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Efficacy and safety of standard and anti-reflux self-expanding metal stent: A systematic review and meta-analysis of randomized controlled trials 预览
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作者 Sudha Pandit Hrishikesh Samant +1 位作者 James Morris Steven J Alexander 《世界胃肠内镜杂志:英文版(电子版)》 2019年第4期271-280,共10页
BACKGROUND Self-expanding metal stents are the main palliative treatment modality for unresectable esophageal cancer. Gastroesophageal reflux is a common adverse outcome after placement of esophageal stent for cancer ... BACKGROUND Self-expanding metal stents are the main palliative treatment modality for unresectable esophageal cancer. Gastroesophageal reflux is a common adverse outcome after placement of esophageal stent for cancer involving the gastroesophageal junction and the gastric cardia. Anti-reflux stents with valve have been designed to prevent the acid reflux. The superiority of anti-reflux stent over standard stent in preventing gastroesophageal reflux has not been established well. This study compares the anti-reflux stent and the standard stent in terms of their efficacy to prevent acid reflux. AIM To compare the standard and the anti-reflux stents in terms of their efficacy, safety, and complications. METHODS The meta-analysis included 8 randomized clinical trials (RCTs) to compare pooled outcomes of total 395 patients. Primary outcomes include improvement in reflux symptoms and dysphagia score. Secondary outcomes include complications of stent migration, occlusion, and bleeding. RESULTS A total of eight RCTs were included in the meta-analysis. Compared to the standard stent, the anti-reflux stent showed a trend towards reduction in the dysphagia score without reaching a statistical significance [Standardized mean difference (SMD):-0.33 (-0.71, 0.05);P = 0.09, I2: 37%]. There was no statistical difference in the gastrointestinal reflux (GER) scores between the two types of stents [SMD:-0.17 (-0.78, 0.45);P = 0.008, I2: 74%]. Compared to standard stent, anti-reflux stent showed no difference in the risk of stent migration [OR: 1.37 (0.66, 2.83);P = 0.40, I2: 0 %], bleeding [OR: 1.43 (0.40, 5.13);P = 0.59, I2: 0 %], and obstruction [OR: 1.66 (0.60, 4.60);P = 0.33, I2: 0 %]. CONCLUSION Traditional self-expanding standard esophageal stent and anti-reflux stent with valve are similar in terms of outcomes and complications. 展开更多
关键词 Self EXPANDING metal STENT Anti-reflux STENT RANDOMIZED controlled trial ESOPHAGEAL STENT META-ANALYSIS
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Lumen-apposing metal stents for malignant biliary obstruction: Is this the ultimate horizon of our experience? 预览
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作者 Andrea Anderloni Edoardo Troncone +4 位作者 Alessandro Fugazza Annalisa Cappello Giovanna Del Vecchio Blanco Giovanni Monteleone Alessandro Repici 《世界胃肠病学杂志:英文版》 SCIE CAS 2019年第29期3857-3869,共13页
In the last years, endoscopic ultrasonography (EUS) has evolved from a purely diagnostic technique to a more and more complex interventional procedure, with the possibility to perform several type of therapeutic inter... In the last years, endoscopic ultrasonography (EUS) has evolved from a purely diagnostic technique to a more and more complex interventional procedure, with the possibility to perform several type of therapeutic interventions. Among these, EUS-guided biliary drainage (BD) is gaining popularity as a therapeutic approach after failed endoscopic retrograde cholangiopancreatography in distal malignant biliary obstruction (MBO), due to the avoidance of external drainage, a lower rate of adverse events and re-interventions, and lower costs compared to percutaneous trans-hepatic BD. Initially, devices created for luminal procedures (e.g., luminal biliary stents) have been adapted to the new trans-luminal EUSguided interventions, with predictable shortcomings in technical success, outcome and adverse events. More recently, new metal stents specifically designed for transluminal drainage, namely lumen-apposing metal stents (LAMS), have been made available for EUS-guided procedures. An electrocautery enhanced delivery system (EC-LAMS), which allows direct access of the delivery system to the target lumen, has subsequently simplified the classic multi-step procedure of EUS-guided drainages. EUS-BD using LAMS and ECLAMS has been demonstrated effective and safe, and currently seems one of the most performing techniques for EUS-BD. In this Review, we summarize the evolution of the EUS-BD in distal MBO, focusing on the novelty of LAMS and analyzing the unresolved questions about the possible role of EUS as the first therapeutic option to achieve BD in this setting of patients. 展开更多
关键词 Interventional ENDOSCOPIC ULTRASONOGRAPHY ENDOSCOPIC ultrasonography-guided BILIARY drainage ENDOSCOPIC ultrasonography-guided choledocho-duodenostomy BILIARY METAL STENT Lumen-apposing METAL STENT
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New antireflux plastic stent for patients with distal malignant biliary obstruction 预览
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作者 Xiang-Lei Yuan Bin Wei +8 位作者 Lian-Song Ye Chun-Cheng Wu Qing-Hua Tan Ming-Hong Yao Yu-Hang Zhang Xian-Hui Zeng Yan Li Yu-Yan Zhang Bing Hu 《世界胃肠病学杂志:英文版》 SCIE CAS 2019年第19期2373-2382,共10页
BACKGROUND Endoscopic biliary stenting is a well-established palliative treatment for patients with unresectable distal malignant biliary obstruction (MBO). However, the main problem with stent placement is the relati... BACKGROUND Endoscopic biliary stenting is a well-established palliative treatment for patients with unresectable distal malignant biliary obstruction (MBO). However, the main problem with stent placement is the relatively short duration of stent patency. Although self-expanding metal stents (SEMSs) have a longer patency period than plastic stents (PSs), the higher costs limit the wide use of SEMSs. A PS with an antireflux valve is an attractive idea to prolong stent patency, but no ideal design for an antireflux PS (ARPS) has been proposed. We developed a new ARPS with a “duckbilled” valve attached to the duodenal end of the stent. AIM To compare the patency of ARPSs with that of traditional PSs (TPSs) in patients with unresectable distal MBO. METHODS We conducted a single-center, prospective, randomized, controlled, double-blind study. This study was conducted at the West China Hospital of Sichuan University. Consecutive patients with extrahepatic MBO were enrolled prospectively. Eligible patients were randomly assigned to receive either an ARPS or a TPS. Patients were followed by clinic visits or telephone interviews every 1-2 mo until stent exchange, death, or the final study follow-up in October 2018. The primary outcome was the duration of stent patency. Secondary outcomes included the rate of technical success, the rate of clinical success,adverse events, and patient survival. RESULTS Between February 2016 and December 2017, 38 patients were randomly assigned to two groups, with 19 patients in each group, to receive ARPSs or TPSs. Stent insertion was technically successful in all patients. There were no significant differences between the two groups in the rates of clinical success or the rates of early or late adverse events (P = 0.660, 1.000, and 1.000, respectively). The median duration of stent patency in the ARPS group was 285 d [interquartile range (IQR), 170], which was significantly longer than that in the TPS group (median, 130 d;IQR, 90, P = 0.005). No significant difference in patient surviva 展开更多
关键词 ANTIREFLUX valve Plastic BILIARY STENT DISTAL malignant BILIARY obstruction STENT PATENCY Endoscopic retrograde CHOLANGIOPANCREATOGRAPHY
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Solid Mechanical and Hemodynamic Analyses of Different Stent Structures in a Curved Stenotic Coronary Artery
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作者 Lingling Wei Qiang Chen Zhiyong Li 《医用生物力学》 CAS CSCD 北大核心 2019年第A01期101-102,共2页
Background Coronary artery stenting is commonly used for the treatment of coronary atherosclerosis,but it causes serious clinical complications,such as the in-stent restenosis(ISR).The main reason leading to ISR is th... Background Coronary artery stenting is commonly used for the treatment of coronary atherosclerosis,but it causes serious clinical complications,such as the in-stent restenosis(ISR).The main reason leading to ISR is the neointimal hyperplasia(NH),which is related to the stresses of plaque and artery,and to the altered local hemodynamic environment due to the presence of stents.Different stent structures indeed have various impacts on the stresses of plaque and artery,and the local hemodynamic environment,such as the wall shear stress(WSS),average WSS(AWSS),and WSS gradient(WSSG).Thus,it is important to evaluate the performance of stents with different structures by the mechanical factors after coronary stenting.Methods Six stents implanted into a stenotic curved coronary artery were treated separately,and they included three typical commercial stents(Palmaz-Schatz,Xience,and Cypher)and three author-developed stents,which were constructed by reducing the numbers of link(C-Rlink)and crown(C-Rcrown),and aligning the strut(C-Astrut)of the commercial Cypher Solid mechanical analyses of the balloon-stent-plaque-artery system in Abaqus were first performed to assess the performance of different stent structures and provide the deformed boundary of lumen for the subsequent hemodynamic analysis.With the deformed boundary,then hemodynamic analyses in Ansys were conducted to quanti-fy the hemodynamic parameters induced by different stent structures.Combining the solid mechanical and hemodynamic analyses,the performance of the six stents was evaluated.Results The results show that among the three commercial stents,the Palmaz-Schatz stent has the least stent dogboning and recoiling,which corresponds to the greatest maximum plastic strain as well as the largest diameter.However,it induces the greatest maximum stress of plaque,intima,and media.From the viewpoint of hemodynamics,the Palmaz-Schatz stent also performs better and it has smaller areas of adverse low WSS(<0.5 Pa),high WSS(>15 Pa),low AWSS(<0.5 Pa),and high WSSG(>5 000 展开更多
关键词 CORONARY artery STENT design in-stent RESTENOSIS SOLID mechanics HEMODYNAMICS
Drug-eluting fully covered self-expanding metal stent for dissolution of bile duct stones in vitro 预览
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作者 Chao Huang Xiao-Bo Cai +3 位作者 Li-Li Guo Xiao-Sheng Qi Qiang Gao Xin-Jian Wan 《世界胃肠病学杂志:英文版》 SCIE CAS 2019年第26期3370-3379,共10页
BACKGROUND The treatment of difficult common bile duct stones(CBDS)remains a big challenge around the world.Biliary stenting is a widely accepted rescue method in patients with failed stone extraction under endoscopic... BACKGROUND The treatment of difficult common bile duct stones(CBDS)remains a big challenge around the world.Biliary stenting is a widely accepted rescue method in patients with failed stone extraction under endoscopic retrograde cholangiopancreatography.Fully covered self-expanding metal stent(FCSEMS)has gained increasing attention in the management of difficult CBDS.AIM To manufacture a drug-eluting FCSEMS,which can achieve controlled release of stone-dissolving agents and speed up the dissolution of CBDS.METHODS Customized covered nitinol stents were adopted.Sodium cholate(SC)and disodium ethylene diamine tetraacetic acid(EDTA disodium,EDTA for short)were used as stone-dissolving agents.Three different types of drug-eluting stents were manufactured by dip coating(Stent I),coaxial electrospinning(Stent II),and dip coating combined with electrospinning(Stent III),respectively.The drugrelease behavior and stone-dissolving efficacy of these stents were evaluated in vitro to sort out the best manufacturing method.And the selected stonedissolving stents were further put into porcine CBD to evaluate their biosecurity.RESULTS Stent I and Stent II had obvious burst release of drugs in the first 5 d while Stent III presented controlled and sustainable drug release for 30 d.In still buffer,the final stone mass-loss rate of each group was 5.19%±0.69%for naked FCSEMS,20.37%±2.13%for Stent I,24.57%±1.45%for Stent II,and 33.72%±0.67%for Stent III.In flowing bile,the final stone mass-loss rate of each group was 5.87%±0.25%for naked FCSEMS,6.36%±0.48%for Stent I,6.38%±0.37%for Stent II,and 8.15%±0.27%for Stent III.Stent III caused the most stone mass-loss no matter in still buffer or in flowing bile,which was significantly higher than those of other groups(P<0.05).In vivo,Stent III made no difference from naked FCSEMS in serological analysis(P>0.05)and histopathological examination(P>0.05).CONCLUSION The novel SC and EDTA-eluting FCSEMS is efficient in diminishing CBDS in vitro.When conventional endoscopic techniques fa 展开更多
关键词 Common BILE duct stone DRUG-ELUTING STENT Fully COVERED self-expanding metal STENT ELECTROSPINNING NANOFIBER film
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Bioreactivity of Stent Material: <i>In Vitro</i>Impact of New Twinning-Induced Plasticity Steel on Platelet Activation 预览
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作者 Carole Verhaegen Sophie Lepropre +6 位作者 Marie Octave Davide Brusa Luc Bertrand Christophe Beauloye Pascal J. Jacques Joelle Kefer Sandrine Horman 《生物材料与纳米技术(英文)》 2019年第4期175-189,共15页
A current challenge concerns developing new bioresorbable stents that combine optimal mechanical properties and biodegradation rates with limited thrombogenicity. In this context, twinning-induced plasticity (TWIP) st... A current challenge concerns developing new bioresorbable stents that combine optimal mechanical properties and biodegradation rates with limited thrombogenicity. In this context, twinning-induced plasticity (TWIP) steels are good material candidates. In this work, the hemocompatibility of a new TWIP steel was studied in vitro via hemolysis and platelet activation assessments. Cobalt chromium (CoCr) L605 alloy, pure iron (Fe), and magnesium (Mg) WE43 alloy were similarly studied for comparison. No hemolysis was induced by TWIP steel, pure Fe, or L605 alloy. Moreover, L605 alloy did not affect CD62P exposure, αIIbβ3 activation at the platelet surface, or phosphorylation of protein kinase C (PKC) substrates upon thrombin stimulation. In contrast, TWIP steel and pure Fe significantly decreased platelet response to the agonist. Given that similar inhibitory effects were obtained when using a conditioned medium previously incubated with TWIP steel, we postulated TWIP steel corrosion to be likely to release components counteracting platelet activation. We showed that the main ion form present in the conditioned medium is Fe3+. In conclusion, TWIP steel resorbable scaffold displays anti-thrombogenic properties in vitro, which suggests that it could be a promising platform for next-generation stent technologies. 展开更多
关键词 Stent TWIP STEEL PLATELET Biomaterial Hemocompatibility
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Success and safety of endoscopic treatments for concomitant biliary and duodenal malignant stenosis:A review of the literature 预览
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作者 Benedetto Mangiavillano Mouen A Khashab +9 位作者 Ilaria Tarantino Silvia Carrara Rossella Semeraro Francesco Auriemma Mario Bianchetti Leonardo Henry Eusebi Chen Yen-I Luca De Luca Mario Traina Alessandro Repici 《世界胃肠外科杂志:英文版(电子版)》 2019年第2期53-61,共9页
Synchronous biliary and duodenal malignant obstruction is a challenging endoscopic scenario in patients affected with ampullary,peri-ampullary,and pancreatic head neoplasia.Surgical bypass is no longer the gold-standa... Synchronous biliary and duodenal malignant obstruction is a challenging endoscopic scenario in patients affected with ampullary,peri-ampullary,and pancreatic head neoplasia.Surgical bypass is no longer the gold-standard therapy for these patients,as simultaneous endoscopic biliary and duodenal stenting is currently a feasible and widely used technique,with a high technical success in expert hands.In recent years,endoscopic ultrasonography(EUS)has evolved from a diagnostic to a therapeutic procedure,and is now increasingly used to guide biliary drainage,especially in cases of failed endoscopic retrograde cholangiopancreatography(ERCP).The advent of lumen-apposing metal stents(LAMS)has expanded EUS therapeutic options,and changed the management of synchronous bilioduodenal stenosis.The most recent literature regarding endoscopic treatments for synchronous biliary and duodenal malignant stenosis has been reviewed to determine the best endoscopic approach,also considering the advent of an interventional EUS approach using LAMS. 展开更多
关键词 MALIGNANT BILIARY strictures MALIGNANT DUODENAL STENOSIS Bilio-duodenal STENOSIS BILIARY self-expandable METAL stent DUODENAL self-expandable METAL stent Lumen-apposing METAL stents Gastro-jejunostomy
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Radiation therapy for extrahepatic bile duct cancer: Current evidences and future perspectives 预览
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作者 Taeryool Koo Hae Jin Park Kyubo Kim 《世界临床病例杂志》 2019年第11期1242-1252,共11页
Extrahepatic bile duct cancer (EBDC) is a rare malignancy that involves neoplastic changes extending from both hepatic ducts to the common bile duct. The treatment of choice is surgical resection, but the predominant ... Extrahepatic bile duct cancer (EBDC) is a rare malignancy that involves neoplastic changes extending from both hepatic ducts to the common bile duct. The treatment of choice is surgical resection, but the predominant pattern of initial treatment failure is locoregional recurrence. Accordingly, adjuvant radiotherapy has been administered after surgical resection based on these rationales. At this time, there is minimal evidence supporting adjuvant radiotherapy, because there have been no phase III trials evaluating its benefit. Relatively small retrospective studies have tried to compare outcomes associated with EBDC treated with or without radiotherapy. We aimed to review studies investigating adjuvant radiotherapy for resected EBDC. Because less than onethird of EBDC cases are amenable to curative resection at diagnosis, other locoregional treatment modalities need to be considered, including radiotherapy. The next aim of this review was to summarize reports of definitive radiotherapy for unresectable EBDC. Patients with advanced EBDC often experience biliary obstruction, which can lead to jaundice and progress to death. Biliary stent insertion is an important palliative procedure, but stents are prone to occlusion after subsequent ingrowth of the EBDC. Radiotherapy can be effective for maintaining the patency of inserted stents. We also reviewed the benefit of palliative radiotherapy combined with the biliary stent insertion. Lastly, we discuss the existing gaps in the evidence supporting radiotherapy in the management of EBDC. 展开更多
关键词 EXTRAHEPATIC BILE duct cancer Patterns of failure ADJUVANT RADIOTHERAPY Definitive RADIOTHERAPY PALLIATIVE RADIOTHERAPY BILIARY stent
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新型硅胶支撑管在泪小管吻合术中的应用效果
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作者 梁娜 陈宁 +2 位作者 黄帅 王瑞红 郭立坤 《中华眼外伤职业眼病杂志》 2019年第7期524-527,共4页
目的评价新型硅胶支撑管在下泪小管吻合术中的应用效果。方法回顾性分析我院2016年3月至2018年3月下泪小管断裂45例(45眼)的临床资料。所有患者术中植入新型硅胶管,8-0可吸收缝线吻合泪小管断端。术后3个月拔管,随访6~12个月。观察泪道... 目的评价新型硅胶支撑管在下泪小管吻合术中的应用效果。方法回顾性分析我院2016年3月至2018年3月下泪小管断裂45例(45眼)的临床资料。所有患者术中植入新型硅胶管,8-0可吸收缝线吻合泪小管断端。术后3个月拔管,随访6~12个月。观察泪道通畅情况及溢泪症状。结果45例中治愈41例(91.11%),好转2例(4.44%),无效2例(4.44%)。总有效率达95.56%。主要并发症为泪管阻塞2例(4.44%)、泪点豁开1例(2.22%)。结论新型硅胶支撑管手术操作简便、外观隐匿、留置状态安全以及取管简便。 展开更多
关键词 吻合术 泪小管 支撑管 硅胶 新型
颈内动脉眼段未破裂动脉瘤的血管内治疗 预览
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作者 黄鹞 白鹏 《昆明医科大学学报》 CAS 2019年第5期80-85,共6页
目的探讨对于颈内动脉眼段的未破裂宽颈动脉瘤,采用支架辅助弹簧圈的血管内治疗方法的安全性和有效性。方法回顾性分析2016年7月至2017年7月昆明医科大学第一附属医院神经外二科收治的28例颈内动脉眼段未破裂动脉瘤患者的临床资料,治疗... 目的探讨对于颈内动脉眼段的未破裂宽颈动脉瘤,采用支架辅助弹簧圈的血管内治疗方法的安全性和有效性。方法回顾性分析2016年7月至2017年7月昆明医科大学第一附属医院神经外二科收治的28例颈内动脉眼段未破裂动脉瘤患者的临床资料,治疗方法均采用支架辅助弹簧圈栓塞治疗,影像学随访方法采用DSA、CTA,预后随访方法采用改良Raymond分级量表(m RS),随访时间均为3~24个月。结果 28例患者共颈内动脉眼段动脉瘤31个,手术的成功率是100%,术后根据改良Raymond分级标准进行影像学评估,统计分析不同动脉瘤位置、大小、治疗方式与即刻栓塞率及复查栓塞率的相关性。结果仅不同动脉瘤位置分型与即刻栓塞率相关(P <0.05)。结论颈内动脉眼段未破裂动脉瘤的治疗策略,支架辅助弹簧圈这种方式是安全的和有效的,并且栓塞率与动脉瘤位置相关。 展开更多
关键词 眼动脉段动脉瘤 未破裂 宽颈 支架 血管内治疗
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Five-year Clinical Outcomes of CAD Patients Complicated with Diabetes after StentBoost-optimized Percutaneous Coronary Intervention 预览
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作者 Qiang Chen Liwei Zhang +5 位作者 Dangsheng Huang Chunhong Zhang Qiushuang Wang Dong Shen Minjun Xiong Feifei Yang 《中国医学科学杂志:英文版》 CAS CSCD 2019年第3期177-183,共7页
Objective To evaluate the instant effects and five-year clinical outcomes of coronary artery disease patients complicated with diabetes mellitus after StentBoost-optimized percutaneous coronary intervention(PCI).Metho... Objective To evaluate the instant effects and five-year clinical outcomes of coronary artery disease patients complicated with diabetes mellitus after StentBoost-optimized percutaneous coronary intervention(PCI).Methods From March 2009 to July 2010,184 patients undergoing PCI at our hospital were found stent underexpansion or malapposition by StentBoost after stents implantation and were divided into the diabetic(n=73,39.67%)and the non-diabetic group(n=111,60.33%).All patients received StentBoost-guided post-dilatation after stent implantation.The instant procedural results were measured and clinical outcome after five-year follow-up was analyzed in each group.Between-group comparisons were performed using Chi-square test or Student’s t test.Multivariate logistic regression analysis was carried out to reveal the independent predictors for long-term clinical outcomes of StentBoost-optimized PCI.Results After StentBoost-guided post-dilatation,the minimum diameter(MinLD),maximum diameter(MaxLD)and average diameter in both groups increased significantly than before(P<0.001),the(MaxLD-MinLD)/MaxLD ratio and the in-stent residual stenosis decreased accordingly(P<0.001).The five-year follow-up showed similar mortality rate(4.92%vs.2.86%,P=0.67)and major adverse cardiac event rate(11.48%vs.11.43%,P=1.0)between the diabetic and the non-diabetic group,whereas the recurrence of angina pectoris was higher in the diabetic group compared to the non-diabetic group(47.54%vs.29.52%;P=0.02).A multivariate logistic regression analysis revealed that age and left ventricular ejection fraction rather than diabetes mellitus were independent predictors for long-term clinical outcomes.Conclusions StentBoost could effectively improve instant PCI results;the long-term clinical outcomes of StentBoost-optimized PCI were similar between diabetic and non-diabetic patients.Age and left ventricular ejection fraction were the independent predictors for long-term clinical outcomes. 展开更多
关键词 PERCUTANEOUS coronary intervention DIABETES MELLITUS STENT prognosis
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血管内支架联合 125I条植入治疗恶性上腔静脉阻塞综合征的初步探讨 预览
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作者 陈敦振 石大群 +5 位作者 杨秋雨 吕墩涛 庄步强 徐浩 祖茂衡 魏宁 《医学影像学杂志》 2019年第6期981-984,共4页
目的探讨“双股静脉”入路血管内支架联合125I粒子条植入治疗恶性上腔静脉阻塞综合征的方法及临床价值。方法对2017年1月~2018年1月在我科应用血管内支架联合125I粒子条治疗的10例恶性肿瘤所致的上腔静脉阻塞综合征患者进行回顾性分析... 目的探讨“双股静脉”入路血管内支架联合125I粒子条植入治疗恶性上腔静脉阻塞综合征的方法及临床价值。方法对2017年1月~2018年1月在我科应用血管内支架联合125I粒子条治疗的10例恶性肿瘤所致的上腔静脉阻塞综合征患者进行回顾性分析。采用一侧股静脉入路植入血管内支架,对侧股静脉入路释放粒子条,利用血管内支架的张力将125I粒子条固定在上腔静脉内壁上。对血管内支架通畅性,症状缓解率,患者的生存和预后进行分析。结果上腔静脉血管内支架和粒子条植入技术成功率100%,SVC症状缓解率98%,血管内支架即刻通畅率96%。患者中位生存期(8个月),随访期3~8个月内血管通畅率98%。结论经“双股静脉入路”血管内支架联合125I粒子条植入治疗恶性肿瘤引起的上腔静脉阻塞,具有扩张血管和抑制肿瘤生长的双重作用。 展开更多
关键词 上腔静脉阻塞 血管内支架 碘-125 肺恶性肿瘤
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主动脉腔内隔绝术在Debakey Ⅲ型主动脉夹层治疗中的应用效果
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作者 钟汝核 黄健宏 +4 位作者 梁清 邱龙兴 李华 刘华剑 袁健 《中国实用医刊》 2019年第11期21-23,共3页
目的探讨主动脉腔内隔绝术(EVGE)在DebakeyⅢ型主动脉夹层治疗中的应用效果。方法选取茂名市人民医院2015年7月至2018年7月收治的42例急性DebakeyⅢ型主动脉夹层患者为研究对象,所有患者均接受EVGE治疗,比较治疗前后瘤体、近端破口水平... 目的探讨主动脉腔内隔绝术(EVGE)在DebakeyⅢ型主动脉夹层治疗中的应用效果。方法选取茂名市人民医院2015年7月至2018年7月收治的42例急性DebakeyⅢ型主动脉夹层患者为研究对象,所有患者均接受EVGE治疗,比较治疗前后瘤体、近端破口水平的真假腔直径测定值,并对其治疗效果、内瘘情况及预后效果进行评价和观察。结果42例患者共置入43枚支架,其中1例患者置入2枚支架。支架长度、支架直径、手术时间分别为(112.52±39.68)mm、(33.85±4.78)mm和(3.12±0.67)h,术中出血量为(66.98±27.54)ml;围术期无死亡患者。术后41例患者使用1枚支架完全隔绝,发生内漏1例,通过增加1枚支架进行处理后,内漏消失;1例出现脑梗死;1例出现血管粥样斑块脱落导致股动脉栓塞,切开股动脉取出脱落的粥样斑块后好转,无后遗症发生;1例术后出现高热,经对症治疗后好转。术后随访3次,与术前相比较,瘤体最大直径无显著增加(P>0.05),真腔增加明显(P<0.05),假腔直径减小(P<0.05)。结论DebakeyⅢ型主动脉夹层患者采用EVGE手术方法治疗,具有较高的安全性和可靠性。 展开更多
关键词 主动脉腔内隔绝术 DEBAKEY Ⅲ型主动脉夹层 支架
Post-endoscopic retrograde cholangiopancreatography pancreatitis: A systematic review for prevention and treatment 预览
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作者 Murat Pekgoz 《世界胃肠病学杂志:英文版》 SCIE CAS 2019年第29期4019-4042,共24页
BACKGROUND Post endoscopic retrograde cholangiopancreatography (ERCP) is comparatively complex application. Researchers has been investigated prevention of post-ERCP pancreatitis (PEP), since it has been considered to... BACKGROUND Post endoscopic retrograde cholangiopancreatography (ERCP) is comparatively complex application. Researchers has been investigated prevention of post-ERCP pancreatitis (PEP), since it has been considered to be the most common complication of ERCP. Although ERCP can lead various complications, it can also be avoided. AIM To study the published evidence and systematically review the literature on the prevention and treatment for PEP. METHODS A systematic literature review on the prevention of PEP was conducted using the electronic databases of ISI Web of Science, PubMed and Cochrane Library for relevant articles. The electronic search for the review was performed by using the search terms “Post endoscopic retrograde cholangiopancreatography pancreatitis” AND “prevention” through different criteria. The search was restricted to randomized controlled trials (RCTs) performed between January 2009 and February 2019. Duplicate studies were detected by using EndNote and deleted by the author. PRISMA checklist and flow diagram were adopted for evaluation and reporting. The reference lists of the selected papers were also scanned to find other relevant studies. RESULTS 726 studies meeting the search criteria and 4 relevant articles found in the edited books about ERCP were identified. Duplicates and irrelevant studies were excluded by screening titles and abstracts and assessing full texts. 54 studies were evaluated for full text review. Prevention methods were categorized into three groups as (1) assessment of patient related factors;(2) pharmacoprevention;and (3) procedural techniques for prevention. Most of studies in the literature showed that young age, female gender, absence of chronic pancreatitis, suspected Sphincter of Oddi dysfunction, recurrent pancreatitis and history of previous PEP played a crucial role in posing high risks for PEP. 37 studies designed to assess the impact of 24 different pharmacologic agents to reduce the development of PEP delivered through various administration methods w 展开更多
关键词 Endoscopic RETROGRADE CHOLANGIOPANCREATOGRAPHY PANCREATITIS Prevention Treatment INDOMETHACIN Stent replacement PROPHYLAXIS
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Effect of intranasal stents (AlaxoLito, AlaxoLito Plus and AlaxoLito Xtreme) on the nasal airway: A case report 预览
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作者 Henry Zhang Bhik Kotecha 《世界耳鼻咽喉科杂志》 2019年第1期4-11,共8页
BACKGROUND The study of intranasal stents on the nasal airway is limited in the medical literature. The authors aim to provide objective measurements on their effects on the nasal airway. The aim is to study the feasi... BACKGROUND The study of intranasal stents on the nasal airway is limited in the medical literature. The authors aim to provide objective measurements on their effects on the nasal airway. The aim is to study the feasibility of three novel intranasal stenting devices, AlaxoLito, AlaxoLito Plus, and AlaxoLito Xtreme, as treatment for nasal obstruction. CASE SUMMARY A 58- year-old man, who had right sided nasal obstruction, used stents during sporting activities intermittently for four years and subsequently in addition to intermittent sports use regularly for sleep for another two years. Magnetic resonance imaging (MRI) of the nasal passages and rhinomanometric measurements were taken with and without stents in situ. The stents tested are all braided from thin nitinol wires. The AlaxoLito Nasal Stent has a length of 35 mm. The AlaxoLito Plus and AlaxoLito Xtreme Nasal Stents have a length of 60 mm. Both have a diameter of about 10 mm in unloaded state and comprise a widened, ball-shaped section (which is positioned at the nasal alar) of about 11 and 14 mm, respectively. Rhinomanometric nasal airflow after application of the stents improved 1.11, 1.23, and 1.38 fold, respectively, with application of the AlaxoLito, AlaxoLito Plus and AlaxoLito Xtreme stents. MRI showed that after application of the stents, the nasal passage increased in diameter. CONCLUSION Intranasal stenting shows improvement in nasal airflow. Intermittent and regular longterm use had been shown to be safe, with no discomfort and no side effects. 展开更多
关键词 INTRANASAL stent Airway OBSTRUCTIVE sleep APNOEA RHINOMANOMETRY Magnetic resonance imaging
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机械取栓治疗急性缺血性脑卒中单中心研究 预览
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作者 贾子昌 李选 +4 位作者 李小刚 曾祥柱 栾景源 王昌明 韩金涛 《北京大学学报:医学版》 CAS CSCD 北大核心 2019年第2期256-259,共4页
目的:评估支架机械取栓治疗急性缺血性脑卒中(acute ischemic stroke,AIS)的有效性和安全性,并初步探讨其临床预后的影响因素。方法:回顾性分析2014年1月至2017年6月北京大学第三医院采用支架机械取栓治疗的26例AIS患者资料,分析即时取... 目的:评估支架机械取栓治疗急性缺血性脑卒中(acute ischemic stroke,AIS)的有效性和安全性,并初步探讨其临床预后的影响因素。方法:回顾性分析2014年1月至2017年6月北京大学第三医院采用支架机械取栓治疗的26例AIS患者资料,分析即时取栓效果,对比患者术前及出院时美国国立卫生研究院卒中量表评分( national institutes of health stroke scale,NIHSS),并分析术后90 d随访时改良Rankin量表评分(modified Rankin scale,mRS),评估患者预后。结果:(1)26例进行支架机械取栓的AIS患者中23例(88.5%)成功获得血管再通,采用脑梗死溶栓分级评分(thrombolysis in cerebral ischemia scale,TICI)进行评估,达到3级或2b级为血管再通;26例患者中3例(11.5%)发生症状性颅内出血,4例(15.4%)出现临床死亡。(2)出院时NIHSS评分比术前明显降低,差异有统计学意义( P <0.01),术后90 d有12例患者(46.2%)达到良好临床预后(mRS 0~2分)。结论:使用支架机械取栓治疗急性脑动脉闭塞导致的AIS可获得较高的再通率,改善临床预后,但部分病例预后差,提示应更加严格地筛选患者进行治疗。 展开更多
关键词 机械取栓 急性缺血性脑卒中 支架
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支架联合植入放射性粒子治疗上腔静脉综合征 预览
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作者 林连城 曾俊莉 +1 位作者 邓伟先 柯明耀 《当代医学》 2019年第24期113-115,共3页
目的探讨经皮上腔静脉支架置入联合经皮碘125放射性粒子植入术治疗上腔静脉压迫综合征的可行性及疗效。方法收集肺癌合并上腔静脉阻塞综合征患者共8例。经右侧股静脉入路上腔静脉造影,了解狭窄情况、血栓形成与否,测量狭窄两端压力,并... 目的探讨经皮上腔静脉支架置入联合经皮碘125放射性粒子植入术治疗上腔静脉压迫综合征的可行性及疗效。方法收集肺癌合并上腔静脉阻塞综合征患者共8例。经右侧股静脉入路上腔静脉造影,了解狭窄情况、血栓形成与否,测量狭窄两端压力,并于狭窄处置入血管支架。支架置入后1周内CT引导下经皮肺穿刺于上腔静脉周围植入碘125放射性粒子,125I活度0.7 mCi,每例植入25~30枚粒子。结果8例患者均一次性成功置入一枚上腔静脉支架,支架植入后造影显示血流恢复通畅,侧支循环明显减少、消失;术前狭窄远端压力30~44 cmH2O,平均(38.00±4.95)cmH2O,术后压力17~37 cmH2O,平均(30.50±8.06)cmH2O,术后上腔静脉压力较术前显著下降(P=0.042);术后的近端压力亦较前明显降低(P=0.042)。粒子植入后随访3~9个月,疗效评价:PR7例,SD1例。结论经皮上腔静脉血管支架置入术是一种创伤小、恢复快、疗效肯定的姑息治疗方法,并为后续的抗肿瘤治疗赢得时间及机会;联合经皮穿刺碘125放射性粒子植入术能有效、持续地控制肿瘤进展,是治疗上腔静脉阻塞综合征的有效方法。 展开更多
关键词 上腔静脉综合征 肺癌 内支架 碘125放射性粒子
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应用新型Pul-Stent支架治疗肺动脉分支狭窄的临床研究 预览
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作者 万俊义 张戈军 +3 位作者 潘湘斌 李守军 宋会军 高华伟 《中国循环杂志》 CSCD 北大核心 2019年第9期904-908,共5页
目的:评价新型Pul-Stent支架治疗肺动脉分支狭窄的安全性和有效性。方法:2014年9月至2016年12月期间,我院收治的先天性心脏病外科术后的肺动脉分支狭窄行新型Pul-Stent支架置入术的患者16例,男性10例,年龄18个月~33岁(112.1±101.7... 目的:评价新型Pul-Stent支架治疗肺动脉分支狭窄的安全性和有效性。方法:2014年9月至2016年12月期间,我院收治的先天性心脏病外科术后的肺动脉分支狭窄行新型Pul-Stent支架置入术的患者16例,男性10例,年龄18个月~33岁(112.1±101.7个月);体重9.2~78.0(29.0±20.4)kg。其中法乐四联症术后6例,肺动脉闭锁术后7例,右心室双出口术后2例,完全性大动脉转位术后1例。结果:16例患者共成功置入16枚支架,其中8例置入左肺动脉,8例置入右肺动脉。支架置入后,狭窄处血管内径由术前(3.7±1.7)mm增加至(9.5±1.8)mm(P<0.01);跨狭窄压力阶差由术前(58.6±28.1)mmHg(1 mmHg=0.133 kPa)降至(9.9±18.3)mmHg(P<0.01);右心室收缩压/主动脉收缩压比值由术前0.91±0.22降为0.72±0.18(P<0.01)。术中1例气管内出血,1例支架脱载重新放置成功。术后随访12个月,2例支架内血管再狭窄,再次球囊扩张成功,1例支架阻塞对侧肺动脉血流行外科肺动脉成形术,其余无并发症发生。结论:新型Pul-Stent支架置入术成功率高、扩张效果良好、并且可再次进一步扩张。初步临床实践表明,Pul-Stent支架置入术治疗先天性心脏病外科术后的肺动脉分支狭窄安全、有效。 展开更多
关键词 肺动脉 狭窄 支架 先天性心脏病
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血清可溶性髓系细胞触发受体1水平与下肢动脉硬化闭塞症患者支架植入术后再狭窄的关系研究 预览
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作者 马强 王慰敏 +1 位作者 庞宏刚 田红燕 《实用心脑肺血管病杂志》 2019年第2期38-42,共5页
背景髓系细胞触发受体(TREM)可通过介导多条信号通路而参与动脉粥样硬化的发生发展,但其在下肢动脉硬化闭塞症患者支架植入术后再狭窄中的作用尚不明确。目的分析血清可溶性髓系细胞触发受体1(sTREM-1)水平与下肢动脉硬化闭塞症患者支... 背景髓系细胞触发受体(TREM)可通过介导多条信号通路而参与动脉粥样硬化的发生发展,但其在下肢动脉硬化闭塞症患者支架植入术后再狭窄中的作用尚不明确。目的分析血清可溶性髓系细胞触发受体1(sTREM-1)水平与下肢动脉硬化闭塞症患者支架植入术后再狭窄的关系。方法选取2010年1月—2016年1月在西安交通大学第一附属医院周围血管科行支架植入术的下肢动脉硬化闭塞症患者185例,根据随访期间再狭窄发生情况分为再狭窄组83例和无再狭窄组102例。比较两组患者临床资料及血清sTREM-1水平,下肢动脉硬化闭塞症患者支架植入术后再狭窄的影响因素分析采用多因素Logistic回归分析;绘制ROC曲线以评价血清sTREM-1水平对下肢动脉硬化闭塞症患者支架植入术后再狭窄的预测价值。结果 (1)本组患者随访2年无一例失访,再狭窄发生率为44.9%(83/185),平均发生时间为术后(17.5±7.9)个月。(2)两组患者年龄、男性比例、体质指数及高血压、高脂血症、冠心病、缺血性卒中发生率比较,差异无统计学意义(P>0.05);再狭窄组患者糖尿病、下肢双侧病变、下肢完全闭塞发生率及吸烟率、血清sTREM-1水平高于无再狭窄组,下肢血管病变长度长于无再狭窄组(P<0.05)。(3)多因素Logistic回归分析结果显示,血清sTREM-1水平是下肢动脉硬化闭塞症患者支架植入术后再狭窄的独立影响因素[OR=2.270,95%CI(1.525,3.379)]。(4)绘制ROC曲线显示,血清sTREM-1水平预测下肢动脉硬化闭塞症患者支架植入术后再狭窄的AUC为0.884[95%CI(0.837,0.906)],最佳截断值为274.29 ng/L,灵敏度为72.8%,特异度为91.1%。结论血清sTREM-1水平是下肢动脉硬化闭塞症患者支架植入术后再狭窄的独立影响因素,且对支架植入术后再狭窄具有一定预测价值。 展开更多
关键词 闭塞性动脉硬化 下肢 可溶性髓系细胞触发受体1 支架 再狭窄
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A minimally invasive alternative for the treatment of nutcracker syndrome using individualized three-dimensional printed extravascular titanium stents
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作者 He Wang Yi-Tong Guo +7 位作者 Yong Jiao Da-Li He Bin Wu Li-Jun Yuan Yan-Yan Li Yong Yang Tie-Sheng Cao Bo Zhang 《中华医学杂志:英文版》 SCIE CAS CSCD 2019年第12期1454-1460,共7页
Background: This study was designed to evaluate the clinical and radiographic outcomes of patients with nutcracker syndrome (NCS) who were treated with three-dimensional printing (3DP) extravascular titanium stents (E... Background: This study was designed to evaluate the clinical and radiographic outcomes of patients with nutcracker syndrome (NCS) who were treated with three-dimensional printing (3DP) extravascular titanium stents (EVTSs). The 3DP EVTS was expected to release the hypertension of the left renal vein (LRV) produced by its compression between the superior mesenteric artery (SMA) and the aorta without causing any complications. Method: The pre-operative kidney model of each patient was printed out to enable surgical planning. After that, the EVTS was designed based on the LRV’s primitive physiologic structure using computer-aided design software, and each stent was printed out with a precision setting of 20 μm. Seventeen patients who had been suffering from NCS underwent laparoscopic 3DP EVTS placement. The surgical procedure was designed for the placement of EVTS, taking great care in positioning and fixing the stent. Surgical data, which included patient demographic characteristics as well as pre- and post-operative test results, were collected and analyzed. Results: The mean duration of surgery was 75 ± 9 min, and the mean blood loss was 20 ± 5 mL. Computed tomography examinations revealed that the pre- and post-operative angle between the SMA and the aorta ranged from 18.7°± 4.3° to 48.0°± 8.8°(P < 0.05);in patients with left varicocele, the mean diameter of the left spermatic vein ranged from 3.7 ± 0.5 to 1.3 ± 0.2 mm (P < 0.05). Moreover, Doppler ultrasound examinations showed that the peak velocity of blood flow at the hilar area ranged from 12.4 ± 3.3 to 18.5 ± 3.4 cm/s (P < 0.05). No side effects were observed in the 24 to 42 months following surgery. Conclusion: The findings after 2 years of follow-up suggest that the 3DP EVTS is a safe and effective minimally invasive alternative for the treatment of NCS. 展开更多
关键词 NUTCRACKER syndrome Extravascular stent THREE-DIMENSIONAL printing TITANIUM MINIMALLY invasive LAPAROSCOPY
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