Department of Gastroenterology, Hepatology, and Nutrition, MD Anderson Cancer Center, University of Texas, Houston, TX, USA.
Expert Rev Gastroenterol Hepatol. 2012 Feb;6(1):105-14. doi: 10.1586/egh.11.95.
Malignant biliary obstruction can be due to direct tumor infiltration, extrinsic compression, adjacent inflammation, desmoplastic reaction from tumors or, more commonly, a combination of the above factors. Pancreatic cancer is the most common cause of malignant biliary obstruction, and jaundice occurs in 70-90% of the patients during the course of the disease. Compared with the uncovered metal stents, covered metal stents have longer patency and a lower rate of tumor ingrowth, but have a higher rate of stent migration. To combat the occlusion and provide an antitumor effect, drug-eluting stents were developed. A duodenal stricture complicates biliary stent placement in 10-20% of patients with distal biliary obstruction due to pancreatic cancer. When both strictures are considered, a biliary stent can be placed either preceding or following duodenal stent placement. Complications of self-expandable metal stents include stent occlusion, stent migration, cholecystitis and pancreatitis.
恶性胆道梗阻可能是由于肿瘤直接浸润、外部压迫、邻近炎症、肿瘤引起的纤维组织反应，或更常见的是上述因素的组合。胰腺癌是恶性胆道梗阻最常见的原因，70-90%的患者在疾病过程中出现黄疸。与无覆盖的金属支架相比，覆盖的金属支架具有更长的通畅时间和更低的肿瘤生长率，但支架迁移率更高。为了对抗阻塞并提供抗肿瘤作用，开发了药物洗脱支架。由于胰腺癌导致的远端胆道梗阻，10-20%的患者在胆道支架放置时会出现十二指肠狭窄。当考虑到这两种狭窄时，胆道支架可以先于或后于十二指肠支架放置。自膨式金属支架的并发症包括支架阻塞、支架迁移、胆囊炎和胰腺炎。
