The Comparison Of Bimetallic And Biplastic Stent Implantation In Patients With Bismuth Ⅳ Hilar Cholangiocarcinoma

Objective:To compare and analyze the safety and efficacy of metal and plastic stent implantation in the treatment of Bismuth IV hilar cholangiocarcinoma,explore the clinical application value of different stent types and stent implantation methods,and summarize the experience to provide the reference for choosing the appropriate stent implantation protocol for patients with Bismuth IV hilar cholangiocarcinoma.Methods:The retrospective analysis was carried out in 68 patients with Bismuth IV hilar cholangiocarcinoma who successfully underwent endoscopic retrograde cholangiopancreatography or percutaneous transh epatic cholangial drainage in our hospital from January 2014 to Dece mber 2019,and were completely followed up.All patients were divided into 2 groups firstly for comparison for the different stent types,including37 cases in bimetal stent group and 31 cases in biplastic group.Patients in the bimetallic stent group were further subdivided into two groups for comparison due to different implantation methods,including 22 cases in the PTCD group and 15 cases in the ERCP group.The liver functions(including total bilirubin,direct bilirubin,alanine aminotransferase,aspartate aminotransferase,alkaline phosphatase,glutamyl transpeptidase)before and 1 week after operation,the effective rate against jaundice,the incidence rates of postoperative complications(including biliary tract infection,hemorrhage,pancreatitis),stent blockage rate,stent patency duration and survival were collected to explore the advantages and disadvantages of different stent types and stent implantation methods for Bismuth IV hilar cholangiocarcinoma.Results:1.The liver function parameters of the patient after the stent implantation were significantly lower than those before the stent implantation(P<0.05).The effect against the jaundice in the biplastic stent group was inferior to that in the bimetallic stent group,and the difference was statistically significant(χ~2=4.746,P=0.029<0.05),however no significant difference was observed between the PTCD group and the ERCP group(χ~2=2.209,P=0.137>0.05).2.No statistical difference was observed in the incidence rates of various postoperative complications between the bimetallic stent group and the biplastic stent group(P>0.05).However,the incidence rate of postoperative biliary tract infection in the ERCP group was higher than that in the PTCD group,and the difference was statistically significant(χ~2=5.440,P=0.020<0.05).3.The stent blockage rate of the bimetallic stent group was lower than that of the biplastic stent group(χ~2=4.446,P=0.035<0.05),however,no significant difference was observed between the PTCD group and the ERCP group(P>0.05).4.Compared with the biplastic stent group,the bimetallic stent group had longer median stent patency duration(169±9.326d VS117±11.623d,P<0.05)and longer median survival of patient(185±10.945d VS 119±16.695d,P<0.05).However,no statistical significance was observed in the median stent patency duration(166±14.127d VS169±16.027d,P>0.05)and the median survival of the patient(185±17.003d VS 179±21.254d,P>0.05)between the PTCD group and the ERCP group.Conclusions:1.Both bimetallic stents and biplastic stents can effectively alleviate jaundice in patients with Bismuth IV hilar cholangiocarcinoma,but bimetallic stent has superior jaundice alleviation.2.Compared with biplastic stent,the bimetallic stent has lower blockage rate,longer stent patency duration and patient survival.3.The PTCD stent implantation and the ERCP stent implantation are both safe and effective in the treatment of Bismuth IV hilar cholangio carcinoma,but the PTCD stent implantation shows lower incidence rate of biliary tract infections.