Hatzidakis Adam, Krokidis Miltiadis, Kalbakis Kostantinos, Romanos Jiannis, Petrakis Ioannis, Gourtsoyiannis Nicholas
Department of Radiology, University Hospital of Heraklion, Medical School of Crete, 71110 Heraklion-Stavrakia, Crete, Greece.
Cardiovasc Intervent Radiol. 2007 Sep-Oct;30(5):950-8. doi: 10.1007/s00270-007-9049-y. Epub 2007 May 17.
To determine the application and clinical effectiveness of ePTFE/FEP-covered metallic stents for palliation of malignant biliary disease, and to evaluate the efficiency of stent coverage in preventing tumor ingrowth.
During a 3-year period, 36 patients with malignant obstructive jaundice were treated with ePTFE/FEP-covered stents, with or without proximal side holes. The stricture was located in the lower common bile duct (CBD) in 18 cases, the upper CBD in 9, the lower common hepatic duct (CHD) in 6, and the upper CHD in 3 patients.
Thirty-seven covered stents were percutaneously implanted. The technical success rate was 97%. Reintervention was required in 6 cases. The 30-day mortality rate was 40%, not procedure-related. Mean survival was 128 days. Primary patency rates were 100%, 55.5%, and 25% at 3, 6, and 12 months, respectively, while the assisted patency rate was 100% at 12 months. Stents without side holes had higher primary patency rates compared with those with side holes, where occlusion was always due to tumor ingrowth. Tumor ingrowth did not occur in the completely covered stents. No stent dysfunction due to sludge incrustation was found. Complications were 1 case of arterial laceration that occurred during percutaneous transhepatic cholangiography, and a subcapsular hematoma and 1 case of bile peritonitis, that both occurred during primary stenting. No complications followed the secondary stenting technique.
ePTFE/FEP-covered metallic stents are safe and effective for palliation of malignant biliary disease. The presence of the ePTFE/FEP coating is likely to prevent from tumor ingrowth.
确定ePTFE/FEP覆膜金属支架在恶性胆道疾病姑息治疗中的应用及临床疗效，并评估支架覆膜在预防肿瘤长入方面的效果。
在3年期间，36例恶性梗阻性黄疸患者接受了带或不带近端侧孔的ePTFE/FEP覆膜支架治疗。狭窄位于胆总管下段（CBD）18例，CBD上段9例，肝总管下段（CHD）6例，CHD上段3例。
经皮植入了37枚覆膜支架。技术成功率为97%。6例需要再次干预。30天死亡率为40%，与操作无关。平均生存期为128天。3个月、6个月和12个月时的初始通畅率分别为100%、55.5%和25%，而12个月时的辅助通畅率为100%。无侧孔支架的初始通畅率高于有侧孔支架，后者闭塞总是由于肿瘤长入。完全覆膜的支架未发生肿瘤长入。未发现因胆泥结痂导致的支架功能障碍。并发症包括1例经皮肝穿刺胆管造影时发生的动脉撕裂，以及1例初次支架置入时发生的肝包膜下血肿和1例胆汁性腹膜炎。二次支架置入技术未出现并发症。
ePTFE/FEP覆膜金属支架用于恶性胆道疾病的姑息治疗安全有效。ePTFE/FEP涂层的存在可能预防肿瘤长入。
