Liu Q, Khay G, Cotton P B
Digestive Disease Center, Medical University of South Carolina, Charleston 29425, USA.
Endoscopy. 1998 Oct;30(8):687-90. doi: 10.1055/s-2007-1001389.
Animal studies suggest that placement of endobiliary stents wholly above the papilla (the "inside-stent") prolongs the duration of stent patency. We reviewed the cholangiographic characteristics of patients with malignant obstructive jaundice in order to evaluate the feasibility of this approach and to assist in the design of a new stent.
A review was conducted of 270 patients who had undergone endoscopic retrograde cholangiopancreatography (ERCP) for malignant obstructive jaundice at our hospital, to determine the relative frequencies of the types of cancers. The ERCP films of 59 relevant consecutive patients with malignant obstructive jaundice were studied to determine the length of the stricture, the distance between the stricture and the papilla, and the angulation of the common duct.
The most frequent primary cancers causing malignant obstructive jaundice were pancreatic cancer (57%), biliary cancer involving the hilum (19%, including metastatic disease), nonhilar biliary cancer (14%), and papillary cancer (10%). The length between the lower end of the stricture and the sphincter was more than 2 cm for all hilar biliary cancer, representing two-thirds of nonhilar biliary cancer cases, while it was less than 1 cm for most pancreatic cancers. There was an average angulation of 30-40 degrees in the axis of the distal common bile duct.
For most biliary cancers, the stricture is high enough to allow the placement of a stent fully above the papilla, but this is not possible for most pancreatic cancers (or any papillary cancers). An "inside-stent" approach would be possible in about one-third of patients with malignant obstructive jaundice if a clearance length of over 2 cm between the stricture and the sphincter is required, and in about 45% of patients if a minimum clearance of 1 cm is required. A 30-40 degrees flexion in the distal part of the stent would approximate the average angulation in the axis of the common bile duct and help to prevent dislocation.
动物研究表明，将胆管内支架完全置于乳头上方（“内置支架”）可延长支架通畅时间。我们回顾了恶性梗阻性黄疸患者的胆管造影特征，以评估这种方法的可行性，并协助设计一种新型支架。
对我院270例行内镜逆行胰胆管造影（ERCP）检查的恶性梗阻性黄疸患者进行回顾，以确定癌症类型的相对频率。研究了59例连续的相关恶性梗阻性黄疸患者的ERCP影像，以确定狭窄长度、狭窄与乳头之间的距离以及胆总管的角度。
导致恶性梗阻性黄疸最常见的原发性癌症为胰腺癌（57%）、累及肝门的胆管癌（19%，包括转移性疾病）、非肝门胆管癌（14%）和乳头状癌（10%）。所有肝门胆管癌患者狭窄下端与括约肌之间的长度均超过2 cm，占非肝门胆管癌病例的三分之二，而大多数胰腺癌患者该长度小于1 cm。胆总管远端轴的平均角度为30 - 40度。
对于大多数胆管癌，狭窄位置足够高，可将支架完全置于乳头上方，但大多数胰腺癌（或任何乳头状癌）患者则无法做到。如果要求狭窄与括约肌之间的间隙长度超过2 cm，约三分之一的恶性梗阻性黄疸患者可行“内置支架”方法；如果要求最小间隙为1 cm，则约45%的患者可行此方法。支架远端30 - 40度的弯曲可接近胆总管轴的平均角度，有助于防止移位。
