胆道支架移位在胆道良性疾病中的影响因素

Risk factors for biliary stent migration in patients with benign biliary strictures

目的:探讨胆道良性狭窄中胆道塑料支架移位的影响因素.方法:回顾性分析2005-01/2009-12244例因胆道良性狭窄在天津市南开医院进行内镜逆行胆管内支架引流术(endoscopic retrogradebiliary drainage,ERBD)的病例资料.记录狭窄的原因、部位,支架的长度和数量,支架移位的方向,支架移位时患者的症状及支架取出的方法.结果:244例胆道良性狭窄患者共行408次E R B D治疗,发生支架移位56例次.与其他病例相比,胆道探查术后狭窄中支架移位率较低,具有统计学意义(6.8%vs21.18%,χ2=42.585,P<0.001).在胆道近端狭窄与远端狭窄中支架的移位方向有统计学意义(23.1%vs76.9%;73.3%vs26.7%,均P<0.001).支架长度与其移位方向有统计学意义(23.1%vs73.3%;76.9%vs26.7%,均P<0.001),短支架多向近端移位,长支架多向远端移位.单、双支架的移位率均高于多支架的移位率(19.3%,20.9%vs2.7%,均P<0.001),但二者间差异无统计学意义.放置支架的数量和移位方向间无统计学意义.所有移位支架均经内镜成功取出.结论:胆道塑料支架的移位与胆道良性狭窄的原因、部位,支架的长度和数量有关.因此,在临床实践中应根据病变特征选择合适的支架以减少移位发生率.

AIM： To investigate risk factors for stent migra- tion in patients with benign biliary strictures. METHODS： The clinical data for 244 patients who underwent endoscopic retrograde biliary drainage （ERBD） for benign biliary strictures （BBS） from January 2005 to December 2009 were retrospectively reviewed. Details noted included the cause and location of stricture, length and number of stents, direction of stent migration, manifestations of patients with migrated stent, and methods used for retrieval of migrated stents. RESULTS： Four hundred and eight biliary plas- tic stent placement procedures were performed for benign biliary strictures in 244 patients. There were 56 migrated stents identified. Compared to other causes, stricture after biliary duct explora- tion was associated with a significantly lower migration rate （6.8% vs 21.18%, 2 = 42.585, P 〈 0.001）. Migration direction was associated with the location of stricture （23.1% vs 76.9%; 73.3% vs 26.7%, both P 〈 0.001）. The length of stent is associated with migration direction （23.1% vs 73.3%; 76.9% vs 26.7%, both P 〈 0.001）. Short stent tends to migrate proximately, whilst long stent more often migrates distally. Both single and double stent placement was associated with higher migration rate than multiple stent place- ment （19.3%, 20.9% vs 2.7%, both P 〈 0.001）. However, there is no significant difference in migration rate between single and double stent placement. The number of stents was not associ- ated with migration direction. All migrated stents could be successfully retrieved endoscopically. CONCLUSION： The risk factors for plastic stent migration in patients with benign biliary duct strictures include etiology of stricture, location of stricture, length and number of stents. There- fore, stent migration rate can be significantly reduced if the above conditions are carefully as- sessed in clinical practice.