Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan.
Dig Dis Sci. 2012 Dec;57(12):3279-85. doi: 10.1007/s10620-012-2270-9. Epub 2012 Jun 26.
The clinical differences between side-by-side and stent-in-stent deployment using a self-expanding metal stent for hilar malignant obstruction have not been evaluated.
The purpose of this study was to compare the clinical features between side-by-side and stent-in-stent deployment.
We compared side-by-side and stent-in-stent deployment in 52 consecutive patients with malignant hilar biliary obstruction who underwent endoscopic bilateral drainage using self-expanding metal stent. Side-by-side deployment (SBS group) was performed in 28 patients from 2002 to 2005, and stent-in-stent deployment (SIS group) in 24 patients from 2006 to 2010. Technical success, functional success, complications, stent occlusion and cumulative stent patency in the SBS and SIS groups were evaluated and compared retrospectively.
There were no significant inter-group differences in technical success (SBS vs. SIS, 89 vs. 100 %, respectively), functional success (96 vs. 100 %), early complications (11 vs. 4 %), late complications (32 vs. 8 %) or stent occlusion (20 vs. 42 %). The incidence of complications was significantly higher for SBS than for SIS (44 vs. 13 %; p = 0.016). Cumulative stent patency was significantly better for SBS than for SIS (log-rank, p = 0.047). SBS was not associated with significantly longer cumulative stent patency in univariate Cox proportional hazard analysis (HR 0.35; 95 % CI 0.12-1.03; p = 0.056) and multivariate analysis (HR 0.39; 95 % CI 0.13-1.16; p = 0.090).
The incidence of complications is higher for side-by-side than stent-in stent deployment in bilateral metal stenting. In terms of cumulative stent patency, side-by-side deployment tends to be more effective than stent-in-stent deployment.
使用自膨式金属支架治疗肝门部恶性梗阻时，并排式和支架内支架式部署的临床差异尚未得到评估。
本研究旨在比较并排式和支架内支架式部署的临床特征。
我们比较了 52 例连续接受内镜双侧引流的恶性肝门胆管梗阻患者的并排式和支架内支架式部署。2002 年至 2005 年期间，28 例患者采用并排式部署（SBS 组），2006 年至 2010 年期间，24 例患者采用支架内支架式部署（SIS 组）。回顾性评估和比较了 SBS 和 SIS 组的技术成功率、功能成功率、并发症、支架闭塞和累积支架通畅率。
SBS 组和 SIS 组在技术成功率（SBS 组 89%，SIS 组 100%）、功能成功率（SBS 组 96%，SIS 组 100%）、早期并发症（SBS 组 11%，SIS 组 4%）、晚期并发症（SBS 组 32%，SIS 组 8%）或支架闭塞（SBS 组 20%，SIS 组 42%）方面无显著组间差异。SBS 组并发症发生率明显高于 SIS 组（44% vs. 13%；p = 0.016）。SBS 组累积支架通畅率明显优于 SIS 组（log-rank，p = 0.047）。SBS 与 SIS 相比，在单因素 Cox 比例风险分析（HR 0.35；95%CI 0.12-1.03；p = 0.056）和多因素分析（HR 0.39；95%CI 0.13-1.16；p = 0.090）中均未显著增加累积支架通畅率。
双侧金属支架内并排式部署的并发症发生率高于支架内支架式部署。在累积支架通畅率方面，并排式部署比支架内支架式部署更有效。
