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首页> 外文期刊>Surgical Endoscopy >Duodenal metal stent placement is a risk factor for biliary metal stent dysfunction: An analysis using a time-dependent covariate
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Duodenal metal stent placement is a risk factor for biliary metal stent dysfunction: An analysis using a time-dependent covariate

机译：十二指肠金属支架置入是胆道金属支架功能障碍的危险因素：使用时间相关协变量的分析

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Background: Although the combination of biliary and duodenal self-expandable metal stents (SEMS) is useful, the exacerbating effect of duodenal SEMS placement on biliary SEMS has not been documented. We conducted a multicenter retrospective study to evaluate the effect of duodenal SEMS placement on biliary SEMS. Methods: Patients who underwent first-time biliary SEMS placement for a distal malignant biliary obstruction between September 1994 and November 2010 were included. Time to dysfunction of biliary SEMS was analyzed to identify risk factors for biliary SEMS dysfunction. Duodenal SEMS placement was analyzed as a time-dependent covariate. Results: In total, 410 eligible patients were identified. Duodenal SEMS were placed in 33 patients (8 %). The median time to dysfunction of biliary SEMS was 170 days. Male gender (hazard ratio 1.37, 95 % confidence interval 1.03-1.83, P = 0.029) and duodenal SEMS placement (hazard ratio 2.00, 95 % confidence interval 1.16-3.45, P = 0.013) were risk factors in the multivariate Cox model. In patients undergoing duodenal SEMS, biliary SEMS dysfunction was observed in 17 (52 %) with a median time to dysfunction of 64 days after duodenal SEMS placement. As many as 60 % of the patients with biliary SEMS dysfunction after duodenal SEMS placement needed permanent percutaneous transhepatic biliary external drainage. Conclusions: Duodenal SEMS placement is a risk factor for biliary SEMS dysfunction. Alternative methods for biliary drainage should be considered for better biliary drainage in patients with a gastric outlet obstruction.
机译：背景：尽管胆管和十二指肠自膨胀金属支架（SEMS）的组合是有用的，但十二指肠SEMS放置对胆管SEMS的加重作用尚未得到证实。我们进行了一项多中心回顾性研究，以评估十二指肠SEMS放置对胆管SEMS的影响。方法：纳入1994年9月至2010年11月间因远端恶性胆道梗阻而进行首次胆管SEMS置入术的患者。分析了胆道SEMS功能障碍的时间，以确定胆道SEMS功能障碍的危险因素。将十二指肠SEMS位置分析为时间依赖性协变量。结果：总共鉴定出410名合格患者。十二指肠SEMS置入33例（8％）。胆管SEMS功能障碍的中位时间为170天。多元Cox模型中，男性（危险比1.37，95％置信区间1.03-1.83，P = 0.029）和十二指肠SEMS放置（危险比2.00，95％置信区间1.16-3.45，P = 0.013）是多因素Cox模型的危险因素。在接受十二指肠SEMS的患者中，有17名（52％）患了胆管SEMS功能障碍，放置十二指肠SEMS后中位功能障碍时间为64天。十二指肠SEMS放置后胆道SEMS功能障碍的患者中，多达60％需要永久性经皮经肝肝胆道外部引流。结论：十二指肠SEMS放置是胆管SEMS功能障碍的危险因素。对于胃出口梗阻的患者，应考虑采用其他方法进行胆道引流，以更好地进行胆道引流。

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