Objective To investigate the effect of implanting uncovered self-expandable metal stent for treatment of distal malignant biliary obstruction through endoscope. Methods The effect of therapy about implanting uncovered self-expandable metal stents to 16 patients who had unsectable malignant tumors companing with obstructive jaundice through endoscope was reviewed. Results Fifteen of the studied patients were implanted uncovered self-expandable metal stents successfully (94%), for their internal drainage were patent. At the seventh and fourteenth day after implantation, liver function and B-ultrasound were rechecked. Compared to the data before operation, total bilirubin, direct bilirubin and transaminase declined respectively (P＜0.01). And the diameter of the total biliary duct became shorter (P＜0.01). Six of them returned to the normal level in three weeks. Early adverse events (in seven days) included mild acute pancreatitis (one case) and acute cholangitis (one case). Mean survival and patency of drainage were 186.93 days (54 to 426 days) and 156 days (51 to 426 days) respectively. All of them, 3 cases occured obstruction of stents (20%). Conclusion Implantation of uncovered selfexpandable metal stent through endoscope is an ideal therapy for distal malignant biliary obstruction.
Drug-eluting stents have great impact to the coronary artery bypass grafting(CABG) in cardiac surgery. Someone even believes that it could replace the surgery procedure. However, the drug-eluting stents are not so ideally in the clinic practice. There are no significant difference between drug-eluting stents and bare metal stents in the mortality and the angina recurrence in middle-long term follow-up. The same results are in the compare with the CABG. As the challenge of the drug-eluting stents, the cardiac surgery has many aspects practice and progress in the harvest of the bypass graft. In the article, the change of the CABG conduit in the era of drug-eluting stents are reviewed.
Objective To systematically evaluate the efficacy and safety of sirolimus-eluting stents (SES) versus bare-metal stents (BMS) in treating patients with ST-segment elevation myocardial infarction. Methods The databases such as PubMed (1960 to Mar. 2011), EMbase (1980 to Mar. 2011), the Cochrane Central Register of Controlled Trials (1989 to Mar. 2011), CBM (1979 to Mar. 2011), VIP (1989 to Mar. 2011) and CNKI (1979 to Mar. 2011) were searched to collect all the randomized controlled trials (RCTs) on SES versus BMS in patients with ST-segment elevation myocardial infarction. After the data extraction and methodological quality evaluation, meta-analysis was conducted with RevMan 4.2 software. Results A total of 7 RCTs were included. Among 2 555 patients involved, 1 282 were in the SES group, while the other 1273 were in the BMS group. The results of meta-analyses showed that SES was superior to BMS in the target-lesion revascularization (OR=0.27, 95%CI 0.16 to 0.45, Plt;0.000 01) and target-vessel revascularization (OR=0.33, 95%CI 0.24 to 0.46, Plt;0.000 01). In contrast, there were no differences between SES and BMS in death, stent thrombosis and recurrence of myocardial infarction. Conclusion With the one-year clinical outcomes, SES is more effective than BMS in reducing the rate of target-vessel revascularization and target-lesion revascularization.
ObjectiveTo evaluate the efficacy and safety of endovascular implantation of bare-metal stent (BMS) and endovascular implantation of drug-eluting stent (DES) in treatment of infrapopliteal arterial occlusive disease by using Meta-analysis. MethodsRandomized controlled trial about endovascular implantation of BMS and endovascular implantation of DES in treatment of infrapopliteal arterial occlusive disease were searched in domestic and international databases, literature screening in accordance with inclusion criteria and exclusion criteria was taken firstly, and then quality assessment was performed. Comparison of 1-year restenosis rate, 1-year patency rate, incidence of limb salvage, mortality, and 1-year target lesion revascularization rate after operation between BMS group and DES group were performed by using RevMan 5.2 software for Meta-analysis. ResultsSix literatures included 572 cases who suffered from infrapopliteal arterial occlusive disease were included at all, including 302 cases in DES group and 270 cases in BMS group. The results of Meta-analysis showed that, compared with BMS group, 1-year patency rate after operation in DES group was higher (OR=1.64, 95% CI:1.35-1.98, P < 0.000 1), but 1-year restenosis rate (OR=0.19, 95% CI:0.12-0.30, P < 0.000 1) and 1-year target lesion revascularization rate after operation (OR=0.09, 95% CI:0.02-0.32, P=0.000 2) were both lower. There were no significance difference between the BMS group and DES group on incidence of postoperative limb salvage (OR=1.29, 95% CI:0.58-2.86, P=0.530 0) and postoperative mortality (OR=0.98, 95% CI:0.58-1.65, P=0.940 0). ConclusionsCompared with endovascular implantation of BMS, endovascular implantation of DES can increase the 1-year patency rate and reduce 1-year restenosis rate or 1-year target lesion revascularization rate after operation for infrapopliteal arterial occlusive disease.
ObjectiveTo compare the short- and long-term effects of emergency surgery (ES) and self-expanding metal stent (SEMS) in treatment of malignant left-sided colonic obstruction.MethodsThe patients with malignant left-sided colonic obstruction who met the inclusion and exclusion criteria in the Third Affiliated Hospital of Soochow University from October 2010 to October 2020 were retrospectively collected and divided into ES group (n=43) and SEMS group (n=22). The baseline data, surgical data, postoperative data, and prognosis (overall survival and relapse free survival) were compared, and the risk factors of tumor recurrence after surgery were further analyzed by Cox proportional hazards regression model. ResultsIn this study, 65 cases of malignant left-sided colonic obstruction were included, including 43 cases in the ES group and 22 cases in the SEMS group. There were no statistical differences in the baseline data of the two groups (P>0.05). There were no significant differences in the incidence of postoperative complications [13.6% (3/22) vs. 23.3% (10/43), P=0.555], recurrence rate [40.9% (9/22) vs. 37.2% (16/43), P=0.772], and rate of receiving postoperative chemotherapy [68.2% (15/22) vs. 48.8% (21/43), P=0.138] between the SEMS group and ES group. Compared with the ES group, although the median hospitalization time was longer (20 d vs. 12 d, P=0.001), and the median hospitalization cost was higher (65 033 yuan vs. 40 045 yuan, P=0.001), the stoma rate of the SEMS group was lower [36.4% (8/22) vs. 88.4% (38/43), P=0.001], and the minimally invasive (laparoscopic) rate was higher [36.4% (8/22) vs. 7.0% (3/43), P=0.008]. There were no significant differences in the 4-year cumulative overall survival (46.9% vs. 48.4%, P=0.333) and 4-year cumulative relapse free survival (36.2% vs. 44.8%, P=0.724) between the SEMS group and ES group, but the overall survival of the SEMS group was better than that of the ES group for the patients with stage Ⅲ–Ⅳ (χ2=4.644, P=0.047). Multivariate analysis of Cox proportional hazards regression model showed that increased TNM stage increased the risk of postoperative tumor recurrence of patients with malignant left-sided colonic obstruction [HR=2.092, 95%CI (1.261, 3.469), P=0.004]. ConclusionsShort- and long-term effects of ES and SEMS in treatment of malignant left-sided colonic obstruction are equivalent. Although SEMS mode has a longer hospital stay and higher hospitalization costs, stoma rate is lower and laparoscopic surgery rate is higher. Overall survival of SEMS mode in treatment malignant left-sided colonic obstruction patients with stage Ⅲ–Ⅳ is better.
Objective To study the incidence and etiological distribution of lower respiratory tract infection (LRTI) after airway metal stent implantation in patients with malignant central airway obstruction (MCAO). Methods The clinical data of 149 patients with MCAO who underwent airway metal stent implantation in Department of Pulmonary and Critical Care Medicine of Hunan Provincial People's Hospital from April 2014 to April 2021 were selected for a retrospective study. The incidence of LRTI after treatment was counted. According to whether LRTI occurred after operation, they were divided into infected group and uninfected group. The clinical data of the two groups were compared and the influencing factors of LRTI were analyzed. Sputum samples and/or bronchoalveolar lavage fluid samples from patients infected with LRTI were collected for pathogen detection and drug susceptibility test, and the distribution and drug resistance of main pathogens were analyzed. Results A total of 149 patients who met the criteria were included in this study and the incidence of LRTI was 21.48%. People in the infected group was older than that in the uninfected one, and the proportion of people with a history of smoking, chemoradiotherapy, covered metal stents, and stent-related granulation tissue proliferation was higher, and the proportion of people with postoperative standardized aerosol inhalation was lower (P<0.05). Age, smoking history, chemoradiotherapy, covered metal stents, stent-related granulation tissue hyperplasia and postoperative standardized aerosol inhalation were all influencing factors of LRTI in these patients (P<0.05). A total of 38 pathogens were detected in 32 patients with LRTI. Gram negative bacteria, gram positive bacteria and fungi accounted for 68.42% (26/38), 21.05% (8/38) and 10.53% (4/38) respectively. Pseudomonas aeruginosa, the main Gram-negative bacteria, had no resistance to tobramycin, gentamicin and amikacin, but had high resistance to compound sulfamethoxazole, tigecycline and ampicillin; Klebsiella pneumoniae had low resistance to tobramycin, amikacin and tigecycline, and high resistance to cefotaxime, ciprofloxacin and cefepime; the main Gram-positive Staphylococcus aureus had no drug resistance to vancomycin, linezolid, compound sulfamethoxazole and quinuptin/dafuptin, but had high drug resistance to tetracycline, penicillin G, levofloxacin, oxacillin and ciprofloxacin; the main fungi Candida albicans showed no resistance to fluconazole, itraconazole, voriconazole, 5-fluorocytosine and amphotericin B. These results of pathogenic detection and drug susceptibility test contributed to the improvement of the rational application rate of antibiotics. Conclusions LRTI occurs in about a quarter of patients with MCAO after airway metal stent implantation. The pathogens are mainly Pseudomonas aeruginosa and Staphylococcus aureus. Antimicrobial treatment should be based on the results of etiological detection and drug susceptibility test.
The complication rate and mortality rate of traditional emergency surgery for acute obstructive colorectal cancer are very high. Self-expanding metal stent (SEMS) as a bridge to surgery can rapidly decompress the intestinal tract and radical surgery can be performed after the patients’ general condition improve. This technology has been widely developed, but its safety is still controversial, mainly related to the risk of SEMS implantation and its impact on the long-term survival of patients. This article will introduce the rationale, pathophysiology, short-term safety and long-term oncology safety of SEMS implantation, in order to provide basis for clinicians to choose treatment methods.
Objective To evaluate the efficacy and safety of the silicone stent for treatment of three common benign central airway stenosis. Methods We retrospectively reviewed 40 patients with benign airway stenosis who were treated with a Dumon silicone stent at Affiliated Hospital of Guizhou Medical University between November 2019 to October 2023, including 14 cases of tracheobronchial tuberculosis (TBTB) stenosis, 14 cases of stenosis after tracheal intubation,and 12 cases of stenosis after tracheotomy. The clinical data and information on bronchoscopic interventional procedures and related complications were collected and analyzed, for evaluating the short-term efficacy, long-term efficacy and stent-related complications. Results The 40 patients were successfully implanted of silicone stents for 48 times totally. The mMRC score, KPS score, blood oxygen saturation and the diameter of the narrowest airway were significantly improved (P<0.05) after the implantation of silicone stents in all patients. Patients in TBTB group achieved inferior efficacy than those in the other two groups (P<0.05), while there was no significant therapeutic effect between tracheal intubation and tracheotomy groups (P>0.05). The main complications after the implantation of silicone stents were granulation hyperplasia, sputum retention and stent displacement. There were higher incidence rates of granulation hyperplasia and sputum retention in the TBTB group compared with the tracheal intubation and tracheotomy groups (P<0.05 ), while there was no statistically significant difference in incidence rates of granulation hyperplasia and sputum retention between the last two groups. Meanwhile, there was no significant difference in the proportion of stent displacement among the three groups.Conclusions The efficacy and safety were satisfied in the treatment of the three common benign central airway stenosis,with a recommendation for the treatment of refractory benign airway stenosis. However, the treatment effect of the TBTB group is inferior to that of the tracheal intubation and tracheotomy groups, with higher rates of obvious granulation hyperplasia and sputum retention simultaneously. More detailed follow-up management was recommended for TBTB patients implanted with silicone stents to avoid the development of stent-related minor complications into serious complications with a worse prognosis.