폐쇄된 담도 금속관 치료에서 피막형 및 비피막형 금속관의 유용성 비교
Management of Occluded Biliary Uncovered Metal Stents: Covered Self Expandable Metallic Stent vs. Uncovered Self Expandable Metallic Stent
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목적: 수술이 불가능한 악성 췌담도 종양으로 인한 폐쇄성 황달은 자가 팽창형 금속배액관(self-expandable metallic stent, SEMS)을 이용하여 치료하고 있다. SEMS의 흔한 합병증으로 종양의 내증식과 외증식이 있으며 아직까지 폐쇄된 SEMS에 대한 가장 효과적인 치료법에 대해서는 연구가 미흡한 실정이다. 폐쇄된 SEMS 환자 치료에서 covered SEMS와 uncovered SEMS의 유용성을 비교 분석하였다. 대상 및 방법: 2006년 1월부터 2007년 12월까지 간문부 담도암을 제외한 악성 담도 폐쇄로 uncovered SEMS를 시술한 163명의 환자 중 추적기간동안 폐쇄되어 SEMS를 유치한 34명의 환자를 대상으로 하였다. 폐쇄된 SEMS는 ERCP를 통해서 uncovered SEMS나 covered SEMS를 유치하였다. 자료는 후향적으로 분석하여 정리하였다. 결과: 폐쇄된 SEMS에서 2차 스텐트 유치한 후 개통 기간의 중앙값은 covered SEMS군 98일(범위: 8∼300), uncovered SEMS군 90일(범위: 10∼643)였다. Covered SEMS와 uncovered SEMS 사이의 통계적으로 유의한 개존 기간 차이는 없었다(p=0.832). 결론: 폐쇄된 SEMS의 치료에 있어서 covered SEMS와 uncovered SEMS는 비슷한 개통 기간을 보였다.
Abstract
Background/Aims: Unresectable malignant biliary obstruction has usually been treated by placement of a self-expandable metallic stent (SEMS). One of the major complications of SEMS is occlusion of the stent by the ingrowth and overgrowth of tumor. The optimal management of an occluded SEMS is still an unresolved problem. We performed this study to evaluate the usefulness of placing a second stent with using an uncovered SEMS or a covered SEMS in patients with stent occlusion. Methods: From January 2006 to December 2007, a total of 163 patients were treated with the placement of an uncovered SEMS for treating malignant biliary obstruction, except for the cases with Klatskin’s tumor. Thirty four patients were occluded and they underwent a second SEMS insertion. All the patients with an occluded uncovered SEMS were managed with placement of a covered SEMS or an uncovered SEMS by ERCP. Results: The median patent duration after intervention was 98 days (range: 8∼300 days) after the second covered SEMS insertion, and the median patent duration after intervention was 90 days (range: 10∼643 days) after the second uncovered SEMS insertion. No significant difference in the patent period was observed between the covered SEMS group and the uncovered SEMS group (P=0.832). Conclusions: The covered SEMS group and the uncovered SEMS group had similar patent periods for the management of occluded uncovered metal stents.
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