Behandlung maligner und benigner biliärer Obstruktionen mit Metallstents

Zusammenfassung.

Die palliative Behandlung maligner Gallengangsobstruktionen mittels Metallstents ist ein in der klinischen Routine etabliertes Verfahren. Primär wird der endoskopisch transpapilläre Zugang zur Stentimplantation gewählt. Ist eine Stentimplantation auf diesem Weg nicht möglich, was bei hohen Obstruktionen häufiger vorkommt, erfolgt die Stentimplantation über den perkutanen Zugang. Es scheint sinnvoll, Metallstents mit einem engen Gitternetz wie zum Beispiel den Wallstent zu verwenden. Metallstents haben eine höhere Offenheitsrate als Plastikstents, so daß die primäre Implantation dieser Stents gerechtfertigt ist. Ummantelte Stents haben bisher keinen wesentlichen Vorteil gebracht. Bei Stentokklusion dürfte die koaxiale Implantation eines Plastikstents am effektivsten sein. Bei benignen Gallengangsstenosen sollten Metallstents nur nach gründlicher Evaluation der chirurgischen Sanierungsmöglichkeiten und Ausschöpfung der Möglichkeiten der Ballondilatation und Langzeitschienung implantiert werden.

Treatment of Malignant and Benign Biliary Obstructions with Metal Stents.

The palliative treatment of malignant bilary tract obstructions using a metal stent is now an established procedure in clinical practice. An endoscopic, transpapillary approach is the first choice for implantation of the stent. If it is not possible to insert the stent in this way, which is often the case with high obstructions, a percutaneous approach is chosen. It appears to be beneficial to use a metal stent with a fine-meshed net such as, for example, the Wall stent. Metal stents have a higher patency rate than plastic stents so that the primary choice of a metal stent is justified. Coated stents have not yet shown any major advantages. In cases of stent occlusion, the coaxial implantation of a plastic stent seems to be the most efficient. In cases of benign biliary tract stenoses, a metal stent should only be implanted after a careful evaluation of all possible surgical modalities and exploitation of balloon dilatation and long-term splinting methods.

Schlüsselwörter:

Gallengangsobstruktion - Therapie - Metallprothese - Stent

Key words:

Biliary tract obstructions - Therapy - Metal prostheses - Stents

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