Song Ho-Young, Shin Ji Hoon, Yoon Chang Jin, Lee Gin Hyug, Kim Tae-Won, Lee Sung-Koo, Yook Jung-Hwan, Kim Byung-Sik
Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Songpa-gu, Seoul, Republic of Korea.
J Vasc Interv Radiol. 2004 Dec;15(12):1443-9. doi: 10.1097/01.RVI.0000142594.31221.AF.
To investigate the technical feasibility and clinical effectiveness of a dual expandable nitinol stent in the palliative treatment of malignant gastroduodenal strictures.
The dual stent consisted of two stents, an outer partially covered stent and an inner bare nitinol stent. The outer diameter of the stent delivery system was 3.8 mm. With fluoroscopic guidance, the outer stent was placed into the stricture, followed by coaxial placement of the inner stent. The stent placement was attempted in 102 consecutive patients with malignant gastroduodenal strictures. The underlying causes of malignant strictures were gastric cancer (n = 55), pancreatic cancer (n = 24), gallbladder cancer (n = 7), cholangiocarcinoma (n = 5), duodenal cancer (n = 5), and metastatic cancer (n = 6). All patients presented with symptoms of gastric outlet obstruction.
Stent placement was technically successful and well tolerated in 101 of 102 patients (99%). After stent placement, 85 of the 101 patients (84%) with technical success experienced improvement of their symptoms. Tumor overgrowth occurred in five patients, stent migration in two, mucosal hyperplasia in one, bleeding in one, and jaundice in two. Seventy one of the 101 patients died 5 to 340 days (mean, 71 days) after stent placement from progression of their disease, myocardial infarction, bleeding, or sepsis. The remaining 30 patients are still alive 6 to 227 days (mean, 39 days) after stent placement. The 30-day, 60-day, 90-day, and 180-day survival rates were 78%, 58%, 39%, and 8%, respectively.
The dual stent with a 3.8-mm stent delivery system is easy to insert, safe, and reasonably effective for the palliative treatment of malignant gastroduodenal strictures.
探讨双腔可扩张镍钛合金支架在恶性胃十二指肠狭窄姑息治疗中的技术可行性及临床疗效。
双腔支架由两个支架组成，一个外部部分覆膜支架和一个内部裸镍钛合金支架。支架输送系统的外径为3.8毫米。在荧光透视引导下，将外部支架置入狭窄部位，随后同轴置入内部支架。对102例连续性恶性胃十二指肠狭窄患者尝试进行支架置入。恶性狭窄的潜在病因包括胃癌（n = 55）、胰腺癌（n = 24）、胆囊癌（n = 7）、胆管癌（n = 5）、十二指肠癌（n = 5）和转移性癌（n = 6）。所有患者均表现出胃出口梗阻症状。
102例患者中有101例（99%）支架置入技术成功且耐受性良好。支架置入后，101例技术成功的患者中有85例（84%）症状得到改善。5例患者出现肿瘤过度生长，2例出现支架移位，1例出现黏膜增生，1例出血，2例黄疸。101例患者中有71例在支架置入后5至340天（平均71天）因疾病进展、心肌梗死、出血或败血症死亡。其余30例患者在支架置入后6至227天（平均39天）仍存活。30天、60天、90天和180天的生存率分别为78%、58%、39%和8%。
采用3.8毫米支架输送系统的双腔支架易于插入，安全且对恶性胃十二指肠狭窄的姑息治疗具有合理疗效。
