经内镜超声引导的胰腺坏死物引流中采用防漏金属支架与传统金属支架的临床疗效和安全性比较：一家三级医院的真实经验。
Comparison of clinical efficacies and safeties of lumen-apposing metal stent and conventional-type metal stent-assisted EUS-guided pancreatic wall-off necrosis drainage: a real-life experience in a tertiary hospital.
机构信息
Department of Medicine and Geriatrics, Tuen Mun Hospital, Tuen Mun, Hong Kong.
Department of Gastroenterology and Hepatology, Hospital Universitario Rio Hortega, Valladolid, Spain.
出版信息
Surg Endosc. 2018 May;32(5):2448-2453. doi: 10.1007/s00464-017-5946-6. Epub 2017 Nov 3.
BACKGROUND
Endoscopic ultrasound (EUS)-guided drainage of pancreatic wall-off necrosis (WON) with transmural stent is regarded as firstline therapy. We aimed at comparing its efficacy and safety with using fully covered self-expandable metal stent (FCSEMS) and lumen-apposing metal stent (LAMS).
METHODS
A retrospective review was performed on all consecutive patients with pancreatic WONs who underwent EUS-guided drainage by either FCSEMS or LAMS.
RESULTS
From 2011 to 2016, 68 patients (66.2% male, median age, 66.5 years) underwent WON drainage (22/68 (32.4%) using FCSEMSs of size 10 × 60 mm (14/22, Hanarostent; 8/22 Wallflex); 46/68 (67.6%) using LAMSs (38/46 and 8/46 with AXIOS of size 15 × 10 mm and 10 × 10 mm, respectively). These two groups were matched for age (66 vs. 70 years, p 0.514), APACHE II (11.5 vs. 10, p 0.693), causes [72.7 vs. 80.4% by gallstone pancreatitis (p 0.472); 9.1 vs. 10.9% by alcoholism (p 0.818)], WON size (8.5 vs. 9 cm, p 0.322), location (36.4 vs. 26.1% at pancreatic head, p 0.384; 54.5 vs. 65.2% at body/tail, p 0.395), and enterostomy site [63.6 vs. 76.1% via transgastric (p 0.285); 31.8 vs. 19.6% via transduodenal (p 0.267)] and their number of necrosectomy (p 0.978). The technical (100 vs. 93.5%, p 0.219) and clinical (95.5 vs. 93.5%, p 0.749) success and adverse event (22.7 vs. 39.1%, p 0.180; 9.1 vs. 19.6% with bleeding, p 0.271; 4.5 vs. 13% with spontaneous stent migration, p 0.28; 9.1 vs. 6.5% with dislodgement during necrosectomy, p 0.704) of the two groups were comparable without significant different. However, the LAMS group associated with early stent revision compared with FCSEMS group (log rank p 0.048).
CONCLUSIONS
EUS-guided drainage of WON using FCSEMSs and LAMSs are comparable in efficacy and safety; however, the latter is associated with early stent revision.
背景
内镜超声（EUS）引导下经壁透壁支架引流胰腺包裹性坏死（WON）被认为是一线治疗方法。我们旨在比较其疗效和安全性与使用完全覆膜自膨式金属支架（FCSEMS）和腔镜吻合金属支架（LAMS）。
方法
对 2011 年至 2016 年间所有接受 EUS 引导下引流的胰腺 WON 患者进行回顾性分析，这些患者分别接受 FCSEMS 或 LAMS 治疗。
结果
2011 年至 2016 年间，共有 68 例患者（66.2%为男性，中位年龄 66.5 岁）接受了 WON 引流（22/68 例（32.4%）采用 10×60mm 的 FCSEMS（14/22，Hanarostent；8/22 Wallflex）；46/68 例（67.6%）采用 LAMS（38/46 例和 8/46 例分别采用 AXIOS 15×10mm 和 10×10mm 支架）。这两组在年龄（66 岁与 70 岁，p0.514）、APACHE II 评分（11.5 与 10 分，p0.693）、病因[72.7%与 80.4%由胆石性胰腺炎引起（p0.472）；9.1%与 10.9%由酒精中毒引起（p0.818）]、WON 大小（8.5cm 与 9cm，p0.322）、位置（36.4%与 26.1%位于胰头部，p0.384；54.5%与 65.2%位于体尾部，p0.395）以及肠造口部位[63.6%与 76.1%经胃（p0.285）；31.8%与 19.6%经十二指肠（p0.267）]和坏死清除术数量（p0.978）方面无显著差异。两组的技术（100%与 93.5%，p0.219）和临床（95.5%与 93.5%，p0.749）成功率以及不良事件（22.7%与 39.1%，p0.180；9.1%与 19.6%出血，p0.271；4.5%与 13%支架自发性迁移，p0.28；9.1%与 6.5%在坏死清除术期间支架移位，p0.704）无显著差异。然而，LAMS 组较 FCSEMS 组更易发生早期支架再调整（log rank p0.048）。
结论
EUS 引导下使用 FCSEMSs 和 LAMSs 引流 WON 的疗效和安全性相当；然而，后者与早期支架再调整相关。
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