一种新型带防反流阀的激光切割全覆膜金属支架治疗常规覆膜金属支架治疗失败的恶性远端胆管梗阻

A novel laser-cut fully covered metal stent with anti-reflux valve in patients with malignant distal biliary obstruction refractory to conventional covered metal stent.

机构信息

Department of Hepato-Biliary-Pancreatic Medicine, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan.

Division of Gastroenterology and Hepatology, Department of Internal Medicine, Omori Medical Center, Toho University, Tokyo, Japan.

出版信息

J Hepatobiliary Pancreat Sci. 2021 Jul;28(7):563-571. doi: 10.1002/jhbp.966. Epub 2021 Apr 26.

DOI:10.1002/jhbp.966

PMID:33835728

Abstract

BACKGROUND

Stenting against recurrent biliary obstruction (RBO) after placement of covered metal stent (CMS) for distal malignant biliary obstruction (MBO) is still challenging. This study investigated the feasibility of a novel laser-cut fully CMS with anti-reflux valve in patients with distal MBO refractory to conventional CMS.

METHODS

Patients who underwent Duckbill-type metal stent (DMS) placement between June 2019 and May 2020 were included. Early complications, causes of RBO including non-occlusion cholangitis, and time to RBO (TRBO) were evaluated. TRBO of DMS was also compared with that of previous CMS.

RESULTS

Thirty patients were included: pancreatic cancer/metastatic lymph nodes in 29 patients/one patient; duodenal stenosis in 13 patients. Technical and functional success were achieved in all patients. Mild cholangitis and mild pancreatitis developed in each one. Median follow-up period was 167 days (range, 23-527 days). RBO occurred in nine patients (30%): sludge formation in four patients, hemobilia in one patient, symptomatic distal stent migration in three patients, and non-occlusion cholangitis in one patient. TRBO of DMS was significantly longer than that of previous CMS (median 224 days vs median 120 days, P = .0025). DMS was successfully removed in all of six patients when re-intervention was needed.

CONCLUSIONS

Duckbill-type metal stent might be safe and effective in patients with distal MBO refractory to conventional CMS.

摘要

背景

对于远端恶性胆道梗阻（MBO）患者放置覆膜金属支架（CMS）后复发胆道梗阻（RBO）的支架治疗仍然具有挑战性。本研究旨在探讨一种新型带反流阀的激光切割全覆膜 CMS 治疗常规 CMS 治疗无效的远端 MBO 患者的可行性。

方法

纳入 2019 年 6 月至 2020 年 5 月期间接受鸭嘴型金属支架（DMS）置入术的患者。评估早期并发症、RBO 的原因（包括非闭塞性胆管炎）和 RBO 时间（TRBO）。并比较了 DMS 的 TRBO 与之前 CMS 的 TRBO。

结果

共纳入 30 例患者：29 例为胰腺癌/转移性淋巴结，1 例为转移淋巴结；13 例为十二指肠狭窄。所有患者均获得技术和功能上的成功。各有 1 例发生轻度胆管炎和轻度胰腺炎。中位随访时间为 167 天（范围 23-527 天）。9 例（30%）发生 RBO：4 例为胆泥形成，1 例为血胆，3 例为症状性远端支架迁移，1 例为非闭塞性胆管炎。DMS 的 TRBO 明显长于之前 CMS 的 TRBO（中位数 224 天 vs 中位数 120 天，P=0.0025）。当需要再次介入时，所有 6 例 DMS 均成功取出。