自膨胀金属支架植入治疗恶性远端胆管梗阻的不良事件：一项大型多中心研究。
Adverse events of self-expandable metal stent placement for malignant distal biliary obstruction: A large multicenter study.
发表日期：2023 Aug 18
作者：
Takashi Tamura, Takuo Yamai, Norimitsu Uza, Tomoaki Yamasaki, Atsuhiro Masuda, Fumimasa Tomooka, Hirotsugu Maruyama, Minoru Shigekawa, Takeshi Ogura, Katsutoshi Kuriyama, Masanori Asada, Hisakazu Matsumoto, Mamoru Takenaka, Koichiro Mandai, Yui Osaki, Kengo Matsumoto, Tsuyoshi Sanuki, Hideyuki Shiomi, Yosuke Yamagata, Toshifumi Doi, Osamu Inatomi, Fumihiko Nakanishi, Tomoya Emori, Masaaki Shimatani, Satoshi Asai, Seiji Fujigaki, Toshio Shimokawa, Masayuki Kitano
来源：
GASTROINTESTINAL ENDOSCOPY
摘要：
恶性远端胆道梗阻（MDBO）的内镜下自膨胀金属支架（SEMS）植入可能伴有多种不良事件。本研究分析了MDBO患者在SEMS植入后发生的不良事件。本研究回顾性调查了26家医院在2018年4月至2021年3月期间接受SEMS植入治疗MDBO的患者中不良事件的发生率和类型。使用单变量和多变量分析评估急性胰腺炎、胆囊炎和复发性胆道梗阻（RBO）的危险因素。
在1425例MDBO患者中，228例（16.0%）和393例（27.6%）在早期发生了不良事件和RBO。胰管无肿瘤侵犯（p = 0.023）、乳头完整（p = 0.025）和穿过乳头的SEMS植入（p = 0.037）是急性胰腺炎的独立危险因素。囊管口（OCD）有肿瘤侵犯是胆囊炎的独立危险因素（p < 0.001）。全覆盖和部分覆盖的SEMS是食物梗阻和/或泥浆的独立危险因素。全覆盖SEMS是支架迁移的独立危险因素。未覆盖的SEMS和激光切割SEMS是肿瘤内生长的独立危险因素。
胰管无肿瘤侵犯、乳头完整和穿过乳头的SEMS植入是急性胰腺炎的独立危险因素，囊管口的肿瘤侵犯是胆囊炎的独立危险因素。在各种类型的SEMS中，食物梗阻和/或泥浆、支架迁移和肿瘤内生长的危险因素有所不同。
版权所有©2023年美国胃肠内镜学会。由Elsevier Inc.出版。保留所有权利。
Endoscopic placement of self-expandable metal stents (SEMSs) for malignant distal biliary obstruction (MDBO) may be accompanied by several types of adverse events. The present study analyzed the adverse events occurring after SEMS placement for MDBO.The present study retrospectively investigated the incidence and types of adverse events in patients who underwent SEMS placement for MDBO between April 2018 and March 2021 at 26 hospitals. Risk factors for acute pancreatitis, cholecystitis, and recurrent biliary obstruction (RBO) were evaluated by univariate and multivariate analyses.Of the 1425 patients implanted with SEMS for MDBO, 228 (16.0%) and 393 (27.6%) experienced early adverse events and RBO, respectively. Pancreatic duct without tumor involvement (p = 0.023), intact papilla (p = 0.025), and SEMS placement across the papilla (p = 0.037) were independent risk factors for acute pancreatitis. Tumor involvement in the orifice of the cystic duct (OCD) was an independent risk factor for cholecystitis (p < 0.001). Fully and partially covered SEMSs were independent risk factors for food impaction and/or sludge. Fully covered SEMS was an independent risk factor for stent migration. Uncovered SEMS and laser-cut SEMS were independent risk factors for tumor ingrowth.Pancreatic duct without tumor involvement, intact papilla, and SEMS placement across the papilla were independent risk factors for acute pancreatitis, and tumor involvement to the OCD was an independent risk factor for cholecystitis. The risk factors for food impaction and/or sludge, stent migration, and tumor ingrowth differed among types of SEMS.Copyright © 2023 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.