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为使难治性胆管狭窄患者支架所致胆管损伤最小化,在乳头状突起上植入改良的全覆膜自膨式金属支架的可行性

发布日期:2014-1-29 12:40:40 文章来源:GIE 作者次数:1078

    为使难治性胆管狭窄患者支架所致胆管损伤最小化,在乳头状突起上植入改良的全覆膜自膨式金属支架的可行性

    背景

    人们已尝试将内镜下全覆膜自膨式金属支架植入术用于治疗胆管良性狭窄,但是目前存在的FCSEMSs可能会致使有着正常预期寿命的患者出现包括新生狭窄在内的意外并发症。

    目的

    对为使胆管良性狭窄患者支架所致胆管损伤最小化而在管内植入改良的FCSEMS的可行性进行评估。

    设计

    前瞻性观察临床可行性研究

    环境

    第三护理研究中心

    病人

    21例表现出胆管良性狭窄症状的患者参与了本研究,这些患者经常规内镜治疗失败。

    干预

    狭窄片段在乏特壶腹上15 mm处。该改良的FCSEMS边缘凸起,带有一个套索,且其中间凹入部位起抗移位作用。将整个支架植入乳头状突起上,并在35个月后移除。

    主要测量指标

    成功率、并发症、可移除性,中期结果指标。

    结果

    在本研究中,我们成功将FCSEMSs植入所有患者的胆管内。管内支架存在期间,未发现胰腺炎、胆管炎和脓毒症等疾病发作。4例(19.0%)患者发生支架移位,但在随访期间,3例患者未表现出临床症状。采用鼠齿钳成功移除所有支架,而且未出现任何并发症。支架移除后的胆管造影片显示,21例患者中有20例胆管狭窄得到改善,未出现新生局部狭窄。本研究临床成功率为95.2%1例胆管狭窄复发。

    局限性

    数量少,且缺乏与其它FCSEMS类型的比较。

    结论

    将新型改良的FCSEMS短期植入胆管内可有效改善胆管狭窄,并且可预防胆管良性狭窄患者发生各潜在的支架所致并发症。需要大规模对照试验来证实FCSEMS的长期疗效。

    缩写词FCSEMS,全覆膜自膨式金属支架。


     

    Feasibility of placing a modified fully covered self-expandable metal stent above the papilla to minimize stent-induced bile duct injury in patients with refractory benign biliary strictures

    Background

    Endoscopic placement of fully covered self-expandable metal stents (FCSEMS) has been attempted to manage benign biliary strictures, but currently available FCSEMSs may be associated with unintended complications, including de novo strictures, in patients with normal life expectancy.

    Objective

    To evaluate the feasibility of an intraductally placed modified FCSEMS to minimize stent-induced bile duct injury in patients with benign biliary strictures.

    Design

    Prospective observational clinical feasibility study.

    Setting

    Tertiary-care academic center.

    Patients

    This study involved 21 patients with symptomatic benign biliary strictures in whom conventional endoscopic management failed.

    Intervention

    Strictured segments were 15 mm above the ampulla of Vater. The modified FCSEMS has convex margins, a lasso, and an anti-migrating waist on the central portion. Stents were placed entirely above the papilla and removed after 3 to 5 months.

    Main Outcome Measurements

    Success, complications, removability, midterm outcome.

    Results

    FCSEMSs were successfully placed inside the bile duct in all patients. No episodes of pancreatitis, cholangitis, or sepsis were noted during the stenting period. Stent migration occurred in 4 patients (19.0%), but 3 were asymptomatic during follow-up. All stents were removed successfully with rat-tooth forceps without complications. Post-stenting cholangiograms showed improvement of strictures in 20 of 21 patients, without de novo focal stricture. The clinical success rate was 95.2%, with one recurrent stricture.

    Limitations

    The small number and lack of comparison with other types of FCSEMSs.

    Conclusion

    Temporary intraductal placement of a newly modified FCSEMS effectively improved strictures and prevented potential stent-induced complications in patients with benign biliary strictures. Controlled large-scale trials are needed to confirm the long-term efficacy.

    Abbreviations:  FCSEMS, fully covered self-expandable metal stent

     

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