Metal stent implantation for palliation of malignant biliary obstruction - a report of 57 cases

摘要

AIMS To report the first experience in China in the treatment of malignant biliary obstruction with expandable metal stent which allows the insertion of an endo-prosthesis as large as one cm in diameter. METHODS Between April 1994 and May 1996, we implanted expandable metal stents in 57 patients with incurable malignant biliary obstruction, among whom 54 underwent endoscopic procedure and the other 3 received percutaneous transhepatic placement. RESULTS Insertion of the stent following guidewire positioning was successful in 95% of the patients. Two patients developed cholangitis after stent insertion and were successfully treated with conservative treatment. The jaundice was eliminated completely in 21 cases and markedly decreased in 23 cases within 2 weeks after placement of the stent. Nine patients, however, had late cholangitis due to stent failure after a median interval of 14 days. Twenty-three cases underwent na-sobiliary transient drainage and 3 underwent plastic stent transient drainage prior to metal stent insertion. Transient drainage was believed to have the advantages of drainage pre-assessment and infection controlling. CONCLUSIONS Our results show that expandable metal stent is suitable for the irresectable malignant choledochal stenosis. It can eliminate the jaundice and improve the patient's life quality. To get the highest benefit, however, the indication should be strictly selected. And to get long-term patency, the proximal and distal end of the stent proceeding the tumor should be no shorter than 2cm. In the case of hilar cancer, Bismuth classification is greatly helpful for the choice of drainage site.