Long-Term Experience in Wallstent Therapy for Malignant Choledochal Stenosis
Long-Term Experience in Wallstent Therapy for Malignant Choledochal Stenosis
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壁支架治疗恶性胆总管狭窄的长期经验
DOI：
10.1055/s-2007-1009046
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发表时间：
1994
期刊：
影响因子：
9.3
通讯作者：
W. Domschke
中科院分区：
文献类型：
--
作者：
N. Hoepffner;E. Foerster;B. Högemann;W. Domschke
截至 1993 年 5 月的四年期间，118 名恶性胆管狭窄患者（平均年龄 69 岁）接受了总共 127 个自膨胀 10 毫米金属内置假体（Wallstent）的治疗，其中大多数是通过内窥镜治疗的（n = 102）。 5 例（4.2%）在植入期间和植入后不久出现技术问题，但均可以通过内窥镜解决。血清胆红素从就诊时的平均 8.0 mg/dl 降至支架植入后的平均 2.0 mg/dl。 19名患者在前三个月内死亡（5%在前30天内死亡）； 14% 的患者出现复发性梗阻，表现为复发性黄疸或胆管炎，或两者兼而有之。对 51 名存活时间较长的患者进行了随访直至死亡或至少 12 个月（平均随访：12 个月）。该组的支架通畅率分别为 86%（6 个月）、72%（12 个月）和 64%（18 个月），这些时间段的生存率分别为 63%、35% 和 17%。没有发现明显的支架相关并发症；平均 168 天后，12% 的患者发生支架闭塞，所有病例均通过内窥镜成功处理（热清洁、植入更多支架）。我们从长期随访数据中得出结论，存活超过三个月的患者最有可能从插入 Wallstent 治疗恶性黄疸中受益。
During a four-year period up to May 1993, 118 patients (mean age 69 years) with malignant bile duct stenoses were treated with a total of 127 selfexpanding 10-mm metal endoprostheses (Wallstent), most of them endoscopically (n = 102). Technical problems during and shortly after implantation occurred in five cases (4.2%), but could all be solved endoscopically. Serum bilirubin decreased from a mean of 8.0 mg/dl at presentation to a mean of 2.0 mg/dl after stenting. Nineteen patients died within the first three months (5% within the first 30 days); recurrent obstruction, as manifested by recurrent jaundice or cholangitis, or both, was encountered in 14%. Fifty-one patients who survived longer were followed up until death or for a minimum of 12 months (mean follow-up: 12 months). Stent patency rates in this group were 86% (six months), 72% (12 months) and 64% (18 months), survival for these time periods being 63%, 35% and 17%, respectively. No significant stent-related complications were noted; stent occlusion occurred in 12% of patients after a mean of 168 days, and was successfully managed endoscopically (thermal cleaning, implantation of further stents) in all cases. We conclude from our long-term follow-up data that patients surviving longer than three months are the ones most likely to benefit from Wallstent insertion for malignant jaundice.