Becker C D, Glättli A, Maibach R, Baer H U
Department of Diagnostic Radiology, University of Berne, Inselspital, Switzerland.
J Vasc Interv Radiol. 1993 Sep-Oct;4(5):597-604. doi: 10.1016/s1051-0443(93)71930-2.
The authors analyzed the follow-up data of 58 patients with malignant obstructive jaundice who underwent percutaneous palliative treatment with Wallstents over a 4-year period.
Thirty-nine patients had obstruction at the hilar level, and 19 patients had common bile duct obstruction without hilar involvement. Stent patency and survival were calculated with the Kaplan-Meier method.
Early complications occurred in 14 patients (24%) and were managed conservatively. There were two procedure-related deaths (3.4%) due to sepsis and pancreatitis, and the overall 30-day mortality was 14%. Forty-eight patients have died, nine patients are surviving (average, 11 months), and one patient was lost to follow-up. Forty-four patients (77%) experienced relief of their initial symptoms, with bilirubin levels returning to normal in 63%. The 12-month patency rate of the endoprostheses was 46% in patients with hilar obstruction and 89% in patients with non-hilar obstruction (P = .029). Late biliary complications were documented in 20 patients (35%). Thirteen patients with hilar obstruction and two patients with common duct obstruction required at least one reintervention; stent patency was restored in all patients but one. The overall 6-month survival rate was 50%, and the 12-month survival rate, 36%; no significant difference was found between patients with hilar and non-hilar obstruction.
The long-term patency of the Wallstent endoprosthesis was excellent if common duct obstruction was treated but was significantly lower in the presence of hilar involvement. Use of the Wallstent did not result in a lower complication rate compared with the reported results of plastic endoprostheses. Reinterventions to restore stent patency were successful in almost all cases. The survival of patients with hilar and with non-hilar obstruction was similar.
作者分析了58例恶性梗阻性黄疸患者在4年期间接受Wallstent经皮姑息治疗的随访数据。
39例患者为肝门部梗阻，19例患者为胆总管梗阻且未累及肝门部。采用Kaplan-Meier法计算支架通畅率和生存率。
14例患者（24%）发生早期并发症，经保守治疗。有2例与操作相关的死亡（3.4%），原因是败血症和胰腺炎，30天总死亡率为14%。48例患者已死亡，9例患者存活（平均11个月），1例患者失访。44例患者（77%）初始症状得到缓解，63%的患者胆红素水平恢复正常。肝门部梗阻患者内支架12个月通畅率为46%，非肝门部梗阻患者为89%（P = 0.029）。20例患者（35%）记录到晚期胆道并发症。13例肝门部梗阻患者和2例胆总管梗阻患者至少需要进行一次再次干预；除1例患者外，所有患者的支架通畅均得以恢复。6个月总生存率为第50%，12个月生存率为36%；肝门部梗阻和非肝门部梗阻患者之间未发现显著差异。
如果治疗胆总管梗阻，Wallstent内支架的长期通畅性良好，但在存在肝门部受累的情况下则显著降低。与报道的塑料内支架结果相比，使用Wallstent并未导致更低的并发症发生率。恢复支架通畅的再次干预在几乎所有病例中均成功。肝门部梗阻和非肝门部梗阻患者的生存率相似。
