Stoker J, Laméris J S
Department of Radiology, University Hospital Dijkzigt, Erasmus University Rotterdam, The Netherlands.
J Vasc Interv Radiol. 1993 Nov-Dec;4(6):767-72. doi: 10.1016/s1051-0443(93)71970-3.
Complications were assessed during and after percutaneous Wallstent endoprosthesis insertion in patients with inoperable malignant biliary obstruction.
Two hundred seven Wallstents were inserted in 176 patients: 74 had hilar strictures and 102 had distal strictures. Median survival after stent placement was 95 days.
Early complications occurred in 12 patients (7%), predominantly cholangitis and reobstruction. Thirty-day mortality was 12%; 2% of deaths (three patients) were procedure related. Late complications, predominantly reobstruction, occurred in 35 patients (20%). Obstruction recurred in 33 patients (19%) after a median period of 135 days; 27 had a hilar stricture. Tumor overgrowth was the major cause of reobstruction (n = 19), especially proximal overgrowth. Tumor ingrowth caused reobstruction in three patients. Other causes were rare. No reobstruction due to sludge occurred. Reintervention was performed in 25 patients. Nineteen of the 25 patients benefited from repeated intervention.
The use of the Wallstent is preferable to use of a plastic stent, as the major complication--reobstruction--is not stent related predominantly but is caused by tumor progression.
评估无法手术的恶性胆管梗阻患者经皮置入Wallstent内支架假体期间及之后的并发症情况。
176例患者共置入207枚Wallstent支架：74例为肝门部狭窄，102例为远端狭窄。支架置入后的中位生存期为95天。
12例患者（7%）出现早期并发症，主要为胆管炎和再梗阻。30天死亡率为12%；2%的死亡病例（3例患者）与手术相关。35例患者（20%）出现晚期并发症，主要为再梗阻。33例患者（19%）在中位时间135天后出现梗阻复发；27例为肝门部狭窄。肿瘤过度生长是再梗阻的主要原因（n = 19），尤其是近端过度生长。肿瘤长入导致3例患者再梗阻。其他原因少见。未出现因胆泥导致的再梗阻。25例患者接受了再次干预。25例患者中有19例从重复干预中获益。
使用Wallstent支架优于使用塑料支架，因为主要并发症——再梗阻——并非主要与支架相关，而是由肿瘤进展所致。
