Biliary Stenting for Unresectable Malignant Biliary Obstruction Biliary self-expandable metallic stent for unresectable malignant distal biliary obstruction: Which is better: covered or uncovered?
Biliary Stenting for Unresectable Malignant Biliary Obstruction Biliary self-expandable metallic stent for unresectable malignant distal biliary obstruction: Which is better: covered or uncovered?
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用于治疗不可切除的恶性胆道梗阻的胆道支架置入术 用于治疗不可切除的恶性远端胆道梗阻的胆道自膨式金属支架：覆盖式还是非覆盖式，哪个更好？
DOI：
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发表时间：
2013
期刊：
影响因子：
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通讯作者：
K. Koike
中科院分区：
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作者：
H. Isayama;Y. Nakai;H. Kogure;N. Yamamoto;K. Koike
自膨式金属支架（SEMS）是一种广泛接受的胆道内支架，用于治疗无法切除的恶性远端胆道梗阻患者。有两种类型的SEMS：覆盖和未覆盖。未覆盖的SEMS（UCSEMS）由于其网状结构和自扩张性而嵌入胆管壁中，并且抗迁移。然而，UCSEMS的缺点是由于肿瘤通过支架网向内生长（TI）而导致闭塞，TI是UCSEMS闭塞的主要原因。为了克服这一点，开发了覆膜SEMS（CSEMS），其通畅性长于UCSEMS。然而，由于未嵌入的支架体而导致的移位是CSEMS功能障碍的主要原因。有一些比较CSEMS和UCSEMS的随机研究;然而，每个研究的结果都不同。根据一项荟萃分析，CSEMS显示通畅率长于UCSEMS。文献综述显示，覆盖SEMS的通畅性长于UCSEMS。一些研究无法明确证明CSEMS的优效性，因为所用CSEMS无法预防TI或移位。SEMS的力学性能可能会影响并发症的发生。最近一项比较覆膜Wallstent和覆膜WallFlex的临床研究显示WallFlex在预防移位方面具有优效性。减小轴向力和增大径向力可导致良好的结果。应通过考虑支架的机械性能和抗迁移系统的开发来防止CSEMS迁移。
Self-expandable metallic stents (SEMS) are a widely accepted biliary endoprosthesis for patients with unresectable malignant distal biliary obstruction. There are two types of SEMS: covered and uncovered. Uncovered SEMS (UCSEMS) embed into the biliary wall due to their mesh structure and self-expandability, and are resistant to migration. However, the disadvantage of UCSEMS is occlusion due to tumor ingrowth (TI) via the stent mesh, and TI is the main cause of UCSEMS occlusion. To overcome this, covered SEMS (CSEMS) were developed and showed longer patency than UCSEMS. However, migration due to the non-embedded stent body is the main cause of CSEMS dysfunction. There are some randomized studies comparing CSEMS and UCSEMS; however, the results are different according to each study. From one meta-analysis, CSEMS showed longer patency than UCSEMS. A literature review revealed that covered SEMS showed longer patency than UCSEMS. Some studies cannot clearly demonstrate the superiority of CSEMS, as the CSEMS used did not prevent TI or migration. Mechanical properties of SEMS may influence the occurrence of complications. A recent clinical study comparing the Covered Wallstent and the Covered WallFlex revealed superiority of the WallFlex for the prevention of migration. Reducing the axial force and increasing the radial force may lead to good results. Migration of CSEMS should be prevented by taking into consideration the mechanical properties of stents and development of anti-migration systems.
Isayama H、Komatsu Y、Tsujino T、Yoshida H、Tada M、Shiratori Y、Kawabe T、Omata M：“用于治疗远端恶性胆道梗阻的聚氨酯覆盖金属支架。”胃肠内镜。
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