Management of dysfunctional covered self-expandable metallic stents in patients with malignant distal biliary obstruction
Management of dysfunctional covered self-expandable metallic stents in patients with malignant distal biliary obstruction
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DOI：
10.1007/s00535-013-0751-z
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发表时间：
2013-11-01
影响因子：
6.3
通讯作者：
Koike, Kazuhiko
中科院分区：
文献类型：
--
作者：
Togawa, Osamu;Isayama, Hiroyuki;Koike, Kazuhiko
内镜下放置有盖自膨胀金属支架（CSEMSs）是有效的远端恶性胆道梗阻。然而，功能失调的CSEMSs的管理尚未建立。在1998年3月至2007年7月期间，共分析74例因cems功能障碍而接受内镜再干预的患者。内镜下进行第二次支架置入（CSEMS或塑料支架）或对闭塞的CSEMS进行机械清洗。计算第二次置入支架至支架功能障碍或患者死亡的时间（至功能障碍的时间；TTD）。清洗后的初始csem作为第二支架进行分析。cems组37例患者中有17例（45.9%）出现第二支架功能障碍，塑料支架组20例中有16例（80.0%）出现第二支架功能障碍，清洁组17例中有13例（76.5%）出现第二支架功能障碍。两组患者的平均治疗时间分别为176天、57天和46天。cems组累积TTD明显高于塑料支架组和清洁组（P = 0.08）。从多因素分析来看，第一根CSEMS的污泥闭塞被确定为第二次支架功能障碍的重要危险因素（HR, 2.51; 95% CI, 1.19-5.46），放置第二根CSEMS可显著降低功能障碍的风险（HR, 0.39; 95% CI, 0.18-0.79）。对于功能失调的CSEMS，应考虑植入新的CSEMS作为治疗的选择。
Endoscopic placement of covered self-expandable metallic stents (CSEMSs) is effective for distal malignant biliary obstruction. However, management of dysfunctional CSEMSs has not been established.Between March 1998 and July 2007, a total of 74 patients who underwent endoscopic re-interventions for CSEMS dysfunction were analyzed. Second stent insertion (CSEMS or plastic stent) or mechanical cleaning of the occluded CSEMS was performed endoscopically. The period between second stent insertion and stent dysfunction or patient death (time to dysfunction; TTD) was calculated. The cleaned initial CSEMSs were analyzed as second stents.Dysfunction of the second stent occurred in 17 of 37 patients (45.9 %) in the CSEMS group, 16 of 20 (80.0 %) in the plastic stent group, and 13 of 17 (76.5 %) in the cleaning group. The median TTD of each group was 176, 57, and 46 days, respectively. The cumulative TTD was significantly higher in the CSEMS group than in the plastic stent and cleaning groups (P = 0.08). From the multivariate analysis, sludge occlusion of the first CSEMS was identified as a significant risk factor for second stent dysfunction (HR, 2.51; 95 % CI, 1.19-5.46), and placement of the second CSEMS significantly reduced the risk of dysfunction (HR, 0.39; 95 % CI, 0.18-0.79).Insertion of a new CSEMS should be considered as the treatment of choice for the management of dysfunctional CSEMSs.