Fourth Department of Internal Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan.
Dig Endosc. 2013 May;25 Suppl 2:94-9. doi: 10.1111/den.12080.
Plastic stent (PS) occlusion occurs as a result of bacterial adherence to the stent's inner wall. To retain the bacteriological barrier, placing a PS above the sphincter of Oddi ('inside stent') has been investigated. We designed a new PS (inside stent with thread [IT] stent) with attachable nylon thread for use as an inside stent and for easy retrieval. The present study evaluated the IT stent's technical feasibility and efficacy for malignant hilar biliary obstruction.
A total of 26 consecutive patients with unresectable malignant hilar biliary obstruction underwent placement of IT stents from August 2007 to February 2011. IT stents were placed across the strictures without sphincterotomy to achieve bilateral drainage.
The overall technical success rate of the IT stent was 100% for one session. Multiple IT stents were inserted in 25 cases(two stents in 15 patients, three stents in 10 patients). No stent-related early complications occurred. The functional success rate was 92% (24/26). The rate of reintervention because of stent malfunction was 50% (13/26). In all 16 patients who underwent stent removal, IT stents were easily retrieved using the nylon thread. According to Kaplan-Meier analysis, the median stent patency period was 136 days.
IT stents for endoscopic placement above the sphincter of Oddi can be used safely and effectively for malignant hilar biliary obstruction.
塑料支架（PS）阻塞是由于细菌附着在支架的内壁上而发生的。为了保留细菌学屏障，已经研究了将 PS 放置在 Oddi 括约肌上方（“支架内”）。我们设计了一种带有可附着尼龙线的新型 PS（带线的支架内[IT]支架），用作支架内并便于取出。本研究评估了 IT 支架在恶性肝门胆管梗阻中的技术可行性和疗效。
2007 年 8 月至 2011 年 2 月，共对 26 例不可切除的恶性肝门胆管梗阻患者进行了 IT 支架置入术。IT 支架穿过狭窄处而不进行括约肌切开术以实现双侧引流。
一次治疗的 IT 支架总体技术成功率为 100％。25 例中插入了多个 IT 支架（15 例中 2 个支架，10 例中 3 个支架）。没有支架相关的早期并发症。功能成功率为 92％（24/26）。由于支架故障而需要再次介入的比例为 50％（26/26）。在所有 16 例接受支架取出的患者中，均使用尼龙线轻松取出 IT 支架。根据 Kaplan-Meier 分析，中位支架通畅期为 136 天。
内镜放置在 Oddi 括约肌上方的 IT 支架可安全有效地用于恶性肝门胆管梗阻。
