Endoscopic reintervention for stent malfunction after stent-in-stent deployment for malignant hilar obstruction.
Endoscopic reintervention for stent malfunction after stent-in-stent deployment for malignant hilar obstruction.
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DOI：
10.1097/md.0000000000008867
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发表时间：
2017-12
期刊：
影响因子：
1.6
通讯作者：
Choi WH
中科院分区：
文献类型：
--
作者：
Hong JB;Kang DH;Nam HS;Choi CW;Kim HW;Park SB;Kim SJ;Choi WH
内镜下双侧支架植入术越来越多地用于晚期肝门梗阻。随着疾病的进展，最终会发生支架故障。然而，这些患者的内镜下再介入是困难的。我们的目的是评价支架中支架（SIS）展开治疗恶性肺门梗阻后支架故障的适当再介入手术。在2009年9月至2016年6月期间使用SIS方法进行双侧支架植入术的52例患者中，20例支架故障患者入组本研究。通过内镜或经皮穿刺进行再次介入。回顾性评估了技术和功能成功率。内镜再次介入的技术和功能成功率分别为83%（10/12）和80%（8/10）。内镜下双侧和单侧再介入成功率分别为75%（6/8）和100%（4/4）。对于双侧再次介入，使用塑料或塑料和金属支架。如果患者在因恶性肺门梗阻置入SIS后情况良好，则可考虑对支架内故障进行内镜下再介入。关于是否使用双侧或单侧引流以及使用的支架类型的决定应取决于疾病和患者的情况。
Endoscopic bilateral stenting has been increasingly performed for advanced hilar obstruction. As disease progresses, stent malfunction eventually occurs. However, endoscopic reintervention is difficult in these patients. We aimed to evaluate a suitable reintervention procedure for stent malfunction after stent-in-stent (SIS) deployment for malignant hilar obstruction. Among 52 patients with bilateral stenting performed using the SIS method between September 2009 and June 2016, 20 patients with stent malfunction were enrolled in this study. Reintervention was performed endoscopically or percutaneously. Technical and functional success rates were evaluated retrospectively. Technical and functional success rates of endoscopic reintervention were 83% (10/12) and 80% (8/10), respectively. Endoscopic bilateral and unilateral reintervention success rates were 75% (6/8) and 100% (4/4), respectively. For bilateral reintervention, either plastic or plastic and metal stents were used. Endoscopic reintervention could be considered for in-stent malfunction if patients are in fair condition after SIS placement for malignant hilar obstruction. Decisions regarding whether to use bilateral or unilateral drainage and the type of stent to use should depend on the conditions of the disease and the patient.