Tesdal I Kaare, Roeren Thomas, Weiss Christel, Jaschke Werner, Dueber Christoph
Department of Clinical Radiology, Universitätsklinikum, Mannheim, Germany.
J Vasc Interv Radiol. 2005 Nov;16(11):1479-87. doi: 10.1097/01.rvi0000173014.99278.08.
To investigate the role of metallic stents in the treatment of benign biliary strictures and analyze the differences in primary patency associated with the various types of stents deployed.
Between 1990 and 1997, 21 patients with benign obstructive jaundice were treated with transhepatic placement of metallic stents (11 Wallstents in 10 patients, nine Palmaz stents in seven patients, and four tantalum Strecker stents in four patients). Nineteen patients presented with strictures not responding to balloon angioplasty (postsurgical, n = 13; cholangitis, n = 5; unknown, n = 1). Estimates for cumulative patency, patency rate in the different stent groups, and survival were calculated with use of life-table analysis; the log-rank test was used to compare the different stent groups. The prognostic relevance of the selected variables-stent type, stent length, etiology, and location-were modeled with respect to patency according to Weibull distribution.
The median follow-up time was 80.5 months (range, 2-116 months). The median survival time was 91 months. One patient was lost to follow-up after 3 months. Repeat intervention for recurrent obstructive jaundice was necessary in 11 patients (55%), and the median patency rate was 26 months (range, 2-96 months). The Palmaz stent was the most effective in achieving long-term patency, with a median patency duration of 36 months (range, 22-96 months), versus 9 months (range, 3-67 months) for the Wallstent and 6 months (range, 2-15 months) for the tantalum Strecker stent. The cumulative patency rate with the Palmaz stent was significantly higher than for the tantalum Strecker stent (log-rank test, P = .017) and nonsignificantly higher compared with the Wallstent (log-rank test, P = .07). Multivariate analysis showed that the type of stent (Wald test, P = .003) and stent length (Wald test, P < .0001) influenced the patency rate.
These results suggest that the type of stent and the stent length have a significant influence on the patency rate. In this series, the Palmaz stent was most effective in achieving long-term patency in benign biliary strictures.
探讨金属支架在良性胆管狭窄治疗中的作用，并分析不同类型支架植入后初始通畅率的差异。
1990年至1997年间，21例良性梗阻性黄疸患者接受了经肝金属支架植入术（10例患者植入11枚Wallstent支架，7例患者植入9枚Palmaz支架，4例患者植入4枚钽制Strecker支架）。19例患者的狭窄对球囊血管成形术无效（术后狭窄，n = 13；胆管炎，n = 5；病因不明，n = 1）。采用寿命表分析计算累积通畅率、不同支架组的通畅率及生存率；采用对数秩检验比较不同支架组。根据Weibull分布对所选变量（支架类型、支架长度、病因及位置）与通畅率的预后相关性进行建模。
中位随访时间为80.5个月（范围2 - 116个月）。中位生存时间为91个月。1例患者在3个月后失访。11例患者（55%）因复发性梗阻性黄疸需要再次干预，中位通畅率为26个月（范围2 - 96个月）。Palmaz支架在实现长期通畅方面最有效，中位通畅持续时间为36个月（范围22 - 96个月），而Wallstent支架为9个月（范围3 - 67个月），钽制Strecker支架为6个月（范围2 - 15个月）。Palmaz支架的累积通畅率显著高于钽制Strecker支架（对数秩检验，P = .017），与Wallstent支架相比虽无显著差异但仍较高（对数秩检验，P = .07）。多因素分析显示，支架类型（Wald检验，P = .003）和支架长度（Wald检验，P < .0001）影响通畅率。
这些结果表明，支架类型和支架长度对通畅率有显著影响。在本系列研究中，Palmaz支架在实现良性胆管狭窄的长期通畅方面最有效。
