Han Young-Min, Hwang Seung-Bae, Lee Soo-Teik, Lee Jeong-Min, Chung Gyung-Ho
Department of Radiology, Chonbuk National University Medical School, 634-18, Keumam Dong, Chonju City, 560-182, South Korea.
Cardiovasc Intervent Radiol. 2002 Sep-Oct;25(5):381-7. doi: 10.1007/s00270-002-0439-x. Epub 2002 Jun 4.
To evaluate the immediate and long-term results in ten patients with malignant biliary obstruction using a polyurethane-covered, self-expandable nitinol stent.
A nitinol stent, fully covered with high-elasticity polyurethane, with an unconstrained diameter of 10 mm and a total length of 60-80 mm, was placed transhepatically under fluoroscopic guidance in ten patients. The length of the biliary obstruction varied between 30-50 mm. The follow-up examination included a clinical assessment, serum bilirubin measurement, and ultrasound examinations at one-month intervals in all patients.
Initial stent deployment was successful in eight patients. Two patients experienced proximal migration, which was solved by insertion of two, uncovered Wallstents. One patient had the stent removed after two weeks because of severe nausea and vomiting. One patient had delayed migration of the covered stent after 40 weeks. The follow-up duration was 3-40 weeks (Mean: 16.9 weeks). Seven patients died (3-26 weeks) and three patients survived (24-40 weeks). The bilirubin measurements in all patients had significantly decreased one week after stent insertion. The levels of amylase and lipase had did not increase after stent insertion.
A polyurethane-covered, self-expandable nitinol stent can be used effectively and safely in the treatment of malignant biliary obstruction. The preliminary results are favorable, but there is a need for further large studies to determine both long-term survival and patency.
评估使用聚氨酯覆盖的自膨式镍钛合金支架治疗10例恶性胆管梗阻患者的近期和远期效果。
在透视引导下，经皮肝穿刺为10例患者置入一种镍钛合金支架，该支架完全覆盖高弹性聚氨酯，无约束直径为10mm，总长度为60 - 80mm。胆管梗阻长度在30 - 50mm之间。所有患者随访检查包括临床评估、血清胆红素测定以及每隔1个月进行超声检查。
8例患者支架初始置入成功。2例患者出现近端移位，通过置入2个未覆盖的Wallstent支架得以解决。1例患者因严重恶心呕吐在2周后取出支架。1例患者在40周后出现覆盖支架延迟移位。随访时间为3 - 40周（平均16.9周）。7例患者死亡（3 - 26周），3例患者存活（24 - 40周）。所有患者在支架置入1周后胆红素测量值均显著下降。支架置入后淀粉酶和脂肪酶水平未升高。
聚氨酯覆盖的自膨式镍钛合金支架可有效、安全地用于恶性胆管梗阻的治疗。初步结果良好，但需要进一步开展大型研究以确定长期生存率和通畅率。
