• 제목/요약/키워드: Metallic stent

검색결과 43건 처리시간 0.027초

Novel Endoscopic Stent for Anastomotic Leaks after Total Gastrectomy Using an Anchoring Thread and Fully Covering Thick Membrane: Prevention of Embedding and Migration

  • Jung, Gum Mo;Lee, Seung Hyun;Myung, Dae Seong;Lee, Wan Sik;Joo, Young Eun;Jung, Mi Ran;Ryu, Seong Yeob;Park, Young Kyu;Cho, Sung Bum
    • Journal of Gastric Cancer
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    • 제18권1호
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    • pp.37-47
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    • 2018
  • Purpose: The endoscopic management of a fully covered self-expandable metal stent (SEMS) has been suggested for the primary treatment of patients with anastomotic leaks after total gastrectomy. Embedded stents due to tissue ingrowth and migration are the main obstacles in endoscopic stent management. Materials and Methods: The effectiveness and safety of endoscopic management were evaluated for anastomotic leaks when using a benign fully covered SEMS with an anchoring thread and thick silicone covering the membrane to prevent stent embedding and migration. We retrospectively reviewed the data of 14 consecutive patients with gastric cancer and anastomotic leaks after total gastrectomy treated from January 2009 to December 2016. Results: The technical success rate of endoscopic stent replacement was 100%, and the rate of complete leaks closure was 85.7% (n=12). The mean size of leaks was 13.1 mm (range, 3-30 mm). The time interval from operation to stent replacement was 10.7 days (range, 3-35 days) and the interval from stent replacement to extraction was 32.3 days (range, 18-49 days). The complication rate was 14.1%, and included a single jejunal ulcer and delayed stricture at the site of leakage. No embedded stent or migration occurred. Two patients died due to progression of pneumonia and septic shock 2 weeks after stent replacement. Conclusions: A benign fully covered SEMS with an anchoring thread and thick membrane is an effective and safe stent in patients with anastomotic leaks after total gastrectomy. The novelty of this stent is that it provides complete prevention of stent migration and embedding, compared with conventional fully covered SEMS.

Analysis of Different Ways of Drainage for Obstructive Jaundice Caused by Hilar Cholangiocarcinoma

  • Xu, Chuan;Lv, Peng-Hua;Huang, Xin-En;Wang, Shu-Xiang;Sun, Ling;Wang, Fu-An
    • Asian Pacific Journal of Cancer Prevention
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    • 제15권14호
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    • pp.5617-5620
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    • 2014
  • Objective: To evaluate the prognosis of different ways of drainage for patients with obstructive jaundice caused by hilar cholangiocarcinoma. Materials and Methods: During the period of January 2006- March 2012, percutaneous transhepatic catheter drainage (PTCD)/ percutaneous transhepatic biliary stenting (PTBS) were performed for 89 patients. According to percutaneous transhepatic cholangiography (PTC), external drainage was selected if the region of obstruction could not be passed by guide wire or a metallic stent was inserted if it could. External drainage was the first choice if infection was diagnosed before the procedure, and a metallic stent was inserted in one week after the infection was under control. Selection by new infections, the degree of bilirubin decrease, the change of ALT, the time of recurrence of obstruction, and the survival time of patients as the parameters was conducted to evaluate the methods of different interventional treatments regarding prognosis of patients with hilar obstruction caused by hilar cholangiocarcinoma. Results: PTCD was conducted in 6 patients and PTBS in 7 (p<0.05). Reduction of bilirubin levels and ALT levels was obvious after the procedures (p<0.05). The average survival time with PTCD was 161 days and with PTBS was 243 days (p<0.05). Conclusions: With both drainage procedures for obstructive jaundice caused by hilar cholangiocarcinoma improvement in liver function was obvious. PTBS was found to be better than PTCD for prolonging the patient survival.

간문부 담관암 환자에서 경피경관 양측성 금속 배액관의 효과 (The Effect of Percutaneous Bilateral Metalic Stent for Hilar Cholangiocarcinoma)

  • 김금래;김주형;박원규;장재천;조재호;김태년;김준환;장병익
    • Journal of Yeungnam Medical Science
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    • 제22권2호
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    • pp.211-220
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    • 2005
  • 간문부 담관암 환자에서 고식적 치료로 경피경간 금속 자가 팽창성 스텐트 삽입술을 시행하여 그 효과를 알아보았다. 영남대학교 의과대학 부속병원에 2001년 11월부터 2002년 7월까지 간문부 담관암으로 진단받은 환자 중 경피경간 양측성 금속 스텐트를 삽입한 48명을 대상으로 하였다. 의무기록과 전화조사를 이용하여 조기합병증, 기술 및 임상적인 성공률, 스텐트 개통율, 환자 생존율을 후향적으로 분석하였다. 금속 스텐트의 삽입은 전 예에서 가능하였으며 기술적인 성공률은 100%로 대상환자 48명 모두에서 추적 담관조영술에서 십이지장으로 조영제가 잘 내려가 경피경간 담도배액관을 제거할 수 있었다. 금속 스텐트 삽입 후 1주 배액율은 평균 72.8%, 최종 배액율은 91.1%로 모든 예에서 성공적인 배액이 이루어졌다. 30일 이내에 조기 합병증으로 경미한 복통 이외의 진통제 투여가 필요한 정도의 복통이 12예에서 있었으나 보존적 치료로 2~3일 내에 호전이 되었고, 급성 담도염이 1예서 발생하였으나 적절한 항생제의 사용으로 호전이 되었다. 후기 합병증으로 급성 담낭염이 2예, 간농양이 1예, 담즙종이 1예 발생하였으나 적절한 배액술로 치료가 가능하였다. 생존율과 개통율은 30일 이내에 사망한 3예와 추적이 되지 않은 3예를 제외한 42예에서 구하였다. 42예의 금속 스텐트의 개통 유지기간의 중앙값은 303일(60~815일)이었으며 6개월 개통율은 64%, 1년 개통율은 33%였다(Fig. 2). 생존기간의 중앙값은 338일(60~1175일)이었으며 6개월 생존율은 69%, 1년 생존율은 38%였다(Fig. 3). 근치적 절제가 불가능한 간문부 담관암 환자에서 고식적 치료로 경피경간 금속 스텐트 삽입은 안전하고 효과적인 시술로 생각된다.

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Portal cavernography during endoscopic retrograde cholangiopancreatography: from bilhemia to hemobilia

  • Rawad A. Yared;Paraskevas Gkolfakis;Arnaud Lemmers;Vincent Huberty;Thierry Degrez;Jacques Deviere;Daniel Blero
    • Clinical Endoscopy
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    • 제56권4호
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    • pp.521-526
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    • 2023
  • Portobiliary fistulas are rare but may lead to life-threatening complications. Biliary plastic stent-induced portobiliary fistulas during endoscopic retrograde cholangiopancreatography have been described. Herein, we present a case of portal cavernography and recurrent hemobilia after endoscopic retrograde cholangiopancreatography in which a portobiliary fistula was detected in a patient with portal biliopathy. This likely indicates a change in clinical presentation (from bilhemia to hemobilia) after biliary drainage that was successfully treated by placement of a fully covered, self-expandable metallic stent.

외상 후 단독 상장간막동맥박리 후에 국소적으로 진행된 박리성 동맥류와 심한 진강의 압박이 있는 환자에서 혈관내 스텐트설치술 1례 (Endovascular Stent Placement in a Patient with a Posttraumatic Isolated Superior Mesenteric Artery Dissection with Focally Progressing Dissecting Aneurysms and a Severely Compressed True Lumen)

  • 김영규;허규희;김승형;김광식
    • Journal of Trauma and Injury
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    • 제28권4호
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    • pp.266-271
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    • 2015
  • Reports on a posttraumatic isolated superior mesenteric artery (SMA) dissection are rare. Recently, endovascular stent placement via percutaneous access, instead of vascular surgery, has been widely accepted as the initial treatment for a patient with an isolated SMA dissection or its complications. A 60-year-old female patient was transferred to our hospital due to an isolated SMA dissection after a car accident. The SMA dissection was 8.5 cm in length, and it involved the true lumen, which was severely compressed by the thrombosed false lumen. The patient was closely observed because she did not complain of any specific visceral pain. On the seventh hospital day, she underwent computed tomography (CT) to decide on a further treatment plan, irrespective of the presence of the abdominal symptom. The findings of the follow-up CT showed no difference compared to those of the previous CT. She was discharged with anti-coagulants. One month later, the follow-up CT revealed focally progressing dissecting aneurysms in the false lumen of the dissected SMA and a more severely compressed true lumen. Two self-expandable metallic stents were successfully placed in the true lumen of the dissected SMA, covering two aneurysmal lesions. Herein, we report a successful endovascular treatment with stent placement for treating focally progressing dissecting aneurysms and a severely compressed true lumen in a patient with a posttraumatic isolated SMA dissection.

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전기분사를 이용한 양성담관 협착 치료용 약물방출 스텐트 개발 (Development of Drug Eluting Stent for the Treatment of Benign Biliary Stricture by Electro-spray Method)

  • 신일균;김동곤;김한기;김상호;전동민;서태석;장홍석
    • 폴리머
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    • 제36권2호
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    • pp.163-168
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    • 2012
  • 최근에 내시경 관련기술의 진보에 따라서 시술 편리성, 회복시간 단축, 환자 고통 경감 등의 장점으로 인해 스텐트 삽입술이 빠르게 진보하였다. 본 연구에서 양성담관 협착 치료를 목적으로 파클리탁셀을 이용한 약물방출 스텐트를 전기분사 방법에 의해 제조하였으며, 이 때 사용된 고분자는 polyether-based polyurethane(상표명 : PELLETHANE 2363-80AE$^{(R)}$)과 첨가제로서 Pluronic F127, 약물로서 파클리탁셀을 사용하여 금속스텐트 표면에 코팅하였다. 그 결과로서, 약물이 코팅된 고분자 필름의 물리적 특성은 SEM, FTIR, 접촉각 측정기, XRD에 의해 확인하였으며, 약물방출속도는 약물함량이 높을수록 감소하였음을 알 수 있었다.

Evaluation of the Biodurability of Polyurethane-Covered Stent Using a Flow Phantom

  • Dong Hyun Kim;Sung-Gwon Kang;Jung Ryul Choi;Ju Nam Byun;Young Chul Kim;Young Moo Ahn
    • Korean Journal of Radiology
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    • 제2권2호
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    • pp.75-79
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    • 2001
  • Objective: To evaluate the biodurability of the covering material in retrievable metallic stents covered with polycarbonate polyurethane. Materials and Methods: Using a peristaltic pump at a constant rate of 1ml/min, bile was recirculated from a reservoir through a long tube containing four stents. Each of these was removed from the system every two weeks and a radial tensile strength test and scanning electron microscopy (SEM) were performed. Each stent, removed at 2, 4, 6 and 8 weeks, was compared with a control stent not exposed to bile juice. Results: Gross examination showed that stents were intact at 2 weeks, but at 4, 6 and 8 weeks cracks were observed. The size of these increased gradually in accordance with the duration of exposure, and at 8 weeks several large holes in the polyurethane membrane were evident. With regard to radial tensile strength, extension and peak load at break were 84.47% and 10.030 N/mm, 54.90% and 6.769 N/mm, 16.55% and 2.452 N/mm, 11.21% and 1.373 N/mm at 0, 2, 4 and 6 weeks, respectively. Scanning electron microscopy at 2 weeks revealed intermittent pitting and cracking, and examination at 4, 6 and 8 weeks showed that the size of these defects was gradually increasing. Conclusion: When the polyurethane membrane was exposed to bile, biodegradation was first observed at week two and increased gradually according to the duration of exposure.

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