恶性胆道梗阻的介入治疗:是改变模式的时候了吗?

IF 1.5 Q3 GASTROENTEROLOGY & HEPATOLOGY
B. Hristov, D. Doykov, Vladimir Andonov, M. Doykov, K. Kraev, P. Uchikov, Rosen Dimov, G. Kostov, Siyana Valova, K. Doykova, D. Chakarov, Milena Sandeva
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引用次数: 0

摘要

导言。胆道梗阻是胆胰恶性肿瘤的常见表现,缓解胆道梗阻是治疗方案的重要组成部分。目前,治疗恶性胆道梗阻有三种技术--内镜逆行胰胆管造影术(ERCP)、经皮经肝胆道引流术(PTBD)和内镜超声引导胆道引流术(EUS-BD)。ERCP已被作为一线治疗方法,但EUS-BD正逐渐成为一种可行的替代方法。本文旨在评估这三种非手术胆道引流术的临床效果。材料和方法。本研究回顾性地纳入了102例不可切除的胆胰恶性肿瘤引起胆道梗阻并通过ERCP、EUS-BD或PTBD接受姑息治疗的连续患者。研究结果在临床和技术成功率方面没有发现差异:ERCP的技术成功率为97.2%,临床成功率为88.9%;PTBD的技术成功率为94.4%,临床成功率为72.2%;EUS-BD的技术成功率为90%,临床成功率为83.3%。与EUS-BD(10%和3.3%)相比,PTBD(38.9%和52.8%)和ERCP(27.9%和25%)的不良事件(AEs)和再次干预的发生率明显更高。与 PTBD 和 ERCP 组相比,EUS-BD 组的总住院时间和住院次数较少。结论。在有足够专业知识的情况下,对于无法切除的恶性肿瘤,EUS-BD 在实现和维持胆道引流方面可能优于 PTBD 和 ERCP。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Interventional Treatment of Malignant Biliary Obstruction: Is It Time to Change the Paradigm?
Introduction. Biliary obstruction is a common manifestation of biliopancreatic malignancies, and its relief is an essential part of the treatment algorithm. Currently, there are three techniques to manage malignant biliary obstruction—endoscopic retrograde cholangiopancreatography (ERCP), percutaneous transhepatic biliary drainage (PTBD), and endoscopic ultrasound-guided biliary drainage (EUS-BD). ERCP has been adopted as a first-line treatment modality but EUS-BD is gradually emerging as a viable alternative. The aim of the current article is to assess the clinical outcomes of the three nonsurgical biliary drainage procedures. Materials and methods. A total of 102 consecutive patients with unresectable biliopancreatic malignancy inducing biliary obstruction and subjected to palliative treatment by means of ERCP, EUS-BD, or PTBD were retrospectively included in the study. Results. No difference in clinical and technical success of the procedures was found: ERCP—97.2% technical; 88.9% clinical; PTBD—94.4% technical, 72.2% clinical; EUS-BD—90% technical; 83.3% clinical. Adverse events (AEs) and reinterventions were significantly more common in PTBD (38.9% and 52.8%) and ERCP (27.9% and 25%) compared to EUS-BD (10% and 3.3%). Total duration of hospital stay and number of hospitalizations were lower in the EUS-BD compared to PTBD and ERCP groups. Conclusions. In the presence of adequate expertise, EUS-BD may be superior to PTBD and ERCP in achieving and sustaining biliary drainage in the setting of unresectable malignancy.
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来源期刊
Gastroenterology Insights
Gastroenterology Insights GASTROENTEROLOGY & HEPATOLOGY-
CiteScore
2.80
自引率
3.40%
发文量
35
审稿时长
10 weeks
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