Arhan Mehmet, Odemiş Bülent, Parlak Erkan, Ertuğrul Ibrahim, Başar Omer
Yunus Emre caddesi, Yigitler sokak, 9/3, Incirli, Ankara, Turkey.
Surg Endosc. 2009 Apr;23(4):769-75. doi: 10.1007/s00464-008-0067-x. Epub 2008 Jul 23.
Stent migration occurs in about 5-10% of patients undergoing biliary stenting. The aim of this study was to analyze the risk factors for stent migration in patients with benign and malignant strictures.
We retrospectively analyzed records of 524 biliary plastic stent placement procedures. Details noted included the cause and localization of stricture, characteristics and number of stents, direction of stent migration, presentation of patient with migrated stent, and the methods used for retrieval of migrated stents.
Two hundred and four (38.9%) of the procedures were performed for benign biliary strictures (BBS) and 320 (61.1%) for malignant biliary strictures (MBS). Thirty-four patients had 45 migrated biliary stents. The rate of migration was 8.58% (proximal 4.58% and distal 4.00%). Migration frequency was higher in BBS compared with MBS (13.7% versus 5.3%, p=0.001). In BBS, the rate of stent migration was higher in cases with one (19.3%) and two stents (20.9%) when compared with cases with multiple stents (2.7%) (p=0.001; p=0.001, respectively). Migration occurred more frequently (10.9%) in cases with two stents when compared both to cases with one stent (3.0%) and those with multiple stents (0%) in MBS (p=0.008; p=0.020, respectively). In BBS, short stents migrated more frequently proximally (77%) and long stents more frequently distally (73%) (p=0.008). In BBS, migration in cases with proximal stricture occurred more frequently distally (76.9%), while in those with distal stricture, migration was more frequently proximal (73.3%) (p=0.008). All of the proximally migrated stents could be successfully retrieved endoscopically.
The risk of stent migration is higher in BBS compared with in MBS. The cases with multiple stents had significantly lower stent migration. In BBS, long stent, proximal and postcholecystectomy strictures were associated with distal migration, while short stent, distal and non-postcholecystectomy strictures were associated with proximal migration.
胆管支架置入术后，约5%-10%的患者会发生支架移位。本研究旨在分析良性和恶性狭窄患者支架移位的危险因素。
我们回顾性分析了524例胆管塑料支架置入手术的记录。记录的详细信息包括狭窄的病因和部位、支架的特征和数量、支架移位的方向、支架移位患者的表现以及取出移位支架所采用的方法。
204例（38.9%）手术是针对良性胆管狭窄（BBS）进行的，320例（61.1%）是针对恶性胆管狭窄（MBS）进行的。34例患者发生了45个胆管支架移位。移位率为8.58%（近端移位4.58%，远端移位4.00%）。与MBS相比，BBS的移位频率更高（13.7%对5.3%，p=0.001）。在BBS中，单支架（19.3%）和双支架（20.9%）患者的支架移位率高于多支架患者（2.7%）（分别为p=0.001；p=0.001）。在MBS中，双支架患者的移位发生率（10.9%）高于单支架患者（3.0%）和多支架患者（0%）（分别为p=0.008；p=0.020）。在BBS中，短支架近端移位更频繁（77%），长支架远端移位更频繁（73%）（p=0.008）。在BBS中，近端狭窄患者的移位更常发生在远端（76.9%），而远端狭窄患者的移位更常发生在近端（73.3%）（p=0.008）。所有近端移位的支架均可通过内镜成功取出。
与MBS相比，BBS患者发生支架移位的风险更高。多支架患者的支架移位明显较少。在BBS中，长支架、近端狭窄和胆囊切除术后狭窄与远端移位相关，而短支架、远端狭窄和非胆囊切除术后狭窄与近端移位相关。
