Knitted nitinol stent insertion for various intestinal stenoses with a modified delivery system.
Knitted nitinol stent insertion for various intestinal stenoses with a modified delivery system.
复制标题
通过改进的输送系统插入针织镍钛合金支架，用于各种肠道狭窄。
DOI：
10.1067/mge.2001.116882
复制
发表时间：
2001
影响因子：
7.7
通讯作者：
Y. Sakai
中科院分区：
文献类型：
--
作者：
I. Maetani;T. Ukita;H. Inone;M. Yoshida;Y. Igarashi;Y. Sakai
背景
金属支架植入治疗食管狭窄是公认的，但这些支架在技术上难以放置在胃肠道的其他地方。此外，当在这些位置放置具有尖锐末端的金属支架时，会发生严重的并发症。目前可用的柔性、钝端、编织镍钛合金支架仅适用于食道。由于其短输送系统无法到达食管远端的肠段，因此对输送装置进行了改良，以便于肠道进入，并评价了其在治疗恶性肠梗阻中的性能。
方法
通过连接额外的塑料管和缝合线对Ultraflex输送系统进行了改良;长度从95 cm增加到150 cm或更长。所用支架直径为18 - 23 mm，长度为10 - 15 cm。10例患者（7例男性，3例女性，平均年龄68岁）使用改良输送系统插入编织金属支架; 8例胃出口，1例空肠，1例近端结肠梗阻。
结果
所有患者的金属支架插入均成功，症状明显缓解，进食能力恢复。由于初始支架弯曲，使用空肠支架的患者需要置入第二枚支架。未发生重大并发症（移位或穿孔）。
结论
该技术似乎有助于在十二指肠、小肠和近端结肠中放置钝端金属支架。制造商应提供带有长输送装置的钝端支架。
BACKGROUND
Insertion of metallic stents for esophageal stenoses is well established, but these stents are technically difficult to place elsewhere in the GI tract. Moreover, major complications have occurred when metal stents with sharp ends have been placed in these locations. The currently available flexible, blunt-ended, knitted nitinol stent is intended for use only in the esophagus. Because its short delivery system cannot reach segments of the gut distal to the esophagus, the delivery device was modified to facilitate intestinal access, and its performance was evaluated in the treatment of malignant intestinal obstructions.
METHODS
The Ultraflex delivery system was modified by connecting an additional plastic tube and a suture cord; the length was increased from 95 cm to 150 cm or more. Stents used were 18 to 23 mm in diameter, and 10 to 15 cm in length. A knitted metal stent was inserted by using the modified delivery system in 10 patients (7 men, 3 women, mean age 68 years); 8 with gastric outlet, 1 with jejunal, and 1 with proximal colonic obstruction.
RESULTS
Metal stent insertion was successful in all patients with significant relief of symptoms and restoration of the ability to eat. The patient with a jejunal stent required placement of a second stent because of bending of the initial stent. No major complications (migration or perforation) occurred.
CONCLUSION
This technique appears to facilitate placement of a metal stent with blunt ends in the duodenum, small intestine, and proximal colon. Manufacturers should offer blunt-ended stents with long delivery devices.