Lee Dong Ki
Department of Internal Medicine, Kangnam Hospital, Yonsei University, P.O. Box 1217, Kangnam, Seoul, Korea.
J Hepatobiliary Pancreat Surg. 2009;16(5):628-32. doi: 10.1007/s00534-009-0135-1. Epub 2009 Jun 24.
In unresectable malignant bile duct obstruction, endoscopic stent insertion is the treatment of choice. However, the current stent allows only mechanical palliation of the obstruction, and has no anti-tumor effect. Currently, in the vascular field, the drug-eluting stent (DES) is very highly favored.
The requirements for a DES in a non-vascular tract, such as the bile duct, are far different from those of a DES to be used in the vascular tract. The non-vascular DES must suppress tumor proliferation as well as mucosal hyperplasia. For example, the non-vascular stent might be covered with a membrane that gradually releases a chemo-agent. We do not have much experience with DES in the bile duct. Nonetheless, we are continuously testing many anti-tumor agents in animal and human studies.
We expect and hope DES will work effectively for tumor cells in diverse ways and, more importantly, will prolong stent patency and the patients' survival periods. But considerable investigation and a clinical study of DES will be required to achieve these goals.
在无法切除的恶性胆管梗阻中，内镜下支架置入是首选治疗方法。然而，目前的支架仅能对梗阻进行机械性缓解，并无抗肿瘤作用。目前，在血管领域，药物洗脱支架（DES）备受青睐。
用于非血管管道（如胆管）的DES的要求与用于血管管道的DES有很大不同。非血管DES必须抑制肿瘤增殖以及黏膜增生。例如，非血管支架可能覆盖有能逐渐释放化疗药物的膜。我们在胆管DES方面经验不多。尽管如此，我们在动物和人体研究中不断测试多种抗肿瘤药物。
我们期望并希望DES能以多种方式对肿瘤细胞产生有效作用，更重要的是，能延长支架通畅时间和患者生存期。但要实现这些目标，还需要对DES进行大量研究和临床研究。
