1 Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Poongnap 2-dong, Songpa-gu, Seoul, 138-736, Republic of Korea.
AJR Am J Roentgenol. 2015 May;204(5):1109-14. doi: 10.2214/AJR.14.13172.
The purpose of this study was to evaluate the incidence, prognostic factors, and secondary management of stent migration in patients with malignant esophageal strictures.
A retrospective study was performed in a single tertiary referral university hospital to identify the incidence, management, and prognostic factors for stent migration in 332 consecutive patients with placement of a retrievable expandable metallic stent. Stent migration was classified into four patterns as locations of a migrated stent: pattern I, partially migrated in the proximal direction; pattern II, partially migrated in the distal direction; pattern III, completely migrated into the stomach; and pattern IV, completely migrated into the bowel.
Stent migration occurred in 42 (12.6%) of 332 patients. Migration was partial (n = 21) or complete (n = 21), and nine (21%), 12 (29%), 11 (26%), and 10 (24%) patients had patterns I, II, III, and IV, respectively. Multivariate analysis identified the following prognostic factors: esophagogastric junction strictures caused by cancer of the gastric cardia (odds ratio 1.330; p = 0.004), patients who underwent anticancer treatment after stent placement (17.514; p < 0.001), and patients with a longer survival time (1.994; p < 0.001). Secondary management was needed for 33 of 42 patients. The strictures in the remaining nine patients improved throughout follow-up.
Stent migration occurs most commonly in patients with cancer of the gastric cardia, patients with longer survival time, and those who underwent anticancer treatment after stent placement. Stent migration is successfully managed by further intervention. Accurate knowledge of the pattern of stent migration is important for successful management.
本研究旨在评估恶性食管狭窄患者中支架迁移的发生率、预后因素和二级管理。
在一家三级转诊大学医院进行回顾性研究，以确定 332 例可回收扩张金属支架置入患者中支架迁移的发生率、处理方法和预后因素。支架迁移分为四种模式：模式 I，近端部分迁移；模式 II，远端部分迁移；模式 III，完全迁移到胃中；模式 IV，完全迁移到肠道中。
332 例患者中有 42 例（12.6%）发生支架迁移。迁移为部分（n=21）或完全（n=21），9 例（21%）、12 例（29%）、11 例（26%）和 10 例（24%）患者分别出现模式 I、II、III 和 IV。多变量分析确定了以下预后因素：由贲门癌引起的食管胃交界处狭窄（优势比 1.330；p=0.004）、支架置入后接受抗癌治疗的患者（17.514；p<0.001）和生存时间较长的患者（1.994；p<0.001）。42 例中有 33 例需要进行二级管理。其余 9 例患者的狭窄在随访中得到改善。
支架迁移最常发生于贲门癌患者、生存时间较长的患者和支架置入后接受抗癌治疗的患者。支架迁移可通过进一步干预成功管理。准确了解支架迁移的模式对于成功管理很重要。
