Guo Yan, Liu Yan, Lu Zheng, Shi Xingang, Zou Duowu, Wang Dong, Liu Feng, Jin Zhendong, Li Zhaoshen
aDepartment of Gastroenterology, The No. 456 Hospital of People's Liberation Army, Jinan bDepartment of Gastroenterology, The No. 307 Hospital of People's Liberation Army, Beijing cDepartment of Gastroenterology, Digestive Endoscopy Center, Changhai Hospital, Second Military Medical University, Shanghai, People's Republic of China.
Eur J Gastroenterol Hepatol. 2014 Jul;26(7):795-802. doi: 10.1097/MEG.0000000000000120.
Endoscopic placement of a iodine-125 radioactive stent is useful to treat obstructive jaundice with unresectable periampullary tumors. This study aimed to retrospectively evaluate the obstructive component of biliary radioactive stents and discuss the different obstructive mechanism with common plastic stents.
Twenty consecutive patients with malignant obstruction underwent insertion of stents into the common bile duct, including 10 radioactive stents and 10 polyethylene stents. The radioactive stents were withdrawn after ∼3 months or earlier if clinical signs suggested stent clogging. Polyethylene stents were withdrawn after physical signs suggested stent clogging. Bacteriologic analyses included identification of aerobic and anaerobic bacteria. Stent surfaces were observed by scanning electron microscopy. Stent deposition was identified by Fourier-transformed infrared spectroscopy and pyrolysis derivatization/gas chromatography/mass spectrometry.
Radioactive stent group and polyethylene stent group stents were placed for 86 days (interquartile range 62, 114) and 146 days (interquartile range 105, 181) respectively. The placement duration of the two types of stents was statistically significant. A variety of microorganisms were cultured from the stent deposits. Scanning electron microscope images showed a thicker necrotic layer on the external surface of polyethylene stent than the radioactive stent group. The proportions of obstructive components in each stent were different, but none of them were statistically significant. Necrotic tumor tissue was found in the radioactive stent group.
Similar clogging events occurred in both radioactive stents and polyethylene stents. The median duration time of the radioactive stent was shorter, probably because of the smaller inner diameter, and the radioactive seeds exerted no beneficial effect in inhibiting microorganisms.
内镜下放置碘-125放射性支架有助于治疗无法切除的壶腹周围肿瘤所致的梗阻性黄疸。本研究旨在回顾性评估胆管放射性支架的梗阻成分，并探讨其与普通塑料支架不同的梗阻机制。
连续20例恶性梗阻患者接受胆总管支架置入术，其中10例置入放射性支架，10例置入聚乙烯支架。放射性支架在约3个月后取出，若出现临床症状提示支架堵塞则提前取出。聚乙烯支架在出现体征提示支架堵塞后取出。细菌学分析包括需氧菌和厌氧菌的鉴定。通过扫描电子显微镜观察支架表面。通过傅里叶变换红外光谱法以及热解衍生化/气相色谱/质谱法鉴定支架沉积物。
放射性支架组和聚乙烯支架组支架分别放置了86天（四分位间距62，114）和146天（四分位间距105，181）。两种支架的放置时间具有统计学差异。从支架沉积物中培养出多种微生物。扫描电子显微镜图像显示，聚乙烯支架外表面的坏死层比放射性支架组更厚。各支架中梗阻成分的比例不同，但均无统计学意义。在放射性支架组中发现了坏死的肿瘤组织。
放射性支架和聚乙烯支架均发生了类似的堵塞事件。放射性支架的中位持续时间较短，可能是因为其内径较小，且放射性粒子在抑制微生物方面没有发挥有益作用。
