Yoshioka T, Sakaguchi H, Yoshimura H, Tamada T, Ohishi H, Uchida H, Wallace S
Department of Radiology, Nara Medical University, Japan.
Radiology. 1990 Oct;177(1):253-7. doi: 10.1148/radiology.177.1.2399327.
A biliary endoprosthesis constructed of self-expanding metallic "Z" stents was placed in 23 patients with obstructive jaundice. The biliary obstruction was due to a malignant neoplasm in 21 patients and a postoperative biliary stricture in two patients. The lesions affected the intrahepatic biliary ducts in 13 patients. Twelve patients had undergone radiation therapy before stent placement. The endoprostheses consisted of 196 expandable metallic biliary stents placed singly (n = 10) or in tandem (n = 186). As many as 18 stents were used to relieve an obstruction in one patient. A transhepatic approach was employed in all patients except one in whom stents were placed through a T-tube tract. Within 1 week after placement, all stents expanded to at least 90% of their original diameter. Three misplaced, two deformed, and two dislodged stents caused no obvious clinical problems. At follow-up, which ranged from 2 to 59 weeks, five patients experienced recurrent jaundice. Two patients with recurrent jaundice due to obstruction of the bile duct containing the stent were treated with external catheter drainage. The expandable biliary endoprosthesis is suggested as an effective treatment for benign and malignant biliary obstruction.
23例梗阻性黄疸患者植入了由自膨式金属“Z”形支架构成的胆道内支架。21例患者的胆道梗阻由恶性肿瘤引起，2例患者由术后胆道狭窄引起。13例患者的病变累及肝内胆管。12例患者在支架置入前接受过放射治疗。内支架由196个可扩张金属胆道支架组成，单个置入（n = 10）或串联置入（n = 186）。有1例患者使用了多达18个支架来缓解梗阻。除1例通过T管窦道置入支架的患者外，所有患者均采用经肝途径。置入后1周内，所有支架均扩张至其原始直径的至少90%。3个支架位置不当、2个支架变形和2个支架移位未引起明显临床问题。随访时间为2至59周，5例患者出现复发性黄疸。2例因含支架胆管梗阻导致复发性黄疸的患者接受了外引流管引流治疗。可扩张胆道内支架被认为是治疗良性和恶性胆道梗阻的有效方法。
