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.	张诚, 杨玉龙, 吴萍, 等.全覆膜自膨式可回收金属支架治疗恶性梗阻性黄疸的并发症及防治策略.中华医学杂志, 2015, 95(6):416-419.
5.	姚红响, 陈根生, 叶冠雄, 等.单纯胆道支架与125I粒子支架腔内照射治疗恶性梗阻性黄疸.中华肝胆外科杂志, 2014, 20(12):869-872.
6.	吴杰, 宋磊, 赵丹懿, 等.胰腺癌梗阻性黄疸患者胆道内支架置入术后放化疗疗效分析.中华普通外科杂志, 2014, 29(8):626-629.
7.	马鸿祥, 周鸣清.内镜下胆道金属支架引流术治疗老年恶性梗阻性黄疸128例的疗效观察.重庆医学, 2014, 43(7):871-873.
8.	王勇, 刘会春, 李宗狂, 等.经皮胆道支架联合125I粒子腔内植入治疗恶性梗阻性黄疸的初步研究.中华放射学杂志, 2014, 48(5):403-407.
9.	侯森林, 乔占英, 康建省, 等.经内镜置支架治疗晚期恶性梗阻性黄疸.中国内镜杂志, 2012, 18(11):1205-1208.
10.	范恒伟, 刘会春, 崔培元, 等.经皮胆道支架置入与姑息性胆肠内引流对胰头癌所致梗阻性黄疸的疗效比较.中华肝胆外科杂志, 2014, 20(2):92-96.
11.	陈萃, 李杰, 郑军, 等. ERCP下胆道内支架引流术治疗老年梗阻性黄疸的疗效及对免疫功能的影响.中国老年学杂志, 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, 刘家云, 翟兢, 等.白藜芦醇退黄保肝作用及其与胆汁酸排泄的相关性研究.南京医科大学学报:自然科学版, 2015, 46(10):1372-1376.
14.	王哲近, 陈海川, 俞海波. PTCD途径胆道金属支架置入术治疗晚期胰头癌的疗效观察.肝胆胰外科杂志, 2015, 27(6):494-496.
15.	李顺宗, 武中林, 李智岗, 等.右侧单通道双支架技术治疗恶性高位胆道梗阻.实用放射学杂志, 2013, 29(8):1311-1313.
16.	李明, 郝芳, 秦鸣放.超声内镜辅助治疗恶性梗阻性黄疸105例.世界华人消化杂志, 2014, 22(5):685-689.
17.	李臻, 李娅, 李腾飞, 等.金属胆道支架治疗恶性梗阻性黄疸的临床疗效.中华肝脏病杂志, 2012, 20(11):843-847.
18.	王俊, 王霓.不同途径胆道内支架置入治疗恶性阻塞性黄疸.中国普通外科杂志, 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. 张诚, 杨玉龙, 吴萍, 等.全覆膜自膨式可回收金属支架治疗恶性梗阻性黄疸的并发症及防治策略.中华医学杂志, 2015, 95(6):416-419.
5. 姚红响, 陈根生, 叶冠雄, 等.单纯胆道支架与125I粒子支架腔内照射治疗恶性梗阻性黄疸.中华肝胆外科杂志, 2014, 20(12):869-872.
6. 吴杰, 宋磊, 赵丹懿, 等.胰腺癌梗阻性黄疸患者胆道内支架置入术后放化疗疗效分析.中华普通外科杂志, 2014, 29(8):626-629.
7. 马鸿祥, 周鸣清.内镜下胆道金属支架引流术治疗老年恶性梗阻性黄疸128例的疗效观察.重庆医学, 2014, 43(7):871-873.
8. 王勇, 刘会春, 李宗狂, 等.经皮胆道支架联合125I粒子腔内植入治疗恶性梗阻性黄疸的初步研究.中华放射学杂志, 2014, 48(5):403-407.
9. 侯森林, 乔占英, 康建省, 等.经内镜置支架治疗晚期恶性梗阻性黄疸.中国内镜杂志, 2012, 18(11):1205-1208.
10. 范恒伟, 刘会春, 崔培元, 等.经皮胆道支架置入与姑息性胆肠内引流对胰头癌所致梗阻性黄疸的疗效比较.中华肝胆外科杂志, 2014, 20(2):92-96.
11. 陈萃, 李杰, 郑军, 等. ERCP下胆道内支架引流术治疗老年梗阻性黄疸的疗效及对免疫功能的影响.中国老年学杂志, 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, 刘家云, 翟兢, 等.白藜芦醇退黄保肝作用及其与胆汁酸排泄的相关性研究.南京医科大学学报:自然科学版, 2015, 46(10):1372-1376.
14. 王哲近, 陈海川, 俞海波. PTCD途径胆道金属支架置入术治疗晚期胰头癌的疗效观察.肝胆胰外科杂志, 2015, 27(6):494-496.
15. 李顺宗, 武中林, 李智岗, 等.右侧单通道双支架技术治疗恶性高位胆道梗阻.实用放射学杂志, 2013, 29(8):1311-1313.
16. 李明, 郝芳, 秦鸣放.超声内镜辅助治疗恶性梗阻性黄疸105例.世界华人消化杂志, 2014, 22(5):685-689.
17. 李臻, 李娅, 李腾飞, 等.金属胆道支架治疗恶性梗阻性黄疸的临床疗效.中华肝脏病杂志, 2012, 20(11):843-847.
18. 王俊, 王霓.不同途径胆道内支架置入治疗恶性阻塞性黄疸.中国普通外科杂志, 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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