Endoscopic Stent Placement For Hilar Cholangiocarcinoma

Object:To investigate the therapeutic effect of endoscopic stent placement in patients with hilar cholangiocarcinoma and the difference between unilateral stent placement and bilateral stent placement.Methods:1.A retrospective analysis was made of 70 patients with hilar cholangiocarcinoma(HCCA)who underwent endoscopic retrograde cholangiopancreatography(ERCP)stent placement from January 2014 to January 2017.Among them,63 patients were successfully implanted stent.Total bilirubin(Tbil)?alanine aminotransferase(ALT)?aspartate aminotransferase(AST),glutamyl transpeptadase(GGT)and alkaline phosphatase(ALP)were measured in 63 patients before operation and after operation.Then compare the preoperative and postoperative values.2.Among the 70 HCCA patients included in the study,60 cases of type III and type IV were implanted with plastic stents.According to the number of plastic stents,they were divided into 33 cases in single plastic stent group and 27 cases in double plastic stent group.The success rates of stent implantation in the two groups were compared.Fifty-three HCCA patients with type III and type IV who were successfully implanted stents were divided into unilateral stent group(group A)31 cases and bilateral stent group(group B)22 cases.Compare the effective rate of reducing jaundice,the incidence of complications,the median patency period of stent and the median survival period of patients between the two groups.Result:1.The indexes of liver function in 63 patients after operation were significantly lower than those before operation(P<0.05);Postoperative clinical symptoms were significantly alleviated.2.There was no difference in the success rate of stent implantation between unilateral stent group and bilateral stent group(93.94%VS 81.48%,P>0.05);There was no significant difference in drainage efficiency between group A and B(58.06%VS72.73%,P>0.05);The overall incidence of complications in group B was higher than that in group A(54.55%VS25.81%,P<0.05),and the incidence of cholangitis was also higher than that in group A(31.82%VS6.45%,P<0.05),there was no significant difference in the incidence of acute pancreatitis(9.68%VS18.18%,P>0.05)and transient hyperamylasemia(3.23%VS9.09%,P>0.05)between groups A and B;The median patency was 130 days in group A and 143 days in group B,there was no difference between the two groups(X~2=3.567,P>0.05);The median survival time of group A was 233 days,while that of group B was 267 days,there was no significant difference(X~2=1.494,P>0.05).Conclusion:1.Endoscopic stent implantation can significantly improve liver function and prolong survival in patients with hilar cholangiocarcinoma in a short period of time.2.Compared with bilateral plastic stent placement,unilateral plastic stent placement for hilar cholangiocarcinoma patients can achieve the same biliary drainage efficacy.