比较覆膜金属输尿管支架和双 J 支架治疗晚期胃癌所致恶性输尿管梗阻。

Comparison of a covered metallic ureteral stent and a double-J stent for malignant ureteral obstruction in advanced gastric cancer.

机构信息

Department of Radiology, Hanyang University Guri Hospital, Guri-si, Gyeonggi-do, Republic of Korea.

Department of Medicine, Graduate School, Kyung Hee University, Seoul, Dongdaemun-gu, Republic of Korea; Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Guro-gu, Republic of Korea.

出版信息

Clin Radiol. 2021 Jul;76(7):519-525. doi: 10.1016/j.crad.2021.02.016. Epub 2021 Mar 15.

DOI:10.1016/j.crad.2021.02.016

PMID:33736879

Abstract

AIM

To compare the patency and safety of covered metallic stents (CMS) and the double-J stent (DJS) for treating malignant ureteral obstruction (MUO) in advanced gastric cancer (AGC).

MATERIALS AND METHODS

Between 2016 and 2018, the medical records of 61 patients (84 ureters; CMS, 39 patients, 54 ureters; DJS, 22 patients, 30 ureters) with MUO caused by AGC were reviewed retrospectively. The Kaplan-Meier method and log-rank test were used to evaluate differences of primary or assisted primary patency between groups. Cox regression was conducted separately for early (within 7 days) and late (after 7 days) primary patency.

RESULTS

Technical success of CMS placement was 100% (54/54) and 96.8% (29/30) for DJS (p=0.357). The cumulative stent patency rates at 1, 3, 6, and 12 months were 77%, 74%, 70%, and 70%, in the CMS group and 72%, 60%, 53%, and 26%, in the DJS group. Apart from the period within 7 days (p=0.784), primary patency was consistently higher in the CMS group when compared to the DJS group over the entire follow-up period (p=0.034). Assisted primary patency was consistently higher in the CMS group than in the DJS group over the entire follow-up period (p=0.001). The CMS group was more likely to have complications than the DJS group (48.1% versus 16.7%, p=0.004). Complications were minor, self-limiting events such as haematuria/haematoma.

CONCLUSION

CMS had better late patency and assisted primary patency than DJS. Procedure-related minor complications more frequently occurred with CMS.

摘要

目的

比较覆膜金属支架（CMS）和双 J 支架（DJS）治疗晚期胃癌（AGC）所致恶性输尿管梗阻（MUO）的通畅性和安全性。

材料与方法

回顾性分析 2016 年至 2018 年间 61 例（84 侧；CMS 组 39 例，54 侧；DJS 组 22 例，30 侧）因 AGC 所致 MUO 患者的病历资料。采用 Kaplan-Meier 法和对数秩检验比较两组患者的主要通畅率和辅助性主要通畅率。采用 Cox 回归分别分析早期（7d 内）和晚期（7d 后）主要通畅率。

结果

CMS 组置管技术成功率为 100%（54/54），DJS 组为 96.8%（29/30）（p=0.357）。CMS 组和 DJS 组 1、3、6、12 个月的累积支架通畅率分别为 77%、74%、70%和 70%，72%、60%、53%和 26%。除 7d 内（p=0.784）外，整个随访期间 CMS 组的主要通畅率均明显高于 DJS 组（p=0.034）。整个随访期间，CMS 组的辅助性主要通畅率也明显高于 DJS 组（p=0.001）。CMS 组的并发症发生率明显高于 DJS 组（48.1%比 16.7%，p=0.004）。并发症均为轻微、自限性事件，如血尿/血肿。