.單純膽道支架與125I粒子支架腔內照射治療惡性梗阻性黃疸.中華肝膽外科雜志, 2014, 20(12):869-872.
6.	吳杰, 宋磊, 趙丹懿, 等.胰腺癌梗阻性黃疸患者膽道內支架置入術后放化療療效分析.中華普通外科雜志, 2014, 29(8):626-629.
7.	馬鴻祥, 周鳴清.內鏡下膽道金屬支架引流術治療老年惡性梗阻性黃疸128例的療效觀察.重慶醫學, 2014, 43(7):871-873.
8.	王勇, 劉會春, 李宗狂, 等.經皮膽道支架聯合125I粒子腔內植入治療惡性梗阻性黃疸的初步研究.中華放射學雜志, 2014, 48(5):403-407.
9.	侯森林, 喬占英, 康建省, 等.經內鏡置支架治療晚期惡性梗阻性黃疸.中國內鏡雜志, 2012, 18(11):1205-1208.
10.	范恒偉, 劉會春, 崔培元, 等.經皮膽道支架置入與姑息性膽腸內引流對胰頭癌所致梗阻性黃疸的療效比較.中華肝膽外科雜志, 2014, 20(2):92-96.
11.	陳萃, 李杰, 鄭軍, 等. ERCP下膽道內支架引流術治療老年梗阻性黃疸的療效及對免疫功能的影響.中國老年學雜志, 2013, 33(17):4309-4310.
12.	Boulay BR, Parepally M. Managing malignant biliary obstruction in pancreas cancer:choosing the appropriate strategy. World J Gastroenterol, 2014, 20(28):9345-9353.
13.	姜超, 劉家云, 翟兢, 等.白藜蘆醇退黃保肝作用及其與膽汁酸排泄的相關性研究.南京醫科大學學報:自然科學版, 2015, 46(10):1372-1376.
14.	王哲近, 陳海川, 俞海波. PTCD途徑膽道金屬支架置入術治療晚期胰頭癌的療效觀察.肝膽胰外科雜志, 2015, 27(6):494-496.
15.	李順宗, 武中林, 李智崗, 等.右側單通道雙支架技術治療惡性高位膽道梗阻.實用放射學雜志, 2013, 29(8):1311-1313.
16.	李明, 郝芳, 秦鳴放.超聲內鏡輔助治療惡性梗阻性黃疸105例.世界華人消化雜志, 2014, 22(5):685-689.
17.	李臻, 李婭, 李騰飛, 等.金屬膽道支架治療惡性梗阻性黃疸的臨床療效.中華肝臟病雜志, 2012, 20(11):843-847.
18.	王俊, 王霓.不同途徑膽道內支架置入治療惡性阻塞性黃疸.中國普通外科雜志, 2012, 21(2):219-222.
19.	Hong HP, Seo TS, Cha IH, et al. Percutaneous placement of self-expandable metallic stents in patients with obstructive jaundice secondary to metastatic gastric cancer after gastrectomy. Korean J Radiol, 2013, 14(5):789-796.
20.	Chatzis N, Pfiffner R, Glenck M, et al. Comparing percutaneous primary and secondary biliary stenting for malignant biliary obstruction:A retrospective clinical analysis. Indian J Radiol Imaging, 2013, 23(1):38-45.
21.	Kahaleh M, Talreja JP, Loren DE, et al. Evaluation of a fully covered self-expanding metal stent with flared ends in malignant biliary obstruction:a multicenter study. J Clin Gastroenterol, 2013, 47(10):96-100.
22.	Park S, Park JY, Bang S, et al. Radiotherapy prolongs biliary metal stent patency in malignant pancreatobiliary obstructions. Gut Liver, 2013, 7(4):480-485.

1. Yamamoto R, Takahashi M, Osafune Y, et al. Comparison of endoscopic stenting for malignant biliary obstruction:A single-center study. World J Gastrointest Endosc, 2015, 7(9):889-894.
2. Chung KH, Lee SH, Park JM, et al. Self-expandable metallic stents vs. plastic stents for endoscopic biliary drainage in hepatocellular carcinoma. Endoscopy, 2015, 47(6):508-516.
3. Alekseev KI, Maady AS, Osipov AS, et al. The experience of biliary self-expendable nitinol stents for malignant jaundice. Eksp Klin Gastroenterol, 2014, (3):81-87.
4. 張誠, 楊玉龍, 吳萍, 等.全覆膜自膨式可回收金屬支架治療惡性梗阻性黃疸的并發癥及防治策略.中華醫學雜志, 2015, 95(6):416-419.
5. 姚紅響, 陳根生, 葉冠雄, 等.單純膽道支架與125I粒子支架腔內照射治療惡性梗阻性黃疸.中華肝膽外科雜志, 2014, 20(12):869-872.
6. 吳杰, 宋磊, 趙丹懿, 等.胰腺癌梗阻性黃疸患者膽道內支架置入術后放化療療效分析.中華普通外科雜志, 2014, 29(8):626-629.
7. 馬鴻祥, 周鳴清.內鏡下膽道金屬支架引流術治療老年惡性梗阻性黃疸128例的療效觀察.重慶醫學, 2014, 43(7):871-873.
8. 王勇, 劉會春, 李宗狂, 等.經皮膽道支架聯合125I粒子腔內植入治療惡性梗阻性黃疸的初步研究.中華放射學雜志, 2014, 48(5):403-407.
9. 侯森林, 喬占英, 康建省, 等.經內鏡置支架治療晚期惡性梗阻性黃疸.中國內鏡雜志, 2012, 18(11):1205-1208.
10. 范恒偉, 劉會春, 崔培元, 等.經皮膽道支架置入與姑息性膽腸內引流對胰頭癌所致梗阻性黃疸的療效比較.中華肝膽外科雜志, 2014, 20(2):92-96.
11. 陳萃, 李杰, 鄭軍, 等. ERCP下膽道內支架引流術治療老年梗阻性黃疸的療效及對免疫功能的影響.中國老年學雜志, 2013, 33(17):4309-4310.
12. Boulay BR, Parepally M. Managing malignant biliary obstruction in pancreas cancer:choosing the appropriate strategy. World J Gastroenterol, 2014, 20(28):9345-9353.
13. 姜超, 劉家云, 翟兢, 等.白藜蘆醇退黃保肝作用及其與膽汁酸排泄的相關性研究.南京醫科大學學報:自然科學版, 2015, 46(10):1372-1376.
14. 王哲近, 陳海川, 俞海波. PTCD途徑膽道金屬支架置入術治療晚期胰頭癌的療效觀察.肝膽胰外科雜志, 2015, 27(6):494-496.
15. 李順宗, 武中林, 李智崗, 等.右側單通道雙支架技術治療惡性高位膽道梗阻.實用放射學雜志, 2013, 29(8):1311-1313.
16. 李明, 郝芳, 秦鳴放.超聲內鏡輔助治療惡性梗阻性黃疸105例.世界華人消化雜志, 2014, 22(5):685-689.
17. 李臻, 李婭, 李騰飛, 等.金屬膽道支架治療惡性梗阻性黃疸的臨床療效.中華肝臟病雜志, 2012, 20(11):843-847.
18. 王俊, 王霓.不同途徑膽道內支架置入治療惡性阻塞性黃疸.中國普通外科雜志, 2012, 21(2):219-222.
19. Hong HP, Seo TS, Cha IH, et al. Percutaneous placement of self-expandable metallic stents in patients with obstructive jaundice secondary to metastatic gastric cancer after gastrectomy. Korean J Radiol, 2013, 14(5):789-796.
20. Chatzis N, Pfiffner R, Glenck M, et al. Comparing percutaneous primary and secondary biliary stenting for malignant biliary obstruction:A retrospective clinical analysis. Indian J Radiol Imaging, 2013, 23(1):38-45.
21. Kahaleh M, Talreja JP, Loren DE, et al. Evaluation of a fully covered self-expanding metal stent with flared ends in malignant biliary obstruction:a multicenter study. J Clin Gastroenterol, 2013, 47(10):96-100.
22. Park S, Park JY, Bang S, et al. Radiotherapy prolongs biliary metal stent patency in malignant pancreatobiliary obstructions. Gut Liver, 2013, 7(4):480-485.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Compative Study of Biliary Metallic Stent Implantation Via ERCP and PTCD Approaches in Treatment of Malignant Obstructive Jaundice

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