Yokota Yudai, Fukasawa Mitsuharu, Takano Shinichi, Kadokura Makoto, Shindo Hiroko, Takahashi Ei, Hirose Sumio, Kawakami Satoshi, Fukasawa Yoshimitsu, Sato Tadashi, Enomoto Nobuyuki
First Department of Internal Medicine, Faculty of Medicine, University of Yamanashi, 1110, Shimokato, Chuo, Yamanashi, 409-3898, Japan.
Department of Gastroenterology, Kofu Municipal Hospital, 366, Masutsubo, Kofu, Yamanashi, 400-0832, Japan.
BMC Gastroenterol. 2017 Oct 11;17(1):105. doi: 10.1186/s12876-017-0662-1.
Self-expandable metal stents (SEMSs) are widely used for malignant biliary obstructions. Nitinol-covered SEMSs have been developed to improve stent patency. Currently, SEMSs may be uncovered, partially covered, or fully covered; however, there is no consensus on the best stent type for the management of malignant distal biliary obstruction (MDBO).
Patients with unresectable MDBO receiving SEMS (Wallflex™) were retrospectively analyzed. Time to recurrent biliary obstruction (TRBO) and survival time were compared among the three types of SEMSs. Univariate and multivariate analyses were performed to identify risk factors for stent dysfunction.
In total, 101 patients received SEMSs for unresectable MDBO (44 uncovered, 28 partially covered, and 29 fully covered SEMSs). Median survival time was 200, 168, and 276 days in the uncovered, partially covered, and fully covered SEMSs groups, respectively. There were no differences in survival among the three groups. Median TRBO was 199, 444, and 194 days in the uncovered, partially covered, and fully covered SEMSs groups, respectively. Partially covered SEMSs had longer TRBO than uncovered (p = 0.013) and fully covered (p = 0.010) SEMSs. Tumor ingrowth occurred only with uncovered SEMSs and stent migration occurred only with fully covered SEMSs. Multivariate analyses confirmed that partially covered SEMSs have lower risk of dysfunction.
Partially covered SEMSs with a proximal uncovered flared end have longer patency than uncovered and fully covered SEMSs by preventing tumor ingrowth and stent migration.
自膨式金属支架（SEMS）广泛应用于恶性胆道梗阻。已研发出镍钛诺覆膜SEMS以提高支架通畅性。目前，SEMS可分为裸支架、部分覆膜支架和全覆膜支架；然而，对于恶性远端胆道梗阻（MDBO）的最佳支架类型尚无共识。
对接受SEMS（Wallflex™）治疗的不可切除MDBO患者进行回顾性分析。比较三种类型SEMS的复发性胆道梗阻时间（TRBO）和生存时间。进行单因素和多因素分析以确定支架功能障碍的危险因素。
共有101例患者接受SEMS治疗不可切除的MDBO（44例裸支架、28例部分覆膜支架和29例全覆膜支架）。裸支架、部分覆膜支架和全覆膜支架组的中位生存时间分别为200天、168天和276天。三组之间的生存率无差异。裸支架、部分覆膜支架和全覆膜支架组的中位TRBO分别为199天、444天和194天。部分覆膜支架的TRBO比裸支架（p = 0.013）和全覆膜支架（p = 0.010）更长。肿瘤向内生长仅发生在裸支架中，支架迁移仅发生在全覆膜支架中。多因素分析证实部分覆膜支架功能障碍风险较低。
近端无覆膜喇叭口端的部分覆膜SEMS通过防止肿瘤向内生长和支架迁移，比裸支架和全覆膜支架具有更长的通畅时间。
