Tsuyuguchi Toshio, Takada Tadahiro, Miyazaki Masaru, Miyakawa Shuichi, Tsukada Kazuhiro, Nagino Masato, Kondo Satoshi, Furuse Junji, Saito Hiroya, Suyama Masafumi, Kimura Fumio, Yoshitomi Hideyuki, Nozawa Satoshi, Yoshida Masahiro, Wada Keita, Amano Hodaka, Miura Fumihiko
Department of Medicine and Clinical Oncology, Chiba University Graduate School of Medicine, Chiba, Japan.
J Hepatobiliary Pancreat Surg. 2008;15(1):69-73. doi: 10.1007/s00534-007-1282-x. Epub 2008 Feb 16.
Together with biliary drainage, which is an appropriate procedure for unresectable biliary cancer, biliary stent placement is used to improve symptoms associated with jaundice. Owing to investigations comparing percutaneous transhepatic biliary drainage (PTBD), surgical drainage, and endoscopic drainage, many types of stents are now available that can be placed endoscopically. The stents used are classified roughly as plastic stents and metal stents. Compared with plastic stents, metal stents are of large diameter, and have long-term patency (although they are expensive). For this reason, the use of metal stents is preferred for patients who are expected to survive for more than 6 months, whereas for patients who are likely to survive for less than 6 months, the use of plastic stents is not considered to be improper. Obstruction in a metal stent is caused by a tumor that grows within the stent through the mesh interstices. To overcome such problems, a covered metal stent was developed, and these stents are now used in patients with malignant distal biliary obstruction. However, this type of stent has been reported to have several shortcomings, such as being associated with the development of acute cholecystitis and stent migration. In spite of these shortcomings, evidence is expected to demonstrate its superiority over other types of stent.
对于无法切除的胆管癌，胆管引流是一种合适的治疗方法，胆管支架置入术用于改善与黄疸相关的症状。由于对经皮经肝胆管引流（PTBD）、手术引流和内镜引流进行了比较研究，现在有多种类型的支架可通过内镜置入。所使用的支架大致分为塑料支架和金属支架。与塑料支架相比，金属支架直径较大，具有长期通畅性（尽管价格昂贵）。因此，对于预期生存期超过6个月的患者，优先使用金属支架；而对于预期生存期少于6个月的患者，使用塑料支架也并非不合适。金属支架的阻塞是由肿瘤通过网眼间隙在支架内生长所致。为克服此类问题，研发了覆膜金属支架，目前这些支架用于治疗恶性远端胆管梗阻患者。然而，据报道这种类型的支架存在一些缺点，如与急性胆囊炎的发生及支架移位有关。尽管存在这些缺点，但有望证明其优于其他类型的支架。
