Soehendra取架器在胆、胰管狭窄患者中的应用

Application of Soehendra stent retriever in patients with pancreatic or bile duct stricture

目的探讨Soehendra取架器在胆、胰管狭窄患者中的应用价值。方法 2010年1月—2012年10月沈阳军区总医院内镜科行治疗性内镜逆行胰胆管造影(ERCP)的患者,均经选择性胆、胰管造影后发现胆管或胰管狭窄,首先常规采用扩张探条扩张,如扩张探条不能通过狭窄段,则使用Soehendra取架器进行扩张。结果共有554例患者经造影后诊断为胆管或胰管狭窄,48例(8.7%)因扩张探条扩张失败改用Soehendra取架器扩张狭窄段。ERCP造影考虑胆总管狭窄8例,肝总管狭窄6例,肝门部狭窄5例,胰头颈部狭窄18例,胰体狭窄4例,肝移植术后吻合口狭窄4例,金属支架堵塞3例。治疗过程中均使用Soehendra取架器扩张胆、胰管狭窄段,再通堵塞的金属支架,成功率100%,无相关并发症发生。结论运用Soehendra取架器扩张胆、胰管狭窄段安全、有效。

Objective To evaluate the efficacy of Soehendra stent retriever as used as a dilator for the patients with high grade stricture of pancreatic or bile duct. Methods Forty-eight patients, who underwent endoscopic retrograde cholangiopancreatography （ERCP） from Jan. 2010 to Oct. 2012 in Endoscopy Department of General Hospital of Shenyang command, were found to have pancreatic or bile duct stricture. Dilation was then attempted using a dilating sound. Once the stricture could not be traversed, the Stent Retriever was inserted over the sound to dilate the stricture. Results A total of 554 patients were diagnosed to suffer from pancreatic or bile duct stricture with the aid of ERCP. Among them dilatation of stricture with catheter failed in 48 cases （8.7%） and Soehendra stent retriever was then used for dilatation. Of the 48 cases, ERCP revealed common bile duct stricture in 8 patients, common hepatic duct stricture in 6 patients, porta hepatis stricture in 5 patients, stricture at neck of pancreas stricture in 18, stricture at body of pancreas in 4, stoma stricture after liver transplant in 4, and occlusion of metallic stent in 3 patients. For these cases, Soehendra stent retriever was used to dilate the stricture prior to setting stent or endoscopic nasobiliary drainage （ENBD） with a success rate of 100%. No related complication was found. Conclusion Pancreatic and bile duct stricture can be dilated successfully with the Soehendra stent retriever. The procedure is of low risk and highly effective.