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首页> 外文期刊>Surgical Endoscopy >Comparison of outcomes among secondary covered metallic, uncovered metallic, and plastic biliary stents in treating occluded primary metallic stents in malignant distal biliary obstruction.
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Comparison of outcomes among secondary covered metallic, uncovered metallic, and plastic biliary stents in treating occluded primary metallic stents in malignant distal biliary obstruction.

机译：二级覆膜金属支架，裸露金属支架和塑料胆道支架治疗恶性远端胆道梗阻的闭塞性一级金属支架的疗效比较。

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BACKGROUND: The self-expandable metallic stent (SEMS) has been widely used for unresectable malignant biliary obstruction but eventually becomes occluded by tumor ingrowth/overgrowth and sludge. Therefore, we aimed to determine the therapeutic effectiveness of secondary stents and to find differences according to various combinations of the first and second stents for the management of occluded SEMSs in patients with malignant distal biliary obstruction. METHODS: Between 1999 and November 2008, 77 patients with malignant biliary obstruction underwent secondary biliary stent placement as "stent-in-stent" at three university hospitals in Korea (40 covered, 26 uncovered, and 11 plastic stents). The membrane of the covered SEMS was regarded as the barrier against tumor ingrowth. We categorized the patients into three groups based on whether the covered SEMS was either the first or the second stent: membrane-SEMS (18 covered-covered; 9 covered-uncovered; 22 uncovered-covered SEMS), bare-SEMS (17 uncovered-uncovered SEMS), and plastic stent (3 covered-plastic; 8 uncovered-plastic). RESULTS: The median patency of second stents was 138, 109, and 88 days (covered, uncovered, and plastic stents). The second covered SEMSs had a significantly longer patency than plastic stents (p=0.047). In a multivariate analysis including membrane-SEMS, bare-SEMS, and plastic stent groups, the bare-SEMS had a worse cumulative stent patency (HR=2.04, CI=1.08-3.86) and survival time (HR=2.37, CI=1.25-4.49) than the membrane-SEMS. Patients with ampulla of Vater cancer had better stent patency (HR=0.27, CI=0.08-0.98) and survival (HR=0.17, CI=0.04-0.77) than those with other pancreatobiliary malignancies. In addition, antitumor treatment prolonged survival time (HR=0.50, CI=0.26-0.99). CONCLUSIONS: The placement of additional biliary stents using the "stent-in-stent" method is an effective treatment for an occluded metallic primary stent. In addition, double biliary SEMS placement using at least one covered SEMS (in the primary and/or secondary procedure) might provide longer cumulative stent patency and survival than using uncovered SEMSs in both procedures.
机译：背景：自膨胀金属支架（SEMS）已被广泛用于不可切除的恶性胆道梗阻，但最终被肿瘤向内生长/过度生长和淤渣阻塞。因此，我们旨在确定辅助支架的治疗效果，并根据第一支架和第二支架的各种组合来发现恶性远端胆道梗阻患者封堵SEMS的差异。方法：在1999年至2008年11月之间，在韩国三所大学医院中，有77例恶性胆道梗阻患者接受了“胆道内支架”置入辅助胆道支架置入术（有盖40支，未覆盖26支，塑料支架11支）。被覆盖的SEMS的膜被认为是防止肿瘤向内生长的屏障。根据覆盖的SEMS是第一支架还是第二支架，我们将患者分为三类：膜SEMS（18个覆盖-覆盖; 9个覆盖-覆盖; 22个覆盖-覆盖的SEMS），裸SEMS（17个覆盖-未覆盖的SEMS）和塑料支架（3个覆盖塑料; 8个未覆盖塑料）。结果：第二个支架的中位通畅时间为138、109和88天（覆盖，未覆盖和塑料支架）。第二个覆盖的SEMS具有比塑料支架更长的通畅性（p = 0.047）。在包括膜SEMS，裸SEMS和塑料支架组的多变量分析中，裸SEMS的累积支架通畅性（HR = 2.04，CI = 1.08-3.86）和存活时间（HR = 2.37，CI = 1.25）更差。 -4.49）。壶腹癌壶腹癌患者的支架通畅性（HR = 0.27，CI = 0.08-0.98）和生存率（HR = 0.17，CI = 0.04-0.77）优于其他胰腺胆道恶性肿瘤。此外，抗肿瘤治疗延长了生存时间（HR = 0.50，CI = 0.26-0.99）。结论：使用“支架内支架”方法放置额外的胆道支架对于闭塞的金属主支架是一种有效的治疗方法。此外，与在两种手术中均使用未覆盖的SEMS相比，使用至少一个覆盖的SEMS（在主要手术和/或次要手术中）进行双胆管SEMS放置可能提供更长的累积支架通畅性和存活率。

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