Department of Digestive Diseases, Hospital Virgen de la Luz, Cuenca, Spain.
Rev Esp Enferm Dig. 2010 Sep;102(9):526-32. doi: 10.4321/s1130-01082010000900003.
biliary self-expanding metal stents (SEMS) have the advantage of being inserted undeployed with very small sizes and provide, when fully opened, large diameters for biliary drainage. However, their use in benign conditions has been very limited, mainly because of difficulty in their extraction. We present our initial experience with a fully covered SEMS (Wallflex) for the management of benign problems of the bile duct.
in a prospective study, stents of 8 mm in diameter and 4, 6 or 8 cm long were inserted by means of ERCP. These SEMS were chosen when according to medical judgement it was thought that diameters greater than 10 French (3.3 mm) were needed for proper biliary drainage. Stents were extracted also endoscopically, several months later when deemed clinically appropriate.
twenty biliary SEMS were inserted. Reasons for insertion were: large intrahepatic biliary fistula after hydatid cyst surgery (1), perforation of the papillary area following endoscopic sphincterotomy (2), coaxial insertion to achieve patency in obstructed uncovered stents inserted in benign conditions (3), benign strictures (7), multiple and large common bile duct stones that could not be extracted because of tapering and stricturing of the distal common bile duct (7). In all cases, successful biliary drainage was achieved and there were no complications from insertion. Stents were easily extracted after a mean time of 132 days (36-270) in place. Complete resolution of biliary problems was obtained in 14 patients (70%).
in our initial experience, the fully covered Wallflex biliary stent was removed without any complication after being in place in the common bile duct for a mean time of over four months. Therefore, it could be used in the management of benign biliary conditions.
胆道自膨式金属支架(SEMS)具有可在未扩张状态下插入非常小尺寸的优势,并在完全打开时提供大的胆管引流直径。然而,它们在良性情况下的应用非常有限,主要是因为取出困难。我们介绍了一种新型全覆膜 SEMS(Wallflex)在治疗良性胆管疾病方面的初步经验。
在一项前瞻性研究中,通过 ERCP 插入直径为 8 毫米、长 4、6 或 8 厘米的支架。这些 SEMS 是根据医学判断选择的,认为需要大于 10 French(3.3 毫米)的直径才能进行适当的胆汁引流。几个月后,当临床认为合适时,也通过内镜取出支架。
共插入 20 个胆道 SEMS。插入的原因是:肝内大胆管瘘(1),内镜括约肌切开术后乳头区穿孔(2),同轴插入以实现阻塞的未覆膜支架通畅,这些支架是在良性情况下插入的(3),良性狭窄(7),多发大胆总管结石因胆总管远端变窄和狭窄而无法取出(7)。在所有情况下,均成功实现了胆汁引流,且插入过程中无并发症。支架在原位放置 132 天后(36-270)平均容易取出。14 例患者(70%)的胆道问题完全解决。
在我们的初步经验中,Wallflex 全覆膜胆管支架在胆总管内放置平均超过四个月后,无任何并发症取出。因此,它可用于治疗良性胆管疾病。