Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
Surg Endosc. 2011 Sep;25(9):3094-100. doi: 10.1007/s00464-011-1675-4. Epub 2011 Apr 13.
Distal malignant biliary obstruction (MBO) due to lymph node metastases (LNM) is a common problem in advanced malignant disease. However, the role of covered self-expandable metal stents (SEMS) in treating MBO has not been studied. The aim of this study was to evaluate the efficacy and safety of covered SEMS for the treatment of distal MBO due to LNM.
Between November 1994 and December 2009, a total of 65 patients with distal MBO due to LNM underwent covered (n = 44) and uncovered (n = 21) SEMS placement.
Successful drainage was achieved in all patients. There was no significant difference in patient survival. The cumulative stent patency of covered SEMS was significantly higher than that of uncovered SEMS (P = 0.0020). Stent occlusion occurred in 5 patients (11%) with covered SEMS and in 8 (38%) with uncovered SEMS. There was no tumor ingrowth in covered SEMS, but seven in the uncovered SEMS group showed some ingrowth. Cholecystitis was not observed, but mild pancreatitis was observed in 6 (14%) of those with covered SEMS. No stent-insertion-related deaths occurred.
Covered SEMS are safe and effective for treatment of distal malignant biliary obstruction due to LNM.
由于淋巴结转移（LNM）导致的远端恶性胆道梗阻（MBO）是晚期恶性疾病中的常见问题。然而，覆膜自膨式金属支架（SEMS）在治疗 MBO 中的作用尚未得到研究。本研究旨在评估覆膜 SEMS 治疗 LNM 所致远端 MBO 的疗效和安全性。
1994 年 11 月至 2009 年 12 月，共有 65 例 LNM 所致远端 MBO 患者接受了覆膜（n=44）和 uncovered SEMS（n=21）置放。
所有患者均成功引流。患者生存无显著差异。覆膜 SEMS 的累积支架通畅率明显高于 uncovered SEMS（P=0.0020）。覆膜 SEMS 组有 5 例（11%）发生支架阻塞，而 uncovered SEMS 组有 8 例（38%）发生支架阻塞。覆膜 SEMS 中未发现肿瘤向内生长，但 uncovered SEMS 组中有 7 例发现了一些向内生长。未观察到胆囊炎，但覆膜 SEMS 组中有 6 例（14%）发生了轻度胰腺炎。无支架置入相关死亡。
覆膜 SEMS 治疗 LNM 所致远端恶性胆道梗阻安全有效。
