| Background and objective: Hilar cholangiocarcinoma(HCCA)has an insidious onset,lacks specific clinical manifestations and signs in the early stage.Therefore,the diagnosis rate is low,and the operation opportunity is often lost at the time of discovery,which leads to low surgical resection rate and poor prognosis.For this group of patients who have no chance of surgery or refuse surgery,the Endoscopic biliary stenting(EBS)or the Percutaneous transhepatic biliary stenting(PTBS)is adopted to timely remove biliary obstruction and improve abnormal liver function,which has positive significance in improving the quality of life and prolonging survival.However,little is known about which is the better option in these patients.The purpose of this study was to retrospectively analyze and compare EBS and PTBS in the treatment of Bismuth type Ⅲor Ⅳ unresectable hilar cholangiocarcinoma,to make an objective evaluation of the two treatment methods and to provide an objective reference for clinicians to make treatment decisions.Methods: A retrospective analysis was performed on 87 patients with Bismuth typeⅢ or Ⅳ unresectable hilar cholangiocarcinoma who were admitted to the Second Affiliated Hospital of Guangzhou Medical University and received EBS or PTBS treatment from January 1,2016 to January 1,2020.49 of the patients were treated with EBS and 38 with PTBS.The effect of jaundice reduction,liver function improvement,incidence of postoperative complications,stent patency time and survival time of patients in the two groups were collected and compared respectively.Results: 1.There was no statistical difference in preoperative general clinical data between the two groups(P>0.05).The indexes of TBIL,ALT,AST and GGT in the two groups decreased to varying degrees after surgery(P<0.05),but there was no statistical difference in degrees of liver function improvement between the two groups(P>0.05).The effective rate of drainage was 85.7% in the EBS group and 78.9% in the PTBS group,respectively,and there was no statistical difference between the two groups(P=0.407).2.The overall postoperative complication rates in the two groups was 28.6% and36.8%,respectively,with no statistical difference(P=0.413).The incidence of postoperative acute pancreatitis in the EBS group was higher(P=0.043),and the incidence of postoperative electrolyte disturbance in the PTBS group was higher(P=0.040),both of which were statistical different.3.A total of 72 of the 87 patients had effective biliary drainage with an overall median stent patency time of 140 days,and the patency rates at 3 months and 6 months were90.2% and 13.5%,respectively.The median stent patency time in the EBS group was 143 days,and the patency rates at 3 months and 6 months were 90.5% and 12.4%,respectively.The median stent patency time in PTBS group was 131 days,and the patency rates at 3months and 6 months were 90.0% and 15.7%,respectively,with no statistical difference between the two groups(χ2=0.989,P=0.320).The number of stents was the influencing factor of stent patency rate(χ2=12.855,P<0.001).The median patency time of single stents was 133 days,while that of double stents was 160 days.4.The overall median survival time of the 87 patients was 205 days,and the 6-month and 12-month cumulative survival rates were 64.2% and 8.3%.The median survival time of the EBS group was 230 days,and the 6-month and 12-month cumulative survival rates were 69.9% and 11.8%.The median survival time of the PTBS group was 218 days,and the 6-month and 12-month cumulative survival rates were 66.4% and 4.4%.There was no statistical difference between the two groups(χ2=0.257,P=0.612).Univariate analysis showed that the number of stents and the effect of biliary drainage were related to overall survival.Multivariate Cox regression analysis showed that the effect of biliary drainage(HR=13.375,P<0.001)was an independent prognostic factor for overall survival.Median survival time was 240 days for patients with effective biliary drainage and 120 days for those with ineffective biliary drainage.Conclusion: 1.For the patients with Bismuth type Ⅲ or Ⅳ unresectable hilar cholangiocarcinoma,timely removal of biliary obstruction and improvement of abnormal liver function are the key to prolong their survival time.Endoscopic biliary stenting(EBS)and Percutaneous transhepatic biliary stenting(PTBS)can both play a role in this effect.There were no significant differences in the degree of liver function improvement,overall postoperative complication rate,stent patency time and survival time between the two groups.2.Compared with unilateral stent,bilateral stent has more advantages in terms of stent patency time,and Bilateral stent drainage can be given priority when technical conditions permit. |
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