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首页> 外文期刊>Pathobiology: journal of immunopathology, molecular and cellular biology >Biliary stent therapy for dominant strictures in patients affected by primary sclerosing cholangitis
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Biliary stent therapy for dominant strictures in patients affected by primary sclerosing cholangitis

机译：胆道支架治疗可治疗原发性硬化性胆管炎患者的优势狭窄

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摘要

The diagnosis and the treatment of dominant strictures (DS) in patients with primary sclerosing cholangitis (PSC) is challenging and the scientific literature on the subject is quite limited. Only level II and level III evidence is available to guide physicians managing patients with DS and PSC. For the diagnosis, intraductal endoscopic ultrasound is the most sensitive (64%) and specific (95%) test. However, the majority of cases require a combination of several different diagnostic tests, as there is no single investigation that can rule out malignancy in this group of patients. For the treatment, serial endoscopic or percutaneous dilatations provide 1-and 3-year biliary duct patency in 80 and 60% of patients, respectively. Dilatation and stenting are the most common interventions, although the optimal duration of treatment has still not been clearly defined. Bile duct resection and/or bilioenteric bypass are currently indicated only for patients with preserved liver function. For all other patients, benign DS can be treated with endoscopic dilatation with short-term stenting. This approach is effective and safe and does not increase the risk of malignant transformation or complications for liver transplant candidates. During the last decade, the use of self-expandable metallic stents for benign diseases has become an innovative option. The aim of this article is to review the diagnostic and therapeutic strategies for patients affected by PSC and DS with specific emphasis on the outcomes of patients treated with temporary stents.
机译：原发性硬化性胆管炎（PSC）患者的优势狭窄（DS）的诊断和治疗具有挑战性，有关该主题的科学文献非常有限。只有II级和III级证据可用于指导医师管理DS和PSC患者。对于诊断，导管内镜超声检查是最敏感的（64％）和特异性的（95％）检查。但是，大多数病例都需要几种不同的诊断测试的组合，因为没有任何一项调查可以排除这一组患者的恶性肿瘤。对于治疗，连续内镜或经皮扩张分别在80％和60％的患者中提供1年和3年的胆道通畅性。扩张和置入支架是最常见的干预措施，尽管最佳治疗持续时间尚未明确。胆管切除术和/或胆肠旁路术目前仅适用于肝功能保留的患者。对于所有其他患者，良性DS可通过短期支架内镜扩张术治疗。这种方法是有效和安全的，不会增加肝移植候选者发生恶性转化或并发症的风险。在过去的十年中，使用自扩张式金属支架治疗良性疾病已成为一种创新选择。本文的目的是回顾针对受PSC和DS影响的患者的诊断和治疗策略，特别侧重于使用临时性支架治疗的患者的预后。

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