远端恶性胆道狭窄患者，胆管金属支架应放置于胆管汇合部附近。
Biliary metal stents should be placed near the hilar duct in distal malignant biliary stricture patients.
机构信息
Department of Gastroenterology, Fukushima Medical University, Fukushima 9601295, Japan.
Department of Endoscopy, Fukushima Medical University Hospital, Fukushima 9601295, Japan.
出版信息
World J Gastroenterol. 2022 May 7;28(17):1860-1870. doi: 10.3748/wjg.v28.i17.1860.
BACKGROUND
Endoscopic biliary drainage using a self-expandable metallic stent (SEMS) has been widely performed to treat distal malignant biliary obstruction (DMBO). However, the optimal position of the stent remains unclear.
AIM
To determine the ideal position for SEMS placement.
METHODS
In total, 135 DMBO patients underwent SEMS (uncovered or covered) placement over a ten-year period. A total of 127 patients with biliary obstruction between the junction of the cystic duct and Vater's papilla were enrolled. An SEMS was placed through the upper common bile duct 2 cm from the biliary hilar duct in 83 patients (Hilar group) or near the top of the biliary obstruction in 44 patients (Lower group). Technical and functional success, adverse events, and risk factors for SEMS dysfunction were evaluated.
RESULTS
The stent patency period was significantly longer in the Hilar group than in the Lower group ( value < 0.01). In multivariate analysis, the only statistically significant risk factor for SEMS dysfunction was being in the Lower group (hazard ratio: 9.94, 95% confidence interval: 2.25-44.0, < 0.01).
CONCLUSION
A longer patency period was achieved by positioning the SEMS near the biliary hilar duct.
背景
采用自膨式金属支架（SEMS）进行内镜下胆道引流已广泛用于治疗远端恶性胆道梗阻（DMBO）。然而，支架的最佳位置仍不清楚。
目的
确定 SEMS 放置的理想位置。
方法
在十年期间，共有 135 例 DMBO 患者接受了 SEMS（uncovered 或 covered）放置。共纳入 127 例胆总管与 Vater 乳头交界处胆道梗阻患者。83 例患者（胆管汇合部组）在上胆总管距胆管汇合部 2cm 处放置 SEMS，44 例患者（胆管下段组）在胆管梗阻的顶部附近放置 SEMS。评估技术和功能成功率、不良事件以及 SEMS 功能障碍的危险因素。
结果
胆管汇合部组的支架通畅时间明显长于胆管下段组（ value < 0.01）。多因素分析显示，SEMS 功能障碍的唯一统计学显著危险因素是处于胆管下段组（风险比：9.94，95%置信区间：2.25-44.0， < 0.01）。
结论
将 SEMS 定位在胆管汇合部附近可获得更长的通畅期。
Zotero 插件