PTFE覆膜自膨式镍钛合金支架介入治疗恶性梗阻性黄疸

目的探讨使用PTFE覆膜自膨式镍钛合金支架进行恶性梗阻性黄疸介入治疗的技术和临床疗效。方法以置人PTFE覆膜自膨式镍钛合金支架的方法治疗37例恶性梗阻性黄疸患者。患者的生存率和支架通畅率分别以Kaplan-Meier法来进行统计；在术前、术后均分别测定胆红素、血清淀粉酶和脂肪酶水平等指标，然后使用Wilcoxon符号秩检验进行比较。平均随访时间为27．9周（范围：2-81周）。结果成功完成所有置入术。76％（28／37）的患者在其余生中有充分的姑息引流。3例患者出现胆泥堵塞支架而需要经皮肝穿刺胆管引流术来再灌通。2例患者分别在第7和第27周的检查中发生了与结石形成相关的延迟性支架移位。尽管已行内镜括约肌切开术（4／6）治疗，仍然有11例患者在术后第1天出现了淀粉酶和脂肪酶水平的急性升高。其胆红素水平在术后l周显著降低（P〈0．01）。本治疗组中，30d死亡率为8％（3／37）。第20和50周患者的生存率分别为49％和27％，主支架通畅率分别为85％和78％。结论PTFE覆膜自膨式镍钛合金支架介入治疗是恶性梗阻性黄疸可行而有效的治疗手段。

PTFE-covered self-expandable nitinol stent in the treatment of malignant biliary obstruction

Objective To determine the technical and clinical efficacy of the treatment of malignant biliary obstruction with a PTFE-covered self-expandable nitinol stent.Methods Thirty seven patients with common bile duct strictures caused by malignant disease were treated by placing nitinol PTFE stents.Used Kaplan-Meier survival analysis for the calculated of patient survival rate and stent patency rate.The bilirubin,serum amylase and lipase levels before and after stent placement were measured and then compared by a Wilcoxon signed-rank test.The average follow-up duration was 27.9 weeks (range:2-81weeks).Results All cases succeeded.Patients experienced adequate palliative drainage for the remainder of their lives were 76% (28/37).Three patients demonstrated stent sludge occlusion that required PTBD (percutaneous transhepatic bil-iary drainage) irrigation.Two patients experienced delayed stent migration with stone formation at 7 and 27 weeks of fol-low-up respectively.Stent insertion resulted in acute elevations of the amylase and lipase levels one day after stent inser-tion in 11 patients in spite of performing endoscopic sphincterotomy,the bilirubin levels of whom were significantly re-duced after one week (P< 0.01).The 30-day mortality rate was 8%,and the survival rates were 49% and 27% at 20 and 50 weeks respectively.The primary stent patency rates were 85% and 78% at 20 and 50 weeks respectively.Conclusion Treatment of malignant biliary obstruction with a PTFE-covered self-expandable nitinol stent is effective to used.