악성 위장관 폐쇄 환자에서 Niti-S ComVi 스텐트의 유용성
Efficacy of Niti-S ComVi Stents for Palliation of Malignant Gastrointestinal Obstruction
0
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
목적: 자가 팽창형 스텐트는 악성 위장관 폐쇄의 고식적 치료에 널리 사용하고 있다. 새로 개발된 Niti-S ComVi 스텐트는 한 가닥의 니켈 티타늄 합금으로 이루어져 부드럽고 유연성이 뛰어나며 원래의 형상을 기억하고 두 겹의 철사망 사이에 polytetrafluoroethylene 막이 끼워져 있어 종양의 내증식을 억제한다. 본 연구는 악성 위장관 폐쇄 환자에서 Niti-S ComVi 스텐트의 유용성을 알아보기 위해 시행하였다. 대상 및 방법: 2004년 4월부터 2006년 4월까지 악성 상부위장관 폐쇄로 서울백병원을 방문하여 스텐트를 삽입한 17명의 환자에서 이루어진 20예의 시술을 대상으로 하였다. 추가적으로 삽입한 3예 중 1예는 기술적 실패로 인해 제거 후에 재삽입하였으며 2예는 추적 중 내증식에 의한 폐쇄가 발생하여 스텐트를 재삽입하였다. 결과: 남자는 10명 여자는 7명이었으며 평균연령은 55.8±12.9세였다. 기저질환은 위암이 16명, 총담관암이 1명이었으며 협착부위는 유문부가 5명, 분문부가 2명, 위공장 문합부가 6명, 식도공장 문합부가 4명이었다. 스텐트 삽입은 18예(90%)에서 기술적으로 성공하였으며 실패한 2예는 문합부에 협착이 심하여 수입각에 삽입되었다. 시술 후 14예(70%)에서 임상적인 호전이 있었다. 평균 위장관 폐쇄지수는 시술 전 0.2에서 시술 후 1.6으로 호전되었으며 12명의 환자는 추적관찰 기간에 사망하였고 평균 생존기간은 67±75일(13일～280일)이었다. 5명이 생존하였고 평균 추적기간은 151±36일이었으며 스텐트의 평균 개방유지 기간은 60±53일이었다. 스텐트 삽입 직후 팽창률은 57%였으며 12시간 후에 71%, 36시간 후에 77%로 팽창하였다. 합병증은 일탈(2예)과 폐쇄(5예)가 발생하였으나 모두 스텐트 재삽입과 풍선 확장술로 호전되었다. 결론: 유연한 Niti-S ComVi 스텐트는 좁고 굴곡진 악성 위장관의 폐쇄에도 적합하여 삶의 질을 향상시키는 데 유용하다고 생각한다.
Abstract
Background/Aims: Niti-S ComVi stents are flexible and retain the shape-memory of the original configuration. ComVi stents are effective in preventing tumor ingrowth because polytetrafluoroethylene is inserted between two stent wires. The aim of this study was to examine the efficacy of Niti-S ComVi stents for the palliation of a malignant gastrointestinal obstruction. Methods: Between April 2004 and April 2006, 17 patients (20 cases) underwent Niti-S ComVi stenting, using a through-the- scope method. The technical and clinical success, complication, and outcome were analyzed. Results: Stent insertion was technically successful in 18 cases (90%). Malposition to the afferent loop occurred in 2 cases. Symptomatic improvement was achieved in 14 cases (70%). The mean gastric outlet obstruction score was 0.2 before stenting and 1.6 after stenting. The complications encountered were stent migration (2 cases) and obstruction (5 cases), which were treated by re-stenting and balloon dilatation. Twelve patients died with a median survival of 67 days. Five patients were still alive with a median follow up of 151 days. The overall median stent patency time was 60 days. The mean waist diameter of the stents was expanded to 57% of full expansion immediately after deployment, and 77% after 36 hours. Conclusions: Niti-S ComVi stenting is an effective palliative technique for inoperable or postoperative recurrent tumors, and significantly improves the quality of life. (Korean J Gastrointest Endosc 2007; 34:185-192)
참고문헌 (23)
- "Enteral stents in the gastric outlet and duodenum", 37, pp.74~81 (2005)
- "Endoscopic palliation of malignant gastric outlet obstruction using self-expanding metal stents: experience in 36 patients", 97, pp.72~78 (2002)
- "Metallic stent placement or gastroenterostomy for gastric outlet obstruction caused by gastric cancer?", 40, pp.1007~1008 (2005)
- "Insertion of self-expandable metal stent in gastric outlet and malignant duodenal obstruction", 28, pp.132S~135S (2004)
- "Mechanical characterization of self-expandable esophageal metal stents", 23, pp.61~68 (2001)
- "Colonic stenting: useful technical advice in stent placement", 32, pp.164S~169S (2006)
- "Enteral self-expandable stents", 58, pp.421~433 (2003)
- "Nasolacrimal polyurethane stent placement for epiphora: technical long- term results", 12, pp.67~71 (2001)
- "Malignant gastric outlet obstructions: treatment by means of coaxial placement of uncovered and covered expandable nitinol stents", 13, pp.275~283 (2002)
- "Treatment of recurrent malignant obstruction with a flexible covered metal stent after gastric surgery", 60, pp.813~817 (2004)
- "The difference in success rate of endoscopic stent insertion with or without fluoroscopic guidance", 29, pp.107~113 (2004)
- "Palliation of anastomotic obstructions in recurrent gastric carcinoma with the use of covered metallic stents: clinical results in 25 patients", 135, pp.171~177 (2004)
- "Advances in gastrointestinal intervention: the treatment of gastroduodenal and colorectal obstructions with metallic stents", 215, pp.659~669 (2000)
- "Self-expanding metal stents for gastroduodenal malignancies: systematic review of their clinical effectiveness", 36, pp.543~550 (2004)
- "Palliation of patients with malignant gastric outlet obstruction with the enteral Wallstent: outcomes from a multicenter study", 60, pp.916~920 (2004)
- "Endoscopic palliation of malignant gastric outlet obstruction using self-expandable metallic stents: results of a multicenter study", pp.483~489 (2003)
- "Role of self-expandable metal stents in the palliation of malignant duodenal obstruction", 17, pp.646~650 (2003)
- "Palliation of patients with malignant gastroduodenal obstruction with self-expanding metallic stents: the treatment of choice?", 60, pp.1010~1017 (2004)
- "Quality improvement guidelines for placement of esophageal stents", 28, pp.284~288 (2005)
- "Palliative procedures for pancreatic cancer: when and which one?", 89, pp.27~32 (1996)
- "Cost-effective analysis of surgical palliation versus endoscopic stenting in the management of unresectable pancreatic cancer", 3, pp.470~475 (1996)
- "Surgical bypass versus metallic stent for unresectable pancreatic cancer", 8, pp.367~373 (2001)
- "Fluoroscopically guided placement of a covered self-expandable metallic stent for malignant antroduodenal obstructions: preliminary results in 18 patients", 178, pp.847~852 (2002)