Biliary tract stents implantation combined with percutaneous portcatheter system in treating hilar cholangiocarcinoma: Does the selection of stent types have effect on therapeutic efficacy? / 中国组织工程研究

ABSTRACT

BACKGROUND:It generally thought that based on cholangiography,biliary tract stents implantation can achieve a same long-term therapeutic efficacy as resection,and obtain good clinical outcomes in treating hilar cholangiocarcinoma when combined with percutaneous portcatheter system.OBJECTIVE:To evaluate the clinical methods of double interventional therapy and the biocompatibility between stent and host in hilar cholangiocarcinoma following stant implantation.METHODS:The databases of MEDLINE,Cochrane library,CNKI and VIP were retrieved with deadline of August 2009.Medium survival time and jaundice decrease rate,complication rate as well as biocompatibility between stent and host were sewed as assessment index.Clinical studies addressing double interventional therapy for treating proximal bile duct cancer were included,and animal studies were excluded.A total of 156 literatures were obtained initially by computer,and 25 literatures were included in further analysis.RESULTS AND CONCLUSION:In vitro test showed that stents carrying antibiotic,silver,or Escherichia coil,which may prevent adhesion of bacteria,however,it obtained poor clinical results.Chitosan is a natural cationic polymer and possess good biocompatibility,antibiosis and biodegradability.For the compare of the therapeutic effectiveness among different surgical procedure,it found that the decrease of total bilirubin were more faster in the internal and external drainage group than the resection group,however,the difference had no statistically significance.According to the Kaplan-Meier survival analysis,the medium survival time of 7 patients in the resection group was 16 months.The 1,3,5 years survival rate were 57.1%(4/7),28.6%(2/7),14.3%(1/7),respectively.Among the double interventional therapy group,the medium survival time of 19 patients was 18 months,and the 1,3,5 years survival rate were 52.6%(10/19),27.8%(5/19),15.8%(3/19),respectively.The medium survival time was 12 months in 14 patients of the control group,with 1,3,5 years survival rate of 57.1%,28.6%,14.2%,respectively.The results demonstrated that biliary tract stents implantation combined with percutaneous portcatheter system can improve life quality and prolong survival time of patients with hilar cholangiocarcinoma.