自膨式金属支架在良性胆道狭窄中的应用——回顾性病例系列。
The utility of self-expanding metal stents in benign biliary strictures- a retrospective case series.
机构信息
CSTAR (Canadian Surgical Technologies & Advanced Robotics), London Health Sciences Centre, and Department of Surgery, Western University, London, Canada.
Department of Surgery, Division of General Surgery, Schulich School of Medicine and Dentistry, Western University, University Hospital, London Health Sciences Centre, 339 Windermere Road, London, ON, N6A 5A5, Canada.
出版信息
BMC Gastroenterol. 2023 Oct 21;23(1):361. doi: 10.1186/s12876-023-02998-8.
BACKGROUND
Benign biliary strictures can have a significant negative impact on patient quality of life. There are several modalities which can be utilized with the goal of stricture resolution. These techniques include balloon dilatation, placement of multiple plastic stents and more recently, the use of metal stents. The aim of this study was to evaluate the local success of self-expanding metal stents in successfully resolving benign biliary strictures.
METHODS
This was a single institution, retrospective case series. Patients included in our study were patients who underwent endoscopic retrograde cholangiopancreatography with placement of self expanding metal stents for benign biliary strictures at our institution between 2016-2022. Patients were excluded for the following: malignant stricture, and inability to successfully place metal stent. Data was evaluated using two-sided t-test with 95% confidence interval.
RESULTS
A total of 31 patients underwent placement of 43 self-expanding metal stents and met inclusion criteria. Mean age of patients was 59 ± 10 years, and were largely male (74.2% vs. 25.8%). Most strictures were anastomotic stricture post liver transplant (87.1%), while the remainder were secondary to chronic pancreatitis (12.9%). Complications of stent placement included cholangitis (18.6%), pancreatitis (2.3%), stent migration (20.9%), and inability to retrieve stent (4.7%). There was successful stricture resolution in 73.5% of patients with anastomotic stricture and 33.3% of patients with stricture secondary to pancreatitis. Resolution was more likely if stent duration was > / = 180 days (73.3% vs. 44.4%, p < 0.05). There was no demonstrated added benefit when stent duration was > / = 365 days (75% vs. 60.9%, p = 0.64).
CONCLUSIONS
This study demonstrates that self expanding metal stents are a safe and effective treatment for benign biliary strictures, with outcomes comparable to plastic stents with fewer interventions. This study indicates that the optimal duration to allow for stricture resolution is 180-365 days.
背景
良性胆道狭窄可显著降低患者的生活质量。目前有多种方法可用于治疗狭窄，包括球囊扩张、放置多个塑料支架，以及最近使用金属支架。本研究旨在评估自膨式金属支架治疗良性胆道狭窄的局部疗效。
方法
这是一项单中心回顾性病例系列研究。我们的研究纳入了 2016 年至 2022 年期间在我院接受内镜逆行胰胆管造影术并放置自膨式金属支架治疗良性胆道狭窄的患者。排除恶性狭窄和无法成功放置金属支架的患者。数据采用双侧 t 检验和 95%置信区间进行评估。
结果
共 31 例患者（共 43 个支架）符合纳入标准。患者平均年龄为 59±10 岁，男性居多（74.2%比 25.8%）。大多数狭窄为肝移植后吻合口狭窄（87.1%），其余为慢性胰腺炎所致（12.9%）。支架置入相关并发症包括胆管炎（18.6%）、胰腺炎（2.3%）、支架移位（20.9%）和无法取出支架（4.7%）。吻合口狭窄患者中 73.5%、胰腺炎所致狭窄患者中 33.3%的狭窄得到了成功缓解。支架留置时间≥180 天（73.3%比 44.4%，p<0.05）的患者狭窄缓解率更高。支架留置时间≥365 天（75%比 60.9%，p=0.64）对狭窄缓解无额外获益。
结论
本研究表明，自膨式金属支架治疗良性胆道狭窄是一种安全有效的方法，其疗效与塑料支架相当，但干预次数更少。本研究表明，允许狭窄缓解的最佳支架留置时间为 180-365 天。
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