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堵塞的胰管内支架的清洁:一项新的体外冲击波碎石术适应症

发布日期:2014-1-29 12:40:18 文章来源:GIE 作者次数:1218

     

    背景
    胰管支架置入被广泛用于桥接慢性胰腺炎患者主胰腺管梗阻。它的主要缺陷是早期支架堵塞,这样使得支架定期交换成为必要。
    目的
    迄今为止,没有任何措施可以防止支架堵塞。这项研究的目的是评估在体外应用冲击波(SWA)对堵塞胰管支架的清洁效果。
    设计
    体外研究
    患者
    我们分析了自21例慢性胰腺炎患者体内移除下来的25个塑料内支架的堵塞率。
    干预
    我们使用42兆帕压力沿着假肢支架每隔10mm实施350个冲击波脉冲,这个假肢是存储在一个充满脱气生理盐水的乳胶气球中。
    主要结果测量
    对支架应用冲击波(SWA)后,再次测量其堵塞率,最后通过与原来支架比较计算冲击波的清洁率。
    结果
    应用冲击波(SWA)前,堵塞率为64.7 ± 28.7 [15%-100%],应用冲击波(SWA)后,其为9.8 ± 25.3 [0-100%],P = 0.038,平均(± SD)堵塞率明显降低。25个支架中有16个(64%)清洁完整。平均而言,剩下9个中有4个(16%)清洁效果好(95%)。结果发现未清洁出的堵塞物主要位于十二指肠末端和支架中间。而且患者或支架相关参数与冲击波清洁效果无显著相关性。
    局限性
    体外研究设计
    结论
    冲击波应用(SWA)能在体外有效清洁堵塞的胰管内支架。如果定期应用冲击波(SWA)清洁支架,那么支架置入时间可能延长。因此,对用胰腺内支架治疗的患者来说,体外冲击波碎石术可能会成为一个新的适应症。
    缩写词:CP为慢性胰腺炎,ESWL,为体外冲击波碎石术,MPD为主胰管,SWA为冲击波应用。
     
     
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    Cleaning of occluded pancreatic duct endoprostheses: a new indication for extracorporeal shock wave lithotripsy?
    Background
    Pancreatic duct stenting is widely performed for bridging main pancreatic duct obstruction in patients with chronic pancreatitis. The major limitation is early stent occlusion, making regular stent exchange necessary.
    Objective
    To date, no measures are available to prevent stent occlusion. The aim of this study was to evaluate the cleansing effect of shock wave application (SWA) on occluded pancreatic duct stents in vitro.
    Design
    In vitro study.
    Patients
    We analyzed occlusion rates of 25 plastic endoprostheses removed from 21 patients with chronic pancreatitis.
    Intervention
    We administered 350 shock wave pulses every 10 mm along the prosthesis, which was stored in a latex balloon filled with gas-free physiologic saline solution, by using a pressure of 42 megapascals.
    Main Outcome Measurements
    After SWA, the occlusion rate was measured again, and the cleansing rate was calculated in comparison with the native prosthesis.
    Results
    The mean (± SD) occlusion rate was significantly reduced (64.7 ± 28.7 [15%-100%]) before SWA vs 9.8 ± 25.3 [0-100%]) after SWA; P = .038). In 16 of 25 prostheses (64%), cleaning was complete. Four of the remaining 9 prostheses (16%) showed satisfactory cleaning of 95%, on average. Residual clogging material was found mainly at the duodenal tip and the middle of the stent. No significant association was found between patient-related or stent-related parameters and the cleansing effect of SWA.
    Limitations
    In vitro study design.
    Conclusion
    SWA is effective in cleaning occluded pancreatic endoprostheses in vitro. Prolongation of stent placement seems possible if regular SWA is performed. Extracorporeal shock wave lithotripsy therefore might become a new indication for patients under treatment with pancreatic endoprostheses.
     
     
     
     
     
     
     
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