• Journal of Hospice and Palliative Care
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• 제12권2호
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• pp.49-55
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• 2009

상부 위장관 스텐트 삽입술은 근치적 수술이 불가능한 상부 악성 종양에 의한 상부 위장관 협착 환자의 폐쇄 증상 완화를 위한 보존적 치료로서 확립되었으며 내시경 개발 기술이 발달하고 임상 경험이 축적됨에 따라서 여러 상부 위장관 질환에서 스텐트 삽입술을 보다 편리하고 안전하게 시행할 수 있게 되었다. 그러나 스텐트 삽입술 이후에는 동통, 출혈, 천공과 같은 조기 합병증이나 스텐트 일탈, 스텐트 폐쇄 등의 후기 합병증이 발생할 수 있으므로 사후 관리 또한 중요하다.

• Clinical Endoscopy
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• 제56권2호
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• pp.143-154
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• 2023

Advanced malignant hilar biliary obstruction (MHBO) with inaccessible papilla poses a significant challenge to endoscopists, as drainage of multiple liver segments may be warranted. Transpapillary drainage may not be feasible in patients with surgically altered anatomy, duodenal stenosis, prior duodenal self-expanding metal stent, and after initial transpapillary drainage, but require re-intervention for draining separated liver segments. Endoscopic ultrasound-guided biliary drainage (EUS-BD) and percutaneous trans-hepatic biliary drainage are the feasible options in this scenario. The major advantages of EUS-BD over percutaneous trans-hepatic biliary drainage include a reduction in patient discomfort and internal drainage away from the tumor, thus reducing the possibility of tissue or tumor ingrowth. With innovations, EUS-BD is helpful not only for bilateral communicating MHBO but also for non-communicating systems with bridging hilar stents or isolated right intra-hepatic duct drainage by hepatico-duodenostomy. EUS-guided multi-stent drainage with specially designed cannulas and guidewires has become a reality. A combined approach with endoscopic retrograde cholangiopancreatography for re-intervention, interventional radiology, and intraductal tumor ablative therapies has been reported. Stent migration and bile leakage can be minimized with proper stent selection and technique, and stent blocks can be managed with EUS-guided interventions in a majority of cases. Future comparative studies are required to establish the role of EUS-guided interventions in MHBO as rescue or primary therapy.

• Clinical Endoscopy
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• 제55권4호
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• pp.564-569
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• 2022

A lumen-apposing metal stent (LAMS) is a saddle-shaped stent with large flanges at both ends, thereby preventing stent migration and helping with approximation of the adjacent structures. We report the case of a 25-year-old female with remnant choledochal cyst which was successfully treated with LAMS after initial treatment failure with a plastic stent. Although complete excision of the cyst is the definite treatment of choledochal cysts, endoscopic ultrasonography-guided cystoduodenostomy can be considered in cases wherein surgery is not feasible and dysplasia is not present. LAMS may be preferred to plastic stents for effective resolution of remnant choledochal cyst and prevention of ascending infection.

• Journal of Chest Surgery
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• 제28권5호
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• pp.499-503
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• 1995

Since the insertion of self expandable metalic stent[SEMS has became popular method for hollow organ stenosis, many attempts for further apply the stent to airway stenosis as an simple procedure has been made, but intrabronchial migration of stent or occurrence of inflammatory granuloma around stent develop occasionally and sometimes it worsen bronchial stenosis further more. This report describes 2 case of surgically treated bronchial restenosis in whom intrabronchial stent were applied for release of bronchial stenosis. Our surgical option was pneumonectomy and bronchoplasty with sleeve right middle and upper lobectomy respectively. During the operation we found the SEMSs were tightly impacted in restenotic bronchial lumen with overgrowth of granulation tissues. The bronchial obstructions occupied more than 90% of lumens in both cases, and needed much complicated procedure to be relieved. Therefore, even though the insertion of SEMS remains as a prcedure determined by the physician`s preference, it has to be considered prudently that the use of SEMS can cause severe restenosis and the surgeon has more difficulties in performing segmental resection of restenotic bronchus in patient with SEMS previously inserted. Throughout these experiences we can conclude that the insertion of SEMS must be performed only in very selected cases of bronchial stenosis.

• Tuberculosis and Respiratory Diseases
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• 제53권4호
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• pp.431-438
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• 2002

배 경 :기체역학적 실험을 기반으로 새로 개발된 Natural 스텐트(N-Stent)의 유효성과 안전성을 기존의 Dumon 스텐트와 비교하고자, Nd-YAG Laser를 이용한 한국산 잡견 기관협착 동물모델에서 연구를 시행하였다. 방 법 : 한국산 잡견 12마리를 Nd-YAG 레이저를 이용하여 기관협착을 유도한 후, 무작위로 선정한 6마리에게는 Dumon 스텐트를, 6마리에게는 Natural 스텐트를 삽입하였다. 실험동물은 매 1주마다 4주 동안 기관지내시경으로 스텐트 위치변동과 점액저류 정도를 반정량적으로 기록하였고, 삽입 4주후에 스텐트를 제거하였다. 스텐트 제거 1주 후, 기관협착 정도를 조사하였다. 결 과 : Natural 스텐트를 삽입한 동물에서 스텐트의 위치 변동의 정도($2.0{\pm}l.0$)는 Dumon 스텐트 삽입동물($3.0{\pm}0.8$)과 차이를 보이지 않았으며, 점액저류의 정도($1.5{\pm}0.6$)도 Dumon 스텐트 삽입동물($1.7{\pm}0.5$)과 차이를 보이지 않았다. 스텐트 제거 1주 후의 협착의 정도도 Dumon 스텐트 삽입통물($1.5{\pm}0.5$)에 비해 Natural 스텐트 삽입동물($1.0{\pm}0.4$)에서 차이를 보이지 않았으며, 협착의 정도는 두군에서 모두 2.0 이하로 관찰되어, 설정한 기도확장의 기준을 만족시켰다. 결 론 : 새로 개발한 Natural 스텐트가 잡견을 이용한 기관협착 동물모델에서, Dumon 스텐트와 비교하여 동일한 유효성과 안전성을 지난 것으로 입증되었다. 향후 인체에서의 유효성과 안전성을 입증하기 위해, 기도협착 환자를 대상으로 한 임상시험이 필요할 것으로 사료된다.

• Clinical Endoscopy
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• 제57권1호
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• pp.134-136
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• 2024

• Clinical and Experimental Pediatrics
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• 제61권6호
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• pp.187-193
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• 2018

Purpose: The efficacy of percutaneous stent implantation for congenital heart disease (CHD) in Korea, where stent availability is limited, has not been determined. This study evaluated the acute and midterm results of stent implantation in different CHD subgroups. Methods: Stents were implanted in 75 patients with 81 lesions: (1) pulmonary artery stenosis (PAS) group, 56 lesions in 51 patients; (2) coarctation of the aorta (CoA) group, 5 lesions in 5 patients; (3) Fontan group, 13 lesions in 12 patients; (4) ductal stent group, 3 lesions in 3 patients; and (5) other CHD group, 4 lesions in 4 patients. Mean follow-up duration was 2.1 years (0.1-4 years). Medical records were reviewed retrospectively. Results: The minimum lumen diameter (MLD) in PAS and CoA increased from $5.0{\pm}1.9mm$ and $8.4{\pm}1.6mm$ to $10.1{\pm}3.6mm$ and $12.3{\pm}2.5mm$, respectively (P<0.01). In the PAS group, pressure gradient decreased from $25.7{\pm}15.6mmHg$ to $10.4{\pm}10.1mmHg$, and right ventricular to aortic pressure ratio from $0.56{\pm}0.21$ to $0.46{\pm}0.19$. In the CoA group, the pressure gradient decreased from $50{\pm}33mmHg$ to $17{\pm}8mmHg$. In the ductal stent group, the MLD of the ductus increased from 2.3 mm to 4.3 mm and arterial oxygen saturation from 40%-70% to 90%. No deaths were associated with stent implantation. Stent migration occurred in 3 patients, but repositioning was successful in all. Stent redilation was performed successfully in 26 cases after $29{\pm}12months$. Conclusion: Percutaneous stent implantation was safe and effective, with acceptable short and mid-term outcomes in Korean CHD patients.

• 동의생리병리학회지
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• 제23권5호
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• pp.974-979
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• 2009

Proliferation of vascular smooth muscle cell(VSMC) is one of the key features in onset of atherosclerosis and restenosis after vascular surgery such as stent implant. Atherosclerotic plaques are usually composed of collagen, elatsin and smooth muscle cells. Release of matrix metalloproteinases(MMPs) is considered to have correlation with development of atherosclerotic plaques. Based on the hypothesis that MMP inhibition would be helpful in the treatment of atherosclerosis, we investigated inhibition of MMP activity and migration of TNF-$\alpha$-induced human aortic smooth muscle cell(HASMC) by Cinnamomi Ramulus(CC). The result from gelatin zymography showed that CC inhibited MMP-9 activity in a dose-dependent manner. In addition, CC considerably inhibited the migration of HASMC induced by TNF-$\alpha$, while it showed little cytotoxic effect on HASMC. These results suggest that CC can be a potential anti-atherosclerotic agent through inhibition of MMP-9 activity and SMC migration.

• 대한영상의학회지
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• 제81권2호
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• pp.442-447
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• 2020

의인성 이물질은 인터벤션 의사와 환자 모두에게 심각한 합병증이며, 환자의 삶의 질을 악화시키고 경제적 부담을 준다. 본 증례 보고에서는 복강 내 이물질을 경피경간적 경로로 성공적으로 제거할 수 있었던 드문 증례를 보고하는 바이다. 72세 남자 환자는 좌간절제술 후에 발생한 난치성 담즙 유출을 치료하기 위해 피막 담도 스텐트 설치를 받았다. 설치 3일 후에, 스텐트에 접힘 변형이 발생하면서, 담즙 유출 부위를 통해 스텐트가 만성 담즙종 공동 내부로 이동하였다. 풍선 카테터 기법을 이용하여 접힌 스텐트를 곧게 펴고 담도 내로 위치를 재조정하여, 제거하는 동안 스텐트-스트럿에 의한 손상을 최소화할 수 있었다. 중재적 시술은 혈관 내 이물질뿐만 아니라 복강 내 이물질에도 유효한 치료 방법이 될 수 있다. 이용 가능한 시술 장비들과 술기들에 대한 철저한 이해는 이물질 제거를 위해 보다 효과적인 전략을 수립하는 데 많은 도움을 줄 수 있다.

• Korean Journal of Radiology
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• 제23권9호
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• pp.889-900
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• 2022

Objective: To investigate the long-term outcomes of percutaneous treatment of benign biliary strictures using temporary placement of a retrievable expanded polytetrafluoroethylene (PTFE) covered stent. Materials and Methods: We retrospectively analyzed the outcomes of 148 patients (84 male and 64 female; age range, 11-92 years) who underwent percutaneous transhepatic placement and removal of a retrievable PTFE-covered stent for the treatment of benign biliary strictures between March 2007 and August 2019 through long-term follow-up. Ninety-two patients had treatment-naïve strictures and 56 had recurrent/refractory strictures. Results: Stent placement was technically successful in all 148 patients. The mean indwelling period of the stent was 2.4 months (median period, 2.3 months; range, 0.2-7.7 months). Stent migration, either early or late, occurred in 28 (18.9%) patients. Clinical success, defined as resolution of stricture after completing stent placement and removal, was achieved in 94.2% (131 of 139 patients). The overall complication rate was 15.5% (23 of 148 patients). During the mean follow-up of 60.2 months (median period, 52.7 months; range, 1.6-146.1 months), 37 patients had a recurrence of clinically significant strictures at 0.5-124.5 months after removal of biliary stent and catheter (median, 16.1 months). The primary patency rates at 1, 3, 5, 7, and 10 years after removal of biliary stent and catheter were 88.2%, 70.0%, 66.2%, 60.5%, and 54.5%, respectively. In the multivariable Cox proportional hazard regression analysis, sex, age, underlying disease, relation to surgery, stricture type, biliary stones, history of previous treatment, and stricture site were not significantly associated with the primary patency. Conclusion: Long-term outcomes suggest that percutaneous treatment of benign biliary strictures using temporary placement of retrievable PTFE-covered stents may be a clinically effective method.