恶性胆道梗阻金属支架堵塞后再次置入金属和塑料支架的比较

背景：在堵塞的支架中再次置入金属或塑料支架可解决支架的堵塞问题,然而关于支架间如何搭配组合将使患者受益更大却一直存在着争论。目的：对比恶性胆道梗阻金属支架堵塞后再次在其内置入不同种类支架之间的临床效果。方法：收集在南昌大学第二附属医院行经内镜胆道金属支架置入的,且在原支架堵塞后再次在其内置入另一支架的中、低位胆道恶性梗阻患者83例,并根据原支架与再次置入支架的不同搭配组合形式,将以上患者分为3组,即覆膜金属支架组、无覆膜金属支架组和塑料支架组。结果与结论：在原金属支架堵塞后,再次置入覆膜金属支架的通畅时间显著长于塑料支架(P < 0.05);覆膜金属支架组的支架累计通畅时间显著长于无覆膜金属支架组(P < 0.05-0.01)。提示经内镜置入胆道金属支架治疗中、低位胆道恶性梗阻时,在原金属支架和支架堵塞后再次置入金属支架时,使用≥1根覆膜支架的累计通畅时间显著长于先后2次置入无覆膜金属支架者。

Clinical comparison of reimplanted metallic and plastic biliary stents for occluded primary metallic stents in malignant biliary obstruction

BACKGROUND:Reimplantation of metallic and plastic biliary stents in the obstructed scents can solve obstruction. However, it is debatable what a kind of combinations in stents can have more benefits for patients.OBJECTIVE:To compare clinical effects of the reimplanted different kinds of stents for occluded primary metallic stents in malignant biliary obstruction.METHODS:Totally 83 patients with malignant biliary obstruction were collected. They underwent endoscopic metal biliary endoprothesis and secondary biliary stent placement in the medium and low levels of the other stent as “stent-in-stent” in the Second Affiliated Hospital of Nanchang University. The patients were divided into three groups according various combinations in primary and secondary implanted stents: covered metallic stent group, uncovered metallic stent group and plastic stent group (5 covered-plastic, 10 uncovered-plastic).RESULTS AND CONCLUSION:After the primary metallic stent was obstructed, the patent time of reimplanted covered metallic stents was significantly longer than that of plastic stents (P < 0.05). Compared with the uncovered metallic stent group, the cumulative patent time in the covered metallic stent group was obviously longer (P < 0.05-0.01). These results suggest that as the primary metallic stents were obstructed, covered metallic stents (at least one in the primary and/or secondary procedure) can provide longer cumulative patent time than uncovered metallic stents in both procedures for malignant biliary obstruction at medium and low levels treated by mendoscopic metal biliary endoprothesis.