Kim Jin Hyoung, Song Ho-Young, Shin Ji Hoon, Choi Eugene, Kim Tae Won, Lee Sung Koo, Kim Byung Sik
Department of Radiology, Asan Medical Center, 388-1 Pungnap-2dong, Songpa-gu, Seoul, Seoul, South Korea 138-736.
AJR Am J Roentgenol. 2007 Jun;188(6):1495-9. doi: 10.2214/AJR.06.1385.
The purpose of this study was retrospective evaluation of the incidence, predictive factors, and interventional management of stent collapse after placement of a covered metallic stent in patients with obstruction of the gastric outlet or duodenum due to malignant disease.
Among 259 patients with symptomatic malignant gastroduodenal obstruction successfully treated with stent placement, stent collapse occurred in 12 (4.6%) of the patients 34-270 days (mean, 101.8 days) after stent placement. Multivariate analysis was performed to evaluate factors predictive of stent collapse. Interventional management of stent collapse also was evaluated.
Multivariate analysis showed that presence of the stent in the peripyloric region (odds ratio, 27.745; p = 0.036), longer survival time (odds ratio, 1.016; p < 0.001), and absence of chemotherapy after stent placement (odds ratio, 31.661; p = 0.048) were independent predictors of stent collapse. Eleven patients with stent collapse were successfully treated with placement of a second bare stent. The twelfth patient refused further treatment.
Stent collapse is an uncommon delayed complication of placement of covered metallic stents in patients with malignant gastroduodenal obstruction. Collapse occurs most commonly in the peripyloric region, in patients with longer survival times, and in patients who do not undergo chemotherapy after stent placement. Stent collapse can be managed by coaxial placement of a second bare stent into the collapsed stent.
本研究旨在回顾性评估因恶性疾病导致胃出口或十二指肠梗阻的患者置入覆膜金属支架后支架塌陷的发生率、预测因素及介入治疗。
在259例因症状性恶性胃十二指肠梗阻成功置入支架治疗的患者中，12例（4.6%）在支架置入后34 - 270天（平均101.8天）发生支架塌陷。进行多因素分析以评估支架塌陷的预测因素。同时也评估了支架塌陷的介入治疗。
多因素分析显示，支架位于幽门周围区域（比值比，27.745；p = 0.036）、生存时间较长（比值比，1.016；p < 0.001）以及支架置入后未进行化疗（比值比，31.661；p = 0.048）是支架塌陷的独立预测因素。11例支架塌陷患者通过置入第二个裸支架成功治疗。第12例患者拒绝进一步治疗。
支架塌陷是恶性胃十二指肠梗阻患者置入覆膜金属支架后一种罕见的延迟并发症。塌陷最常发生在幽门周围区域、生存时间较长的患者以及支架置入后未接受化疗的患者中。支架塌陷可通过将第二个裸支架同轴置入塌陷支架内进行处理。
