塑料与金属胆管支架的材料特征及其生物相容性

Material characteristics and biocompatibility of plastic and metal biliary stents

背景:经消化内镜塑料及金属胆管支架置入技术是治疗胆道良恶性梗阻的有效手段。尤其是高位梗阻胆管内支架置入治疗,对不能进行外科治疗的胆系肿瘤患者急需消除黄疸,顺应生理性引流,延长生存期,提高生活质量有极大的临床应用价值。目的:对比经消化内镜置入塑料及金属胆管支架治疗胆道良恶性梗阻的临床效果,并探讨塑料及金属胆管支架与宿主间的生物相容性。方法:由第一作者以"胆道梗阻,塑料胆管支架,金属胆管支架,生物相容性"为中文检索词,以"cerebrovascular disease,stent,biocompartibility"为英文检索词,在中国期刊全文数据库(CNKI:1989/2009)及Medline(1989/2009)数据库中采用电子检索的方式进行文献检索。排除Meta分析及重复性研究。筛选纳入35篇文献进行评价,探讨塑料及金属胆管支架的治疗现状、并发症和生物相容性。结果与结论:经内镜置入胆管支架是治疗胆道良恶性梗阻的主要手段。胆管内支架主要包括金属支架和塑料支架两种。金属支架在预防细菌滋生,保持支架持久通畅等方面有很大的优势,但价格昂贵。塑料支架较易细菌附着,胆泥淤积导致支架阻塞,但具有容易更换、价格低廉的优点。塑料及金属胆管支架的生物相容性均有待于提高,对于胆管恶性梗阻的患者,胆管内支架置入与放射治疗相结合有助于预防支架梗阻。对于胆泥的形成,支架的移位和堵塞,以及支架降解产物等问题尚需要进一步的观察和研究。

BACKGROUND：Implantation of plastic and metal biliary stent under digestive endoscopy is an effective means in the treatment of benign and malignant bile duct obstruction.Particularly stent implantation provides great clinical application value for high biliary obstruction in biliary cancer patients who are not suitable for surgical treatment and need to eliminate jaundice,accommodate physiologic drainage,prolong survival,and improve quality of life.OBJECTIVE：To compare the clinical effects of endoscopic implantation of plastic and metal biliary stents in the treatment of benign and malignant bile duct obstruction,and to explore the biocompatibility of plastic and metal biliary stents with the host.METHODS：Using ＂bile duct obstruction,plastic biliary stent,metal biliary stent,biocompatibility＂ in Chinese and ＂cerebrovascular disease,stent,biocompatibility＂ in English as the key words,China Academic Journal Full-text Database（CNKI：1989/2009） and Medline（1989/2009） database were searched online by the first author.Meta analysis and repeatable studies were excluded.Totally 35 studies were screened and evaluated,focusing on the research progress,complications,and biocompatibility in treatment of plastic and metal biliary stent.RESULTS AND CONCLUSION：Endoscopic biliary stent implantation is the principal means in the treatment of benign and malignant biliary obstruction.Biliary stent includes metal stent and plastic stent.Metal stents have exhibited great advantages in preventing the growth of bacteria and maintaining stent patency,but the price is expensive.Plastic stents are easy for bacterial attachment,biliary sludge deposition causes stent obstruction,but they are easy to replace and low price.The biocompatibility of plastic and metal biliary stents needs to be improved,for patients with malignant biliary obstruction,bile duct stent implantation in combined with radiation therapy will help to prevent stent obstruction.Further observation and studies should investigate the formation of biliary sludge,stent shift and obstruction,as well as the degradation product of stent.