比较未覆盖支架和覆盖支架治疗胰胆管癌引起的恶性十二指肠梗阻。
Comparison of uncovered and covered stents for the treatment of malignant duodenal obstruction caused by pancreaticobiliary cancer.
机构信息
Center for Liver Cancer, National Cancer Center, 111 Junbalsan-ro, Ilsandong-gu, Goyang, Gyeonggi, 410-769, South Korea.
出版信息
Surg Endosc. 2013 Jun;27(6):2031-9. doi: 10.1007/s00464-012-2705-6. Epub 2013 Jan 4.
BACKGROUND
Few clinical studies to date have compared different types of self-expandable metallic stents (SEMS) and their outcomes in patients with pure duodenal obstruction caused by pancreaticobiliary cancer. The aim of this study was to compare the clinical effectiveness and side effects of uncovered and covered SEMS for the palliation of duodenal obstruction caused by pancreaticobiliary cancer.
METHODS
We retrospectively analyzed all patients with pancreaticobiliary cancer who underwent upper endoscopy with SEMS placement for malignant duodenal obstruction at the National Cancer Center of Korea between April 2003 and December 2010. The technical and clinical success rates of the procedure, complications, and durations of stent patency and overall survival were evaluated.
RESULTS
We identified 70 patients with a mean age of 51.2 years (range = 39-81 years); of these, 46 (65.7 %) had pancreatic cancer, 9 (12.9 %) had bile duct cancer, 11 (15.7 %) had gallbladder cancer, and 4 (5.7 %) had cancer of the ampulla of Vater. Twenty-four patients (34.3 %) received covered SEMSs and 46 (65.7 %) received uncovered SEMSs. Technical and clinical success rates were similar for the covered and uncovered stent groups. The complication rate was higher in the covered than in the uncovered group (62.5 vs. 34.8 %, P = 0.025), due primarily to a significantly higher stent migration rate (20.8 vs. 0 %, P = 0.004). Perforation as a late complication occurred in four patients, two in each group (8.3 vs. 4.3 %, P = 0.425). Stent patency tended to be shorter for covered than for uncovered duodenal stents (13.7 ± 8.6 weeks vs. not reached, P = 0.069).
CONCLUSIONS
The use of uncovered stents may be a preferred option for duodenal obstruction secondary to pancreaticobiliary malignancies, since they were effective in preventing stent migration and tended to have longer patency than covered stents. Careful attention should be paid to signs and symptoms of perforation during follow-up.
背景
目前为止，仅有少数临床研究比较了不同类型的自膨式金属支架（SEMS）及其在由胰胆恶性肿瘤导致的单纯性十二指肠梗阻患者中的应用效果。本研究旨在比较未覆膜和覆膜 SEMS 治疗胰胆恶性肿瘤所致十二指肠梗阻的临床效果和副作用。
方法
我们回顾性分析了 2003 年 4 月至 2010 年 12 月期间在韩国国家癌症中心行上消化道内镜并置入 SEMS 以治疗恶性十二指肠梗阻的所有胰胆恶性肿瘤患者。评估了该操作的技术和临床成功率、并发症、支架通畅时间和总生存时间。
结果
我们共纳入 70 例平均年龄 51.2 岁（范围 39-81 岁）的患者；其中 46 例（65.7%）为胰腺癌，9 例（12.9%）为胆管癌，11 例（15.7%）为胆囊癌，4 例（5.7%）为壶腹癌。24 例（34.3%）接受了覆膜 SEMS，46 例（65.7%）接受了未覆膜 SEMS。覆膜和未覆膜支架组的技术和临床成功率相似。覆膜组的并发症发生率高于未覆膜组（62.5%比 34.8%，P=0.025），主要是由于支架迁移率显著较高（20.8%比 0%，P=0.004）。4 例（8.3%）患者出现迟发性穿孔并发症，两组各 2 例（4.3%比 2.1%，P=0.425）。覆膜支架的通畅时间倾向于短于未覆膜支架（13.7±8.6 周比未达到，P=0.069）。
结论
对于由胰胆恶性肿瘤引起的十二指肠梗阻，使用未覆膜支架可能是一种优选方案，因为它们可以有效预防支架迁移，且通畅时间长于覆膜支架。在随访过程中应密切注意穿孔的迹象和症状。
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