Background

To date, there is controversy regarding unilateral versus bilateral stent placement in patients with malignant hilar biliary strictures (MHBSs). The aim of this study was to compare the clinical outcomes and complications of unilateral and bilateral (stent-in-stent method) stent placements for these patients.

Methods

We conducted a multicenter retrospective analysis of patients with inoperable MHBS who underwent endoscopic self-expandable metal stent (SEMS) placement from January 2009 to December 2019. Two groups classified according to the stent procedure method were compared for demographic, procedural, and postprocedure factors. Survival analysis for patency loss and overall survival was also conducted.

Results

A total of 236 subjects were included. A superior technical success rate was found in the unilateral stent group (98.8% vs. 82.5%, P < 0.001), whereas the clinical success rate was higher in the bilateral group (85.7% vs. 70.5%, P = 0.028). There was no significant difference with respect to complications or patency loss, and the bilateral group had better overall survival (P < 0.01). In the Cox proportional hazard model, MHBSs from lymph node compression were associated with a higher risk of death (HR = 9.803, P = 0.003). In contrast, bilateral SEMS insertion showed reduced postprocedural mortality (HR = 0.316, P = 0.001).

Conclusions

Y-type stent-in-stent bilateral SEMSs are technically difficult but demonstrated more favorable overall survival for palliative bile drainage of inoperable MHBS patients compared to unilateral insertions.

中文翻译：

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单侧与双侧 Y 型支架内金属支架置入无法手术的恶性肝门胆道狭窄：一项多中心回顾性研究

背景

迄今为止，关于恶性肝门胆管狭窄（MHBS）患者的单侧支架与双侧支架置入存在争议。本研究的目的是比较这些患者单侧和双侧（支架内支架法）支架置入的临床结果和并发症。

方法

我们对 2009 年 1 月至 2019 年 12 月接受内镜下自膨胀金属支架 (SEMS) 置入的无法手术的 MHBS 患者进行了多中心回顾性分析。比较了根据支架手术方法分类的两组人口、手术和手术后因素。还进行了通畅丧失和总生存期的生存分析。

结果

共纳入 236 名受试者。单侧支架组的技术成功率更高（98.8% vs. 82.5%，P < 0.001），而双侧支架组的临床成功率更高（85.7% vs. 70.5%，P  = 0.028）。并发症或通畅丢失无显着差异，双侧总生存期较好（P < 0.01）。在 Cox 比例风险模型中，淋巴结压迫导致的 MHBS 与较高的死亡风险相关（HR = 9.803，P  = 0.003）。相比之下，双侧 SEMS 插入显示术后死亡率降低（HR = 0.316，P  = 0.001）。

结论

Y 型支架内支架双侧 SEMS 在技术上很困难，但与单侧置入相比，对于不能手术的 MHBS 患者的姑息性胆汁引流，其总体生存率更高。