经内镜胆管支架置入术对恶性胆管梗阻的治疗意义
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摘要
目的探讨分析经内镜胆管支架置入术治疗恶性胆管梗阻的疗效并将其与外科姑息手术行对比。
方法回顾对比31例行胆管支架置入术及29例行外科姑息手术治疗的恶性胆管梗阻患者资料。
结果(1)经内镜胆管支架置入术成功率为93.55%。(2)行支架置入术与行外科姑息手术后,患者的肝功各项指标均有改善,改善程度方面两组尚无明显差别(P>0.05)。(3)支架术后患者近期并发症出现率9.68%,与外科组的17.24%相比尚无明显差别(P>0.05)。(4)支架组术后住院时间中位数为5天,短于外科组的13天(P<0.05)。(5)支架组术后胆道平均通畅时间为154.95天,外科组为223.37天,两组尚无明显差别(P>0.05)。(6)支架术平均生存时间182.06天与外科组为239.37天相比尚无明显差别(P>0.05)。
结论(1)胆管支架置入术安全可行,对缓解恶性梗阻性黄疸效果良好。(2)胆管支架置入术对中晚期恶性梗阻性黄疸之疗效不逊于外科手术,基本可替代姑息性手术治疗。
Objectives To investigate the efficacy of biliary stent placement through endoscope to treat malignant biliary obstruction and compare it with surgical palliation.
Methods Analysed the data of 31 cases of malignant biliary obstruction patients treated by biliary stent placement and the data of 29 cases of this kind disease patients treated by surgical palliation retrospectively
Results (1)The percent of the successful biliary stent placement is 93.55%.(2)The function of liver can be protected through both biliary stent placement and surgical palliation, and their degree for it is not different obviously(p>0.05). (3)The rate of recent complications is 9.68% in the group of biliary stent placement while it is 17.24% in the surgical palliation group. It is not different obviously(p>0.05)between the two groups.(4)The median time in hospital of the patients treated by biliary stent placement is 5 days. It is shorter than this time of the patients who have surgical palliation which is 13 days(p<0.05). (5)The average unobstructed time of biliary after stent placement is 154.95 days and this time is 223.37 days in surgical palliation group. They are not different obviously(p>0.05).(6) In stent group,the average live time of patients is 182.06 days and it is 239.37 days in surgical palliation group. The two time is not different obviously(p>0.05).
Conclusions (1)Bliary stent placement is safe and efficient. It has efficacy to malignant biliary obstruction.(2) The efficacy of stent placement is not worse than surgical palliation. So to the malignant biliary obstruction patients in advanced stage,the billiary stent placement can almostly replace the surgical palliation.
方法回顾对比31例行胆管支架置入术及29例行外科姑息手术治疗的恶性胆管梗阻患者资料。
结果(1)经内镜胆管支架置入术成功率为93.55%。(2)行支架置入术与行外科姑息手术后,患者的肝功各项指标均有改善,改善程度方面两组尚无明显差别(P>0.05)。(3)支架术后患者近期并发症出现率9.68%,与外科组的17.24%相比尚无明显差别(P>0.05)。(4)支架组术后住院时间中位数为5天,短于外科组的13天(P<0.05)。(5)支架组术后胆道平均通畅时间为154.95天,外科组为223.37天,两组尚无明显差别(P>0.05)。(6)支架术平均生存时间182.06天与外科组为239.37天相比尚无明显差别(P>0.05)。
结论(1)胆管支架置入术安全可行,对缓解恶性梗阻性黄疸效果良好。(2)胆管支架置入术对中晚期恶性梗阻性黄疸之疗效不逊于外科手术,基本可替代姑息性手术治疗。
Objectives To investigate the efficacy of biliary stent placement through endoscope to treat malignant biliary obstruction and compare it with surgical palliation.
Methods Analysed the data of 31 cases of malignant biliary obstruction patients treated by biliary stent placement and the data of 29 cases of this kind disease patients treated by surgical palliation retrospectively
Results (1)The percent of the successful biliary stent placement is 93.55%.(2)The function of liver can be protected through both biliary stent placement and surgical palliation, and their degree for it is not different obviously(p>0.05). (3)The rate of recent complications is 9.68% in the group of biliary stent placement while it is 17.24% in the surgical palliation group. It is not different obviously(p>0.05)between the two groups.(4)The median time in hospital of the patients treated by biliary stent placement is 5 days. It is shorter than this time of the patients who have surgical palliation which is 13 days(p<0.05). (5)The average unobstructed time of biliary after stent placement is 154.95 days and this time is 223.37 days in surgical palliation group. They are not different obviously(p>0.05).(6) In stent group,the average live time of patients is 182.06 days and it is 239.37 days in surgical palliation group. The two time is not different obviously(p>0.05).
Conclusions (1)Bliary stent placement is safe and efficient. It has efficacy to malignant biliary obstruction.(2) The efficacy of stent placement is not worse than surgical palliation. So to the malignant biliary obstruction patients in advanced stage,the billiary stent placement can almostly replace the surgical palliation.
引文
[1] Bahra M, Jacob D.Surgical palliation of advanced pancreatic cancer[J]. Recent Results Cancer Res,2008,177(2):111-120
[2] Dinkel HP, Triller J.Primary and long-term success of percutaneous biliary metallic endoprotheses (Wallstents) in malignant obstructive jaundice[J]. rofo, 2001 ,173(12):1072-1078
[3]黄晓东,等.内镜下胆道支架置入术治疗恶性胆道梗阻122例[J]世界华人消化杂志,2008,16(28): 3234-3237
[4]Loseff SV, Druy E, Jelinger E, et a1.Use of hot-tip laser probes to recanalize occluded expandable metallic biliary endoprostheses[J]. AJR Am J Roentgenol,1992, 158(1):199-201
[5]Tham TCK, Carr-Locke DL, Vandervoort J, et al. Management of occluded biliary Wallstents[J]. Gut,1998,42 (5):703–707
[6]Cremer M, Deviere J, Sugai B, et al. Expandable biliary metal stents for malignancies: endoscopic insertion and diathermic cleaning for tumor ingrowth[J]. Gastrointest Endosc,1990;36 (5):451–457
[7]Ell C, Fleig WE, Hochberger J.et al.Broken biliary metal stent after repeated electrocoagulation for tumor ingrowth[J]. Gastrointest Endosc,1992,38 (2):197–199
[8]王志强。PTCD与ERCP对接术——微创胆道治疗的新途径[J]。现代消化及介入诊疗。2005,10(3):154-156
[9]Ki Tae Suk. Human application of a metallic stent covered with a paclitaxel- incorporated membrane for malignant biliary obstruction: multicenter pilot study[J].JVIR,2007,66(4): 798-803
[10]He GJ, Sun DD, Ji DW, et al.Induction of biliary cholangiocarcinoma cell apoptosis by 103Pd cholangial radioactive stent gamma-rays [J]. Chin Med J (Eng), 2008 , 121(11):1020-1024
[11]郑建伟,唐滔,肖宝来,等。磁化胆道支架联合磁性纳米药物靶向治疗胆管癌[J]中华实验外科杂志,2007,24(8):936-938
[12] Lee DK . Drug-eluting stent in malignant biliary obstruction[J].J Hepatobiliary Pancreat Surg, 2009,16(5):628-632
[13]张盛,刘爱民,潘永林,等。胆道支架植入联合灌注化疗方法治疗恶性梗阻性黄疸17例分析[J]。重庆医学,2009,38(10):1209-1210
[14] Kiesslich T, Wolkersd?rfer G, Neureiter D, et al.Photodynamic therapy for non-resectable perihilar cholangiocarcinoma[J].Photochem Photobiol Sci, 2009 ,8(1):23-30
[1]Cameron JL, Gayler BW, Zuidema GD et a1.Long term transhepatic intubation for hilar hepaticduct strictures[J]. Annals of surgery.1976,183(5):488-495
[2]Vitale GC,Reed DN,Nguyen CT,et al.Endoscopic treatment of distal bile duct stricture from chronic pancreatitis[J].Surg Endosc,2000,14(4):411-417
[3]Rossi AF,Grosso C,Zanasi G,et al.Long-term efficacy of endoscopic stent in patient with stricture of the biliary anastomosis after orthotopic liver transplantation[J]. Endoscopy .1998 ,30(4):360-366
[4]楚有良,韩坤,张沥,等。梗阻性黄疸650例临床分析[J]。现代医药卫生。2007,23(15): 2297-2298
[5]寇声涛。内镜下胆道支架置入治疗肝胆外科术后胆漏的临床观察[J]。临床和实验医学杂志。2008,7(6):121-121
[6]沈利明.金一琦.经皮肝穿刺胆道内支架植入治疗恶性胆道梗阻64例[J]。临床内科杂志。2003,20(12):647-648
[7]李红,楼茂克。左右肝管同时狭窄的高位胆管梗阻单双支架治疗的对比性研究[J]。临床放射学杂志。2007,26(3):291-293.
[8]许林锋,陈耀庭,张靖等。TY型胆管支架治疗肝门部恶性梗阻性黄疸的临床应用价值[J]。临床放射学杂志。2007,26(9):911-913
[9] Mallery S, Matlock J, Freeman ML et a1.EUS-guided rendezvous drainage of obstructed biliary and pancreatic ducts: Report of 6 cases[J]. Gastrointest Endosc. 2004,59(1):100-107
[10]王志强。PTCD与ERCP对接术——微创胆道治疗的新途径[J]。现代消化及介入诊疗。2005, 10(3):154-156
[11] G Mendez, E Russell, JU Levi, et a1. Percutaneous brush biopsy and internal drainage of biliary tree through endoprosthesis[J]. American Journal of Roentgenology.1980 ,134(4):653-659
[12]MeAllister EW, Carey LC, Brady PG, et al. The role of polymeric surface smoothness of biliary stents in bacterial adherence,biofilm deposition and stent occlusion[J]. Gastrointest Endosc, 1993,39(3):422-425
[13]Costamagna G, Mutignani M, Rotondano G, et a1. Hydrophilic hydromer-coated polyurethane stents versus uncoated stents in malignant biliary obstruction: a randomized trial[J]. Gastrointest Endosc. 2000 ,51(1):8-11
[14] Binmoeller KF, Seitz U, Seifert H, et a1 The Tannenbaum stent: a new plastic biliary stent without side holes[J]. Am J Gastroenterol. 1995 ,90(10):1764-1768
[15] CH Carrasco,S Wallace,C Chamsangavej,et a1.Expandable biliary endoprosthesis:an experimentalstudy[J].Am J Roentgenol.1985,145(6):1279-1281
[16] Yoshioka T, Sakaguchi H, Yoshimura H, et a1.Development and clinical application of biliary endoprosthesis using expandable metallic stents[J]. Nippon Igaku Hoshasen Gakkai Zasshi. 1988,48(9):1183-1185
[17] Saito H ,Sakurai Y,Takam ura A et a1.Biliary endoprosthesis using Gor-Tex covered expandable metallic stents:Preliminary clinical evaluation[J].Nippon Acta Radiologica.1994,54(2):180-l82
[18]Isayama H,Komatsu Y,Tsujino T, et al. A prospective randomised study of“covered”versus“uncovered”diamond stents for the management of distal malignant biliary obstruction[J]. Gut. 2004 ,53(5):729-734.
[19] Shin HP,Kim MH,Jung SW ,et a1.Endoscopic removal of biliary self_expandable metallic stents:8 prospective study[J].Endoscopy.2006,38(12):l250—1255.
[20]Nakai Y ,lsayam a H ,Komatsu Y.et a1.Efficacy and safety of the covered Wallstent in patients with distal malignant biliary obstruction[J].Gastrointest Endosc.2005,62(5):742—748
[21]杨光等。胆道支架覆膜研究现状[J]。中国介入影像与治疗学。2008,5(4):316-319
[22]Gwon DI, Shim HJ, Kwak BK et a1.Retrievable biliary stent-graft in the treatment of benign biliary strictures[J]. J Vasc Interv Radiol. 2008 ,19(9):1328-1335
[23] Uno, Koji; Yasuda, Kenjiro,Tanka, Kiyohito; Hayakumo, Takanobu; Nakajima, Masatusugu. Evanution of new plastic stent for malligant bilary obstruction[J]. Digestive Endoscopy.2001,13(3):159-162
[24]Ki Tae Suk et al. Human application of a metallic stent covered with a paclitaxel-incorporated membrane for malignant biliary obstruction: multicenter pilot study[J]. Gastrointest Endosc .2007,66(4): 798-803
[25]王敬等。可降解聚乳酸支架在胆管损伤治疗中作用的实验研究[J]。中华肝胆外科杂志。2004,10(12):841-843
[26]张文智,黄晓强,周宁新,等。胆道良性狭窄金属支架置入术后并发症及其处理[J]。中华肝胆外科杂志。2005,11(9): 599-560
[27]Tesdal IK, Roeren T, Weiss C, et a1. Metallic stents for treatment of benign biliary obstruction: a long-term study comparing different stents[J].J Vasc Interv Radiol. 2005,16(11):1479-1487.
[28]王成,黄强,胡圆国,等。经内镜胆管支架置放技术相关问题探讨[J]。肝胆胰外科杂志。2008,20(5):319-321
[29]黄晓东等。内镜下胆道支架置入术治疗恶性胆道梗阻122例[J]。世界华人消化杂志。2008,16(28): 3234-3237
[30]曹立瀛,陈宝丽,刘四清等。恶性梗阻性黄疸的内引流治疗[J]。肝胆外科杂志。2001,9(6):455-456
[31] Maillot N.Archer T.Regert S,et a1.Polythylene stent blockage:a porcine model[J].Gastrointest Endosc.2000 ,51(1):12-18.
[32] Pietro Familiari , Milutin Bulajic et al. Endoscopic removal of malfunctioning biliary self-expandable metallic stents[J]. Gastrointestinal Endoscopy. 2005,62(6): 903-910
[33] Dimitri Coumaros, et al. Stent-In-Stent Insertion Using Argon Plasma Coagulation for the Cannulation of Multiple Malfunctioning Biliary Noncovered Self-Expandable Metal Stents[J]. The American Journal of Gastroenterology. 2008,103 (12):3215–3217
[34] Matsushita Mitsunobu .et al.Malfunctioning covered biliary metallic stents: ineffective trimming or effective removal[J]?Gastrointestinal Endoscopy.2009,69(1):189-189
[35]黄永德,宛新建,孙振兴。2例胆管塑料支架移位致十二指肠穿孔[J]。中国内镜杂志。2005,11(12): 1329-1330
[36]刘伟,卢武胜。胆管内支架治疗梗阻性黄疸的临床应用[J]。中国普外基础与临床杂志。2007,14(4):490-492
[37]周君,李玉东。经皮肝穿刺胆管内支架置入联合动脉化疗治疗恶性阻塞性黄疸18例[J]。中原医刊。2004,31(14):38-39
[38]常钢,游洋,孟凡喆等?裥怨W栊曰起阒瘟铺教郑旱ǖ乐Ъ苤萌耄?125粒子腔内照射联合治疗[J]。中国医学影像技术。2007,23(3):439-441
[39]刘超群,浦江,付山峰等。经内镜胆管支架或鼻胆管置放结合γ刀治疗晚期胰腺癌的临床观察[J]。临床消化病杂志。2007,l9(4):228-230
[40]Wang LW, Li LB, Li ZS, et al. Self-expandable metal stents and trans-stent light delivery: Are metal stents and photodynamic therapy compatible[J]? Lasers Surg Med. 2008 ,40(9):651-659
[41]He GJ, Sun DD, Ji DW, et al.Induction of biliary cholangiocarcinoma cell apoptosis by 103Pd cholangial radioactive stent gamma-rays[J]. Chin Med J (Eng). 2008 ,121(11):1020-1024
[42]郑建伟,唐滔,肖宝来等。磁化胆道支架联合磁性纳米药物靶向治疗胆管癌[J]。中华实验外科杂志。2007,24(8):936-938
[2] Dinkel HP, Triller J.Primary and long-term success of percutaneous biliary metallic endoprotheses (Wallstents) in malignant obstructive jaundice[J]. rofo, 2001 ,173(12):1072-1078
[3]黄晓东,等.内镜下胆道支架置入术治疗恶性胆道梗阻122例[J]世界华人消化杂志,2008,16(28): 3234-3237
[4]Loseff SV, Druy E, Jelinger E, et a1.Use of hot-tip laser probes to recanalize occluded expandable metallic biliary endoprostheses[J]. AJR Am J Roentgenol,1992, 158(1):199-201
[5]Tham TCK, Carr-Locke DL, Vandervoort J, et al. Management of occluded biliary Wallstents[J]. Gut,1998,42 (5):703–707
[6]Cremer M, Deviere J, Sugai B, et al. Expandable biliary metal stents for malignancies: endoscopic insertion and diathermic cleaning for tumor ingrowth[J]. Gastrointest Endosc,1990;36 (5):451–457
[7]Ell C, Fleig WE, Hochberger J.et al.Broken biliary metal stent after repeated electrocoagulation for tumor ingrowth[J]. Gastrointest Endosc,1992,38 (2):197–199
[8]王志强。PTCD与ERCP对接术——微创胆道治疗的新途径[J]。现代消化及介入诊疗。2005,10(3):154-156
[9]Ki Tae Suk. Human application of a metallic stent covered with a paclitaxel- incorporated membrane for malignant biliary obstruction: multicenter pilot study[J].JVIR,2007,66(4): 798-803
[10]He GJ, Sun DD, Ji DW, et al.Induction of biliary cholangiocarcinoma cell apoptosis by 103Pd cholangial radioactive stent gamma-rays [J]. Chin Med J (Eng), 2008 , 121(11):1020-1024
[11]郑建伟,唐滔,肖宝来,等。磁化胆道支架联合磁性纳米药物靶向治疗胆管癌[J]中华实验外科杂志,2007,24(8):936-938
[12] Lee DK . Drug-eluting stent in malignant biliary obstruction[J].J Hepatobiliary Pancreat Surg, 2009,16(5):628-632
[13]张盛,刘爱民,潘永林,等。胆道支架植入联合灌注化疗方法治疗恶性梗阻性黄疸17例分析[J]。重庆医学,2009,38(10):1209-1210
[14] Kiesslich T, Wolkersd?rfer G, Neureiter D, et al.Photodynamic therapy for non-resectable perihilar cholangiocarcinoma[J].Photochem Photobiol Sci, 2009 ,8(1):23-30
[1]Cameron JL, Gayler BW, Zuidema GD et a1.Long term transhepatic intubation for hilar hepaticduct strictures[J]. Annals of surgery.1976,183(5):488-495
[2]Vitale GC,Reed DN,Nguyen CT,et al.Endoscopic treatment of distal bile duct stricture from chronic pancreatitis[J].Surg Endosc,2000,14(4):411-417
[3]Rossi AF,Grosso C,Zanasi G,et al.Long-term efficacy of endoscopic stent in patient with stricture of the biliary anastomosis after orthotopic liver transplantation[J]. Endoscopy .1998 ,30(4):360-366
[4]楚有良,韩坤,张沥,等。梗阻性黄疸650例临床分析[J]。现代医药卫生。2007,23(15): 2297-2298
[5]寇声涛。内镜下胆道支架置入治疗肝胆外科术后胆漏的临床观察[J]。临床和实验医学杂志。2008,7(6):121-121
[6]沈利明.金一琦.经皮肝穿刺胆道内支架植入治疗恶性胆道梗阻64例[J]。临床内科杂志。2003,20(12):647-648
[7]李红,楼茂克。左右肝管同时狭窄的高位胆管梗阻单双支架治疗的对比性研究[J]。临床放射学杂志。2007,26(3):291-293.
[8]许林锋,陈耀庭,张靖等。TY型胆管支架治疗肝门部恶性梗阻性黄疸的临床应用价值[J]。临床放射学杂志。2007,26(9):911-913
[9] Mallery S, Matlock J, Freeman ML et a1.EUS-guided rendezvous drainage of obstructed biliary and pancreatic ducts: Report of 6 cases[J]. Gastrointest Endosc. 2004,59(1):100-107
[10]王志强。PTCD与ERCP对接术——微创胆道治疗的新途径[J]。现代消化及介入诊疗。2005, 10(3):154-156
[11] G Mendez, E Russell, JU Levi, et a1. Percutaneous brush biopsy and internal drainage of biliary tree through endoprosthesis[J]. American Journal of Roentgenology.1980 ,134(4):653-659
[12]MeAllister EW, Carey LC, Brady PG, et al. The role of polymeric surface smoothness of biliary stents in bacterial adherence,biofilm deposition and stent occlusion[J]. Gastrointest Endosc, 1993,39(3):422-425
[13]Costamagna G, Mutignani M, Rotondano G, et a1. Hydrophilic hydromer-coated polyurethane stents versus uncoated stents in malignant biliary obstruction: a randomized trial[J]. Gastrointest Endosc. 2000 ,51(1):8-11
[14] Binmoeller KF, Seitz U, Seifert H, et a1 The Tannenbaum stent: a new plastic biliary stent without side holes[J]. Am J Gastroenterol. 1995 ,90(10):1764-1768
[15] CH Carrasco,S Wallace,C Chamsangavej,et a1.Expandable biliary endoprosthesis:an experimentalstudy[J].Am J Roentgenol.1985,145(6):1279-1281
[16] Yoshioka T, Sakaguchi H, Yoshimura H, et a1.Development and clinical application of biliary endoprosthesis using expandable metallic stents[J]. Nippon Igaku Hoshasen Gakkai Zasshi. 1988,48(9):1183-1185
[17] Saito H ,Sakurai Y,Takam ura A et a1.Biliary endoprosthesis using Gor-Tex covered expandable metallic stents:Preliminary clinical evaluation[J].Nippon Acta Radiologica.1994,54(2):180-l82
[18]Isayama H,Komatsu Y,Tsujino T, et al. A prospective randomised study of“covered”versus“uncovered”diamond stents for the management of distal malignant biliary obstruction[J]. Gut. 2004 ,53(5):729-734.
[19] Shin HP,Kim MH,Jung SW ,et a1.Endoscopic removal of biliary self_expandable metallic stents:8 prospective study[J].Endoscopy.2006,38(12):l250—1255.
[20]Nakai Y ,lsayam a H ,Komatsu Y.et a1.Efficacy and safety of the covered Wallstent in patients with distal malignant biliary obstruction[J].Gastrointest Endosc.2005,62(5):742—748
[21]杨光等。胆道支架覆膜研究现状[J]。中国介入影像与治疗学。2008,5(4):316-319
[22]Gwon DI, Shim HJ, Kwak BK et a1.Retrievable biliary stent-graft in the treatment of benign biliary strictures[J]. J Vasc Interv Radiol. 2008 ,19(9):1328-1335
[23] Uno, Koji; Yasuda, Kenjiro,Tanka, Kiyohito; Hayakumo, Takanobu; Nakajima, Masatusugu. Evanution of new plastic stent for malligant bilary obstruction[J]. Digestive Endoscopy.2001,13(3):159-162
[24]Ki Tae Suk et al. Human application of a metallic stent covered with a paclitaxel-incorporated membrane for malignant biliary obstruction: multicenter pilot study[J]. Gastrointest Endosc .2007,66(4): 798-803
[25]王敬等。可降解聚乳酸支架在胆管损伤治疗中作用的实验研究[J]。中华肝胆外科杂志。2004,10(12):841-843
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