이중막 구조의 스텐트를 이용한 위암으로 인한 위 배출구 폐쇄의 치료
Treatment of Gastric Outlet Obstruction by Stomach Cancer with using Double-layered Pyloric Stent
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초록
목적: 악성 위배출구 폐쇄는 수술이 불가능한 경우가 많고 수술로 인한 합병증의 위험성이 높아 내시경적 스텐트 삽입술이 선호된다. 그러나 기존의 스텐트는 종양성장으로 인한 재협착과 스텐트의 일탈의 문제점을 가지고 있다. 이러한 단점을 보안하기 위해 저자들은 새롭게 고안된 이중막 구조의 콤비 스텐트의 기술적, 임상적 유용성을 대해 알아보고자 한다. 대상 및 방법: 2005년 4월부터 2007년 5월까지 방사선학적 또는 내시경 검사를 통해 악성 위배출구 장애로 진단받았으며 수술이 불가능한 환자 15명을 대상으로 하여 입원 당시의 성별, 연령, 폐쇄 부위, 수술을 하지 못한 이유 등을 조사하였으며 스텐트 삽입의 성공률, 삽입 전후 음식물 섭취의 변화, 합병증 여부를 추적 관찰하였다. 스텐트는 내부는 피복형 스텐트로, 외부는 비피복형 스텐트로 구성되어진 이중막 구조의 스텐트를 이용하였다. 결과: 15예 모두(100%)에서 성공적으로 스텐트를 삽입하였고 임상적 증상 호전은 14예(93.3%)에서 보였다. 추적 기간 동안 3예(20.0%)에서 치료를 필요로 하는 합병증을 보였으며 2예(13.3%)에서 종양의 과도 성장을 보였고 1예(6.7%)에서 스텐트의 일탈을 보였다. 스텐트의 개통 기간은 7∼141일(중앙값 120일)을 보였다. 결론: 새롭게 고안된 이중막 구조의 스텐트는 수술이 불가능한 위배출구 폐쇄를 가진 환자에서 비교적 간단하면서 안전하게 시술할 수 있으며 스텐트의 일탈과 스텐트 내부로 종양의 성장을 줄일 수 있는 치료법으로 생각한다.
Abstract
Backgroud/Aims: Endoscopic stent placement is widely used to treat an unresectable malignant gastric outlet obstruction. The covered stent has the disadvantage of an increased risk of migration, and the uncovered stent has an increased risk of ingrowth. This study examined the technical and clinical efficiency of stent placement of a double-layered combination pyloric stent that was newly designed to reduce tumor ingrowth and stent migration. Methods: Fifteen patients with a gastric outlet obstruction caused by unresectable stomach cancer were treated with the endoscopic placement of a double-layered combination pyloric stent (an outer uncovered stent to reduce migration and an inner PTEF-covered stent to prevent tumor ingrowth). The technical success, clinical success, and complication especially tumor ingrowth and stent migration were analyzed. Results: Technical success was achieved in 15 out of 15 (100%) patients. Among the 15 patients in whom endoscopic stenting was placed successfully, the clinical success rate was 93.3%, the incidence of tumor ingrowth was 0%, the rate of migration was 6.7%, and tumor overgrowth was observed in 13.3%. The median stent patency period was 105 days. Conclusions: The placement of a double- layered pyloric combination stent appears to be effective in overcoming the disadvantage of the increased migration observed for a covered stent and the increased ingrowth observed for the uncovered stent. (Korean J Gastrointest Endosc 2007;35:221-227)
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