共查询到20条相似文献,搜索用时 31 毫秒
1.
U. Seitz M. K. Goenka S. Bohnacker K. F. Binmoeller N. Soehendra 《Journal of Hepato-Biliary-Pancreatic Surgery》1997,4(1):24-30
Since its introduction 1979, endoscopic biliary stenting has become the method of first choice to treat cholestasis in malignant or benign biliary obstuction or leakage of biliary fistulas. The success rate of endoscopic biliary stenting generally exceeds 90% and procedure-related complications are rare. Although metal stents are becoming more popular, plastic stents are still the first choice. Their major drawback is occlusion with sludge mediated by bacteria. Pharmaco-chemical measures failed to prevent occlusion. With Teflon material and a 10-French stent, stent exchange rates were reduced to 15% in patients with malignant biliary obstruction, the shape without sideholes showing the best results. Stent exchange is easily feasable. Metal stents are expensive and more difficult to handle. Occlusion with sludge is rare, but patency is limited by tumor ingrowth. Metal stents may be indicated in selected patients, such as those with recurrent stent occlusion causing cholangitis. If only a small-caliber prosthesis (7-Fr) can be placed (e.g. in Klatskin tumor) metal stents may have a longer patency than plastic stents. Metal stents should not be used in benign biliary obstruction because these stents are not removable. 相似文献
2.
Effect of Preoperative Biliary Decompression on Pancreaticoduodenectomy-Associated Morbidity in 300 Consecutive Patients 总被引:18,自引:0,他引:18
Peter W. T. Pisters Wayne A. Hudec Kenneth R. Hess Jeffrey E. Lee Jean-Nicolas Vauthey Sandeep Lahoti Isaac Raijman Douglas B. Evans 《Annals of surgery》2001,234(1):47-55
OBJECTIVE: To examine the relationship between preoperative biliary drainage and the morbidity and mortality associated with pancreaticoduodenectomy. SUMMARY BACKGROUND DATA: Recent reports have suggested that preoperative biliary drainage increases the perioperative morbidity and mortality rates of pancreaticoduodenectomy. METHODS: Peri-operative morbidity and mortality were evaluated in 300 consecutive patients who underwent pancreaticoduodenectomy. Univariate and multivariate logistic regression analyses were done to evaluate the relationship between preoperative biliary decompression and the following end points: any complication, any major complication, infectious complications, intraabdominal abscess, pancreaticojejunal anastomotic leak, wound infection, and postoperative death. RESULTS: Preoperative prosthetic biliary drainage was performed in 172 patients (57%) (stent group), 35 patients (12%) underwent surgical biliary bypass performed during prereferral laparotomy, and the remaining 93 patients (31%) (no-stent group) did not undergo any form of preoperative biliary decompression. The overall surgical death rate was 1% (four patients); the number of deaths was too small for multivariate analysis. By multivariate logistic regression, no differences were found between the stent and no-stent groups in the incidence of all complications, major complications, infectious complications, intraabdominal abscess, or pancreaticojejunal anastomotic leak. Wound infections were more common in the stent group than the no-stent group. CONCLUSIONS: Preoperative biliary decompression increases the risk for postoperative wound infections after pancreaticoduodenectomy. However, there was no increase in the risk of major postoperative complications or death associated with preoperative stent placement. Patients with extrahepatic biliary obstruction do not necessarily require immediate laparotomy to undergo pancreaticoduodenectomy with acceptable morbidity and mortality rates; such patients can be treated by endoscopic biliary drainage without concern for increased major complications and death associated with subsequent pancreaticoduodenectomy. 相似文献
3.
Background
It is unclear whether plastic or metal stents are more suitable for preoperative biliary decompression in pancreatic cancer. The objective of this study was to compare the rate of endoscopic reinterventions in patients with pancreatic cancer undergoing plastic or self-expandable metal stent (SEMS) placements for preoperative biliary decompression. 相似文献4.
Yasuhiko Miura Itaru Endo Shinji Togo Hitoshi Sekido Koichiro Misuta Yoshiro Fujii Toru Kubota Kuniya Tanaka Kaoru Nagahori Hiroshi Shimada 《Journal of Hepato-Biliary-Pancreatic Surgery》2001,8(2):113-117
The aim of this study was to analyze the patency of expandable metallic stents in malignant biliary obstruction and to evaluate
the efficacy of adjuvant therapy accompanied by biliary stenting. We analyzed 29 patients in whom bile duct stenting was performed
for malignant biliary obstruction. Their types of disease were: hilar ductal carcinoma (n = 8), gallbladder carcinoma (n = 11), and pancreatic carcinoma (n = 10). Initially, 46 expandable metallic stents were placed in 29 patients. In 23 of the 29 patients, adjuvant therapy was
administered. Seventeen patients underwent radiotherapy, and 16 patients received various systemic chemotherapies. In principle,
hyperthermia was performed twice a week, simultaneously with radiotherapy. Patient survival and the probability of stent patency
were calculated using actuarial life table analysis. There was no significant difference in stent patency among the patients
according to type of disease. Hyperthermia did not influence the stent patency rate. The median stent patency time was significantly
greater in the chemo-radiation group than in the no-adjuvant therapy group: 182 days versus 68 days, respectively (P = 0.017). Moreover, a significant increase was seen in the median survival time in the chemo-radiation group: 261 days versus
109 days (P = 0.0337). Complications occurred in 9 patients (31.0%). Stent occlusion occurred in 6 patients (20.7%), with all of these
patients managed successfully using a transhepatically placed new expandable metallic stent, employing the stent-in-stent
method. Stent migration occurred in 2 patients after radiotherapy. Adjuvant therapies such as radiotherapy and systemic chemotherapy,
in combination with stent insertion, resulted in an increase in the patency period of expandable metallic stents and in increased
patient survival time.
Received: August 18, 2000 / Accepted: December 1, 2000 相似文献
5.
Katsinelos P Paikos D Kountouras J Chatzimavroudis G Paroutoglou G Moschos I Gatopoulou A Beltsis A Zavos C Papaziogas B 《Surgical endoscopy》2006,20(10):1587-1593
Background Stent clogging is the major limitation of palliative treatment for malignant biliary obstruction. Metal stents have much better
patency than plastic stents, but are more expensive. Preliminary data suggest that the recently designed plastic (Tannenbaum)
stent has better duration of patency than the polyethylene stent. This study aimed to compare the efficacy and cost effectiveness
between the Tannenbaum stent without side holes and the uncovered metal stent for patients with malignant distal common bile
duct obstruction.
Methods In this study, 47 patients (median age, 73 years, range, 56–86 years) with inoperable malignant distal common bile duct strictures
were prospectively randomized to receive either a Tannenbaum stent (n = 24) or an uncovered self-expandable metal stent (n = 23). The patients were clinically evaluated, and biochemical tests were analyzed if necessary until their death or surgery
for gastric outlet obstruction. Cumulative first stent patency and patient survival were compared between the two groups.
Cost-effectiveness analysis also was performed for the two study groups.
Results The two groups were comparable in terms of age, gender, and diagnosis. The median first stent patency was longer in the metal
group than in the Tannenbaum stent group (255 vs 123.5 days; p = 0.002). There was no significant difference in survival between the two groups. The total cost associated with the Tannenbaum
stents was lower than for the metal stents (17,700 vs 30,100 euros; p = 0.001), especially for patients with liver metastases (3,000 vs 6,900 euros; p < 0.001).
Conclusions Metal stent placement is an effective treatment for inoperable malignant distal common bile duct obstruction, but Tannenbaum
stent placement is a cost-saving strategy, as compared with metal stent placement, especially for patients with liver metastases
and expected short survival time. 相似文献
6.
可膨式金属胆道支架解除恶性胆管梗阻的临床应用及其疗效分析 总被引:27,自引:1,他引:27
目的 探讨可膨式金属胆道支架支解除恶性胆管梗阻的中远期疗效及初步分析影响疗效的因素,方法 134例各类恶性肿瘤导致胆管梗阻的患者接受金属支架放置术,其中内镜下经乳头放置128例,经皮经肝放置6例,随访引流效果并与同期97例内镜下放置塑料支架的患者进行对比。结果 操作成功率95.7%,并发症6.4%,黄疸消除率85.6%,金属支架的平均通畅期为300天,明显高于塑料支轲的80天(P〈0.01);平均 相似文献
7.
内镜置入胆道金属支架治疗肝门部胆管癌 总被引:1,自引:0,他引:1
目的 探讨通过内镜置入自膨式胆道金属支架治疗肝门部胆管癌的疗效.方法 回顾性分析2004年7月至2009年7月成都军区总医院收治的73例肝门部胆管癌患者行内镜胆道金属支架置入术的操作成功率、减黄有效率、支架通畅时间和生存时间以及术后并发症.结果 支架置入成功70例,3例失败.其中单金属支架置入62例,双侧金属支架置入3例,金属支架+塑料支架置人5例.减黄有效率为87%(61/70),中位支架通畅时间为190 d,中位生存时间为246 d.术后发生胆管炎7例,胰腺炎3例,出血2例.结论 内镜置入自膨式胆道金属支架治疗肝门部胆管癌创伤小、减黄效果好,可作为无法手术切除的肝门部胆管癌患者解除胆道恶性梗阻的首选治疗方法. 相似文献
8.
目的 探讨通过内镜置入自膨式胆道金属支架治疗肝门部胆管癌的疗效.方法 回顾性分析2004年7月至2009年7月成都军区总医院收治的73例肝门部胆管癌患者行内镜胆道金属支架置入术的操作成功率、减黄有效率、支架通畅时间和生存时间以及术后并发症.结果 支架置入成功70例,3例失败.其中单金属支架置入62例,双侧金属支架置入3例,金属支架+塑料支架置人5例.减黄有效率为87%(61/70),中位支架通畅时间为190 d,中位生存时间为246 d.术后发生胆管炎7例,胰腺炎3例,出血2例.结论 内镜置入自膨式胆道金属支架治疗肝门部胆管癌创伤小、减黄效果好,可作为无法手术切除的肝门部胆管癌患者解除胆道恶性梗阻的首选治疗方法. 相似文献
9.
目的 探讨通过内镜置入自膨式胆道金属支架治疗肝门部胆管癌的疗效.方法 回顾性分析2004年7月至2009年7月成都军区总医院收治的73例肝门部胆管癌患者行内镜胆道金属支架置入术的操作成功率、减黄有效率、支架通畅时间和生存时间以及术后并发症.结果 支架置入成功70例,3例失败.其中单金属支架置入62例,双侧金属支架置入3例,金属支架+塑料支架置人5例.减黄有效率为87%(61/70),中位支架通畅时间为190 d,中位生存时间为246 d.术后发生胆管炎7例,胰腺炎3例,出血2例.结论 内镜置入自膨式胆道金属支架治疗肝门部胆管癌创伤小、减黄效果好,可作为无法手术切除的肝门部胆管癌患者解除胆道恶性梗阻的首选治疗方法. 相似文献
10.
Mosca F Consoli A Stracqualursi A Persi A Lipari G Portale TR 《Chirurgia italiana》2002,54(3):341-350
Rapid palliation of malignant dysphagia is usually possible by means of the endoscopic implantation of a plastic prosthesis, but this device has a high morbidity rate. Recently, expandable metal stents have become available and may reduce the morbidity and mortality rates. The aim of this retrospective study was to evaluate self-expanding metal stents compared with conventional plastic prosthesis in malignant strictures of the oesophagus and cardia. One hundred and thirteen endoscopic tube implantations were carried out in 120 patients with malignant stenosis of the oesophagus and cardia using a plastic prosthesis over the period 1980-1993 (72 cases) and self-expanding metal stents over the period 1993-2001 (48 cases). The underlying causes of strictures were oesophageal or cardial cancer in 108 cases and oesophageal invasion by lung cancer in 12. The indications for endoscopic intubation were advanced tumour stage and/or risk factors which made resection inadvisable. The stents used in the conventional group were the Celestin pulsion tube in 18, the Atkinson prosthesis in 23 and the Wilson-Cook tube in 27, while the Ultraflex stent was always employed in the other group. Dysphagia was scored according to the Atkinson and Ferguson classification and the preoperative median score (3.6) was comparable in the two groups. The technical success rate was 94.4% with the plastic prosthesis (68/72) and 93.7% with the self-expanding metal stents (45/48) because in 4 and 3 patients, respectively, it proved impossible to implant the stent. After intubation the dysphagia score was improved in both groups (median score = 0.9) and the functional success rates were 85.2% (58/68) and 88.8% (40/45), respectively, while 10 and 5 patients showed no improvement of symptoms. The early complication rate was 5.9% (4/68) in the conventional stent group (1 perforation, 2 severe bleedings and 1 stent proximal migration) and nil in the other group. Late complications occurred in 14 (20.6%) (7 food obstruction, 4 neoplastic obstructions and 3 dislodgements) and 9 patients (20%) (3 neoplastic obstructions, 1 food obstruction, 3 distal migrations and 2 bleedings), respectively, but all the complications were easily corrected. Three deaths occurred with the plastic prosthesis (4.4%), while the mortality was nil with the metal stents. The median survival times were 183 (range: 58-486) and 151 days (range; 25-545), respectively. Our experience suggests that endoscopic placement of self-expanding metal stents is effective and safe for the management of dysphagia in malignant strictures of the oesophagus and cardia and has to be preferred to conventional plastic prostheses for easier implantation. The technical and functional success rates are similar in both groups, but the acute complication and mortality rates of the Ultraflex prosthesis are lower as compared to the traditional prosthesis. 相似文献
11.
Use of endoscopic stents to manage patients with malignant obstructive jaundice is a well accepted measure. Interpretation
of the results of endoscopic stenting must be made with reference to the level of the bile duct obstruction. Results were
generally unsatisfactory for hilar lesions, especially when the intrahepatic ducts were segregated into multiple isolated
systems. After deployment, stent dysfunction due to clogging by biliary sludge is apparently an inevitable process for the
conventional plastic stent. Considerable efforts had been made to prolong the stent patency by changing its physical configuration,
coating the inner lumen, and the choice of material but with little success. The development of a self-expandable metal stent
is a major advance, but the benefits derived from a larger stent lumen are compromised by the initial expense and the tumor
ingrowth through the wires for all models available commercially. Current data failed to substantiate the value of routine
preoperative biliary decompression, as there is no reduction in the morbidity and mortality rates after surgery. Although
biased patient selection may have resulted in the negative observations made, repeated clinical trials should probably focus
on patients with distal bile duct tumors who are preparing for a major pancreatic resection. As a definitive palliative measure,
endoscopic stenting is a more cost-effective option than surgery for patients with limited life expectancy based on data regarding
plastic stents. The recommendations are evolving however, as there is progressive refinement of laparoscopic surgery techniques
and designs of endoscopic stents. 相似文献
12.
Tsuyuguchi T Takada T Miyazaki M Miyakawa S Tsukada K Nagino M Kondo S Furuse J Saito H Suyama M Kimura F Yoshitomi H Nozawa S Yoshida M Wada K Amano H Miura F;Japanese Association of Biliary Surgery;Japanese Society of Hepato-Biliary-Pancreatic Surgery;Japan Society of Clinical Oncology 《Journal of Hepato-Biliary-Pancreatic Surgery》2008,15(1):69-73
Together with biliary drainage, which is an appropriate procedure for unresectable biliary cancer, biliary stent placement
is used to improve symptoms associated with jaundice. Owing to investigations comparing percutaneous transhepatic biliary
drainage (PTBD), surgical drainage, and endoscopic drainage, many types of stents are now available that can be placed endoscopically.
The stents used are classified roughly as plastic stents and metal stents. Compared with plastic stents, metal stents are
of large diameter, and have long-term patency (although they are expensive). For this reason, the use of metal stents is preferred
for patients who are expected to survive for more than 6 months, whereas for patients who are likely to survive for less than
6 months, the use of plastic stents is not considered to be improper. Obstruction in a metal stent is caused by a tumor that
grows within the stent through the mesh interstices. To overcome such problems, a covered metal stent was developed, and these
stents are now used in patients with malignant distal biliary obstruction. However, this type of stent has been reported to
have several shortcomings, such as being associated with the development of acute cholecystitis and stent migration. In spite
of these shortcomings, evidence is expected to demonstrate its superiority over other types of stent. 相似文献
13.
Outcomes after placement of colorectal stents 总被引:3,自引:0,他引:3
A. J. M. Watson V. Shanmugam I. Mackay S. Chaturvedi M. A. Loudon V. Duddalwar† J. K. Hussey† 《Colorectal disease》2005,7(1):70-73
BACKGROUND: Colonic stents are increasingly used to palliate or alleviate large bowel obstruction in patients with colon cancer and other obstructing lesions in whom a definitive surgical procedure is inappropriate. We report on the outcomes of a large group of patients who underwent deployment of a colon stent in a single institution by a single operator. PATIENTS AND METHODS: This was a retrospective observational cohort study of all patients undergoing colonic stenting between September 1995 and May 2002. Data collected included nature of pathology, type of stent used, procedure morbidity, patient survival and details of any definitive procedures performed after stenting. RESULTS: One hundred and seven patients were evaluated (58 male) with a median age of 75 years (range 36-99 years). A total of 112 stents were successfully deployed (46 as an emergency). Twelve patients had double stents inserted coaxially and overlapping. In 7 patients the stent could not be safely deployed. Eighty-seven patients had colorectal cancer, 13 patients had an extra-luminal malignancy, 5 had diverticular strictures and in 2 patients the pathology was unknown. At last review (May 2002) 18 patients were alive, 82 patients had died and 7 patients had been lost to follow-up. Of those patients who died, the median survival after stenting alone was 6 weeks (range 4 days-36 weeks). Ten patients underwent subsequent definitive surgery. Stent complications included, 2 colonic perforations, 3 stent occlusions and 4 stent migrations. CONCLUSION: Colonic stenting can be used effectively, with acceptable morbidity, to manage patients presenting with large bowel obstruction. In a smaller number of patients colon stents may safely temporize symptoms while definitive surgery is planned. 相似文献
14.
Endoscopic biliary drainage in patients with pancreatic cancer 总被引:5,自引:0,他引:5
Kahl S Zimmermann S Pross M Schulz HU Malfertheiner P 《Zentralblatt für Chirurgie》2003,128(5):406-410
Obstructive jaundice is a common clinical sign in patients with pancreatic cancer. 52% of all patients with a potentially resectable pancreatic cancer suffer from painless obstructive jaundice. There are no prospective studies showing a beneficial effect of preoperative drainage in patients with resectable pancreatic cancer. Morbidity (53%) and mortality (15%) in patients without preoperative biliary drainage are not significantly different from those who had endoscopic drainage preoperatively (morbidity 41%; mortality 15%). However, there are some logistic reasons for preoperative drainage, especially if surgery is delayed. In cases of nonresectable pancreatic cancer endoscopic drainage for palliation of obstructive jaundice is the method of choice. The decision between metallic and plastic stents for palliation is based on expected survival time and quality of life. Implantation of metal stents is the method of choice in patients with life expectancy exceeding six months. Scheduled three months exchange of plastic stents is recommended to avoid complications. After a six months interval about 70% of patients with scheduled exchange are without symptoms, compared to about 40% of patients who had exchange of plastic stents on demand. Scheduled three months exchange of plastic stents leeds to a patency rate of plastic stents comparable to those of metallic stents. 相似文献
15.
[摘要] 目的 探讨经内镜放置胆道支架治疗高位胆管恶性梗阻的疗效及影响因素。方法 回顾性分析2008年8月~2014年4月168例高位胆管恶性梗阻行内镜胆道支架置入术的成功率、有效引流率、并发症发生率与30天死亡率、支架通畅时间及生存时间。结果 168例患者中148例成功通过ERCP置入塑料或金属支架,其中13例联合PTCD途径反向导丝与ERCP对接的会师技术置入,成功率88.1%;另外20例行两种处理方法仍未能成功,改行PTCD外引流;有效引流率为91.9%,早期并发症发生率为23.0%,总的支架有效时间59天,总的中位生存时间248天。结论 高位胆管恶性梗阻的内镜治疗应根据个体化原则选择不同的治疗方案;内镜治疗过程中进行有效的操作,减少并发症,是临床内镜医生应重视的问题。 相似文献
16.
目的对比内镜双金属支架和塑料支架引流治疗晚期肝门部胆管恶性梗阻的安全性和疗效。方法回顾性分析2007年1月至2013年10月收治的41例采用内镜支架引流治疗的晚期肝门部胆管恶性梗阻的临床资料。结果双金属支架相对于单塑料及双支架有更长的支架通畅时间(187±10 d vs 139±8.8 d;P0.05)。两组之间的术后并发症比较无明显统计学差异。双金属支架可以明显增加肝脏的容积。结论采用内镜双金属支架引流治疗晚期肝门部胆管恶性梗阻是安全可行的,同时可以明显改善肝脏的功能。 相似文献
17.
经内我间胆管引流术在肝门部恶性胆管梗阻中的应用及其评价 总被引:5,自引:0,他引:5
肝门部恶性肿瘤手术切除率极低,临床处理十分棘手。作者采用内镜胆管引流术治疗此类肿瘤288例次,其中行内镜鼻胆管引流162例次、塑料内置管引流80例次、放置可膨式金属胆道支架46例、4例患者接受同期双内置管引流。引流总有效率为67.0%,其中效果满意者43.1%。 相似文献
18.
Background: Self-expanding metallic mesh stents are designed to remain patent longer than polyethylene (PE) stents, which generally clog
in 3 to 4 months. Though more expensive, metal stents may therefore be a better choice for malignant strictures.
Methods: From January 1991 to October 1995, we performed ERCP in 212 patients with malignant or benign strictures, and 34 ultimately
had insertion of a metallic stent. These stents were placed by the percutaneous transhepatic route in 17 patients and endoscopically
in 17.
Results: Metallic stent insertion was successful in each case and relieved the preoperative jaundice and cholangitis. There were no
procedure-related deaths; complications were pancreatitis (one) and hemorrhage (one). Overall stent patency was 6.2 months.
Three of 34 stents occluded due to tumor ingrowth at 3, 4.5, and 8 months and were treated by placing a new PE stent through
the blocked metal stent. The remaining 31 stents remained patent until patient death (n= 15, mean survival = 4.9 months) or are still open (n= 16, mean patency = 12.2 months).
Conclusions: Self-expanding metal stents provide effective palliation of malignant biliary strictures and should be considered an alternative
to open surgery. Metal stents remain patent much longer than PE stents and usually a single session of metal stenting can
palliate biliary obstruction for life.
Received: 20 March 1996/Accepted: 9 May 1996 相似文献
19.
经内镜胆管引流术在肝门部恶性胆管梗阻中的应用及其评价 总被引:9,自引:2,他引:7
肝门部恶性肿瘤手术切除率极低,临床处理十分棘手。作者采用内镜胆管引流术治疗此类肿瘤288例次(肝门部胆管癌184例、胆囊癌23例、肝细胞癌侵犯肝门部胆管47例、其他转移性肿瘤34例),其中行内镜鼻胆管引流162例次、塑料内置管引流80例次、放置可膨式金属胆道支架46例、4例患者接受同期双内置管引流。引流总有效率为67.0%,其中效果满意者43.1%;40例患者术后1个月内发生胆管炎,发生率为13.8%,3例死亡;长期随访病例的平均存活期5.3个月。我们观察到治疗的效果与Bismuth分型有密切关系,如果全肝40%以上的胆系得到引流,黄疸有望消退;左、右两侧胆管同时引流可扩大引流范围,提高疗效;应合理选择三种内镜胆管引流方法并适时灵活转换才能获得满意的疗效。结论:对于肝门部肿瘤,内镜胆管引流术是一种安全有效的治疗手段,可作为首选的姑息性治疗。 相似文献
20.
Marín-Gómez LM Sobrino-Rodríguez S Alamo-Martínez JM Suárez-Artacho G Bernal-Bellido C Serrano-Díaz-Canedo J Padillo-Ruiz J Gómez-Bravo MA 《Transplantation proceedings》2010,42(8):2975-2977