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首页> 外文期刊>Surgical Endoscopy >Outcome of second interventions for occluded metallic stents in patients with malignant biliary obstruction.
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Outcome of second interventions for occluded metallic stents in patients with malignant biliary obstruction.

机译：恶性胆道梗阻患者第二次封闭金属支架的干预结果。

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BACKGROUND: Although self-expandable metallic stent (SEMS) has a longer patency than plastic stent (PS) for malignant biliary obstruction, stent occlusion can occur and drainage has to be reestablished in a patient with expected long survival. However, the choices are still controversial among restenting with SEMS, PS, and percutaneous transhepatic biliary drainage (PTBD). This study was designed to determine the efficacy and outcome of PS, SEMS, and PTBD for patients with occluded SEMS. METHODS: A total of 154 ERCPs with SEMS insertion were performed at the Endoscopy Unit of Chulalongkorn University. The causes of obstructive jaundice were cholangiocarcinoma (n = 110), pancreatic cancer (n = 41), and metastatic carcinoma (n = 3). Thirty-two patients (20.9%) with occluded SEMS (uncovered SEMS = 22 and covered SEMS = 10) were identified. PS, SEMS, and PTBD were used to reestablish drainage in 11, 14, and 7 patients, respectively. The second stent was inserted as stent-in-stent. Patients with less advanced disease were preferably opted to have a second SEMS. RESULTS: The median stent patency of second SEMS (100 days) was significantly longer than PS (60 days) and PTBD (75 days; p < 0.05). The median survival time for patients with second SEMS (230 days) was significantly longer than patients with PS (130 days) and PTBD (150 days; p < 0.05). Subgroup analysis in hilar obstructions showed no statistical difference in second stent patency and survival between PS and SEMS. Pain that required oral narcotic developed in 71% (5/7) of PTBD patients. CONCLUSIONS: In general, a second SEMS insertion in occluded SEMS provides a significant longer patency time than PS and PTBD. However, the benefit of SEMS as a second intervention in hilar obstructed patients is still doubtful.
机译：背景：尽管对于患有恶性胆道梗阻的患者，自膨胀金属支架（SEMS）的通畅性比塑料支架（PS）更长，但仍可能发生支架闭塞，必须在预期长生存期的患者中重建引流。然而，在对SEMS，PS和经皮肝穿刺胆道引流术（PTBD）的止痛方面，选择仍然存在争议。本研究旨在确定PS，SEMS和PTBD对SEMS闭塞患者的疗效和结局。方法：在朱拉隆功大学内窥镜科共进行了154例带有SEMS插入的ERCP。阻塞性黄疸的原因是胆管癌（n = 110），胰腺癌（n = 41）和转移性癌（n = 3）。确定了32例（20.9％）阻塞的SEMS患者（未发现SEMS = 22和覆盖SEMS = 10）。 PS，SEMS和PTBD分别用于11、14和7例患者的引流重建。插入第二个支架作为支架。病情较轻的患者最好选择再次接受SEMS。结果：第二次SEMS（100天）的中位支架通畅时间明显长于PS（60天）和PTBD（75天; p <0.05）。第二例SEMS患者（230天）的中位生存时间显着长于PS患者（130天）和PTBD患者（150天; p <0.05）。肺门梗阻的亚组分析显示PS和SEMS在第二支架通畅性和生存率方面无统计学差异。 71％（5/7）的PTBD患者发生了需要口服麻醉药的疼痛。结论：通常，在阻塞的SEMS中第二次插入SEMS会比PS和PTBD提供更长的通畅时间。然而，将SEMS作为肺门梗阻患者的第二种干预措施的益处仍然令人怀疑。

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