Shapiro M J
Cardiovascular-Interventional Radiology, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
Oncology (Williston Park). 1995 Jun;9(6):493-6, 499; discussion 499-500, 503.
Biliary tract drainage, with or without placement of an endoprosthesis, is used as a palliative therapy for malignant biliary obstruction. The first truly internal endoprostheses represented a distinct improvement over internal-external catheters but still remained patent for only 4 to 6 months. Metallic stents have a long-term patency of 6 to 8 months. At present, it appears that patients with unresectable pancreatic cancer should be palliated with endoscopically placed plastic or metal stents, whereas those with malignant obstructions higher in the biliary tree are probably better managed with transhepatically placed stents. The combination of brachytherapy plus external-beam radiation followed by implantation of a Gianturco metal stent may be a viable approach to treating obstructions in patients with cholangiocarcinoma. For those with other noncholangiocarcinomas, particularly when life expectancy exceeds anticipated stent patency duration, the Wallstent may be the device of choice.
胆道引流，无论是否放置内支架，都用作恶性胆道梗阻的姑息治疗。首批真正的内置支架相比内外引流管有显著改进，但通畅时间仍仅为4至6个月。金属支架的长期通畅时间为6至8个月。目前，似乎无法切除的胰腺癌患者应通过内镜放置塑料或金属支架进行姑息治疗，而胆道树高位恶性梗阻的患者可能采用经肝放置支架治疗效果更佳。近距离放疗加外照射放疗后植入Gianturco金属支架的联合治疗可能是治疗胆管癌患者梗阻的可行方法。对于其他非胆管癌患者，特别是预期寿命超过预期支架通畅时间的患者，Wallstent支架可能是首选装置。
