Krokidis Miltiadis, Hatzidakis Adam
Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
Department of Medical Imaging and Interventional Radiology, University Hospital of Heraklion, Medical School of Crete, Heraklion, Greece.
Ann Palliat Med. 2017 Aug;6(Suppl 1):S58-S64. doi: 10.21037/apm.2017.06.03. Epub 2017 Aug 2.
Covered biliary stents have shown significant effectiveness in the palliative management of patients with malignant biliary disease due to prevention of tumour ingrowth. However, stent dysfunction may still occur due to growth of tumour at the borders of the covered stent (tumour overgrowth). The aim of this study is to assess the effectiveness of a bare extension in the prevention of tumour overgrowth when covered stents are used in the palliative treatment of malignant biliary strictures.
This is a prospective, single arm, cohort study. Twenty-two patients with inoperable malignant biliary strictures in the distal common bile duct (Bismuth I-II) and life expectancy more than 6 months were included in the study. The combination of a fully covered biliary stent and a bare proximal and distal extension was used in all cases. All patients were followed-up until death. Primary patency, survival, complication rates and dysfunction cause were assessed.
Mean survival was 263.7 days (median 255, SD: 77.6). Mean patency was 240 days (median: 237, SD: 87). The primary patency rate at 3, 6 and 12 months was 90%, 86% and 86% respectively. Tumour inor overgrowth did not occur in any of the patients. Dysfunction due to sludge formation occurred in three cases; all three were treated with bilioplasty.
The combined use of a covered biliary stent and a bare extension appears to be a very effective tool in the palliation of malignant biliary disease, offering long-term patency for patients with inoperable malignant distal common bile duct strictures and increasing the quality of life of such patients.
覆膜胆管支架在恶性胆管疾病患者的姑息治疗中已显示出显著疗效，因其可防止肿瘤向内生长。然而，由于覆膜支架边缘肿瘤生长（肿瘤过度生长），支架功能障碍仍可能发生。本研究的目的是评估在恶性胆管狭窄的姑息治疗中使用覆膜支架时，裸段延长部分在预防肿瘤过度生长方面的有效性。
这是一项前瞻性、单臂队列研究。纳入22例远端胆总管不可切除恶性狭窄（Bismuth I-II型）且预期寿命超过6个月的患者。所有病例均采用完全覆膜胆管支架与裸段近端和远端延长部分相结合的方法。所有患者随访至死亡。评估主要通畅率、生存率、并发症发生率及功能障碍原因。
平均生存期为263.7天（中位数255天，标准差：77.6）。平均通畅时间为240天（中位数：237天，标准差：87）。3个月、6个月和12个月时的主要通畅率分别为90%、86%和86%。所有患者均未发生肿瘤向内或过度生长。3例患者因胆泥形成出现功能障碍；所有3例均接受了胆管成形术治疗。
覆膜胆管支架与裸段延长部分联合使用似乎是恶性胆管疾病姑息治疗中一种非常有效的工具，可为不可切除的恶性远端胆总管狭窄患者提供长期通畅，并提高此类患者的生活质量。
