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

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

Clinical application of expandable metal stent for palliation of malignant biliary obstruction

Objective To investigated the longterm result of expandable metallic biliary stent implantation and evaluated preliminarily the factors that might impact the therapeutic effectiveness.Methods 134 patients with malignant choledochal stenosis were treated with metallic endoprotheses (128 transpapillary endoscopically and 6 transhepatic percutaneously). The followup results were compared with those of 97 patients with conventional plastic stents during the same period. Results The success rate was 957%,and the procedure related complications were found in 64% of patients. The jaundice was eliminated completely in 856% patients. During longterm followup, the metal stents were shown patent for a mean duration of 300 days, which was significantly longer than 80 days of polyethylene endoprostheses (P<001). The mean survival was 210 days. From classified data assessment, the stent patency in primary bile duct neoplasm group was almost similar to that in metastatic group, but the median survival of the former was slightly longer than that of the latter. There were flow differences in patancy and survival rates between the hilar obstruction group and the middle and low obstruction group. Conclusions The median patancy of expandable metal stents was significantly longer than that of conventional plastic prostheses. To get the highest benefit, however, the indication should be strictly selected.