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十二指肠入侵是治疗无法切除的胰腺癌而置入的胆管金属支架的早期功能障碍危险因素之一

发布日期:2014-1-29 12:40:19 文章来源:GIE 作者次数:1110
    背景
    尽管自膨式金属支架(SEMSs)置入已被广泛用于缓减胆管远端恶性梗阻,但其早期功能障碍危险因素仍不明确。
    目的
    对无法切割胰腺癌的患者,确认其早期(不到3个月)自膨式金属支架(SEMS)功能障碍的危险因素。
    设计
    一项多中心回顾性研究。
    环境
    5所三级转诊中心。
    患者
    本研究包含那些于1994年4月至2010年8月间首次接受自膨式金属支架置入术治疗由胰腺癌引起的胆道远端恶性梗阻的患者。
    主要测量指标
    评估早期功能障碍发生率及其原因,并分析其危险因素。
    结果
    总共317例患者符合条件并被纳入本研究。其中82%的患者置入了覆膜自膨式金属支架(SEMSs)。內镜下观察到37%患者存在十二指肠入侵。功能障碍发生的中位时间为170天。所有的和早期自膨式金属支架(SEMS)功能障碍发生率分别为55%,31%。自膨式金属支架(SEMS)功能障碍发生的主要原因是早期障碍中的食物嵌塞和非阻塞性(nonocclusion)胆管炎(各占21%),以及非早期(nonearly)障碍中的沉淀物(29%)。有与没有十二指肠入侵的早期障碍发生率分别为42%,24%(P=0.001)。对有十二指肠入侵的患者来说,由食物嵌塞引起的早期功能障碍发生更频繁(10%和4%, P =0.053)。十二指肠入侵在多元逻辑(logistic)回归模型中是一个危险因素(比值比为2.35;95%置信区间CI为1.43-3.90,P = 0.001)。
    局限性
    回顾性设计。
    结论
    十二指肠入侵是胰腺癌患者早期自膨式金属支架功能障碍的危险因素之一。
    缩写词SEMS:自膨式金属支架
     
     
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    Background
    Although the placement of self-expandable metal stents (SEMSs) has been widely accepted as palliation for distal malignant biliary obstruction, the risk factors for their early dysfunction remain unclear.
    Objective
    To identify risk factors for early (<3 months) SEMS dysfunction in unresectable pancreatic cancer.
    Design
    A multicenter retrospective study.
    Setting
    Five tertiary referral centers.
    Patients
    Patients were included who underwent first-time SEMS placement for distal malignant biliary obstruction caused by pancreatic cancer between April 1994 and August 2010.
    Main Outcome Measurements
    Rates and causes of early dysfunction were evaluated, and risk factors were analyzed.
    Results
    In all, 317 eligible patients were identified. Covered SEMSs were placed in 82% of patients. Duodenal invasion was observed endoscopically in 37%. The median time to dysfunction was 170 days. The rates of all and early SEMS dysfunction were 55% and 31%, respectively. The major causes of SEMS dysfunction were food impaction and nonocclusion cholangitis (21% each) in early dysfunction and sludge (29%) in nonearly dysfunction. The rate of early dysfunction was 42% with duodenal invasion and 24% without duodenal invasion (P = .001). Early dysfunction caused by food impaction was more frequent in patients with duodenal invasion (10% and 4%, P = .053). Duodenal invasion was a risk factor (odds ratio 2.35; 95% CI, 1.43–3.90; P = .001) in a multiple logistic regression model.
    Limitations
    A retrospective design.
    Conclusions
    Duodenal invasion is a risk factor for early SEMS dysfunction in patients with pancreatic cancer.
     
     
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