自制C／S—J型胆道自行脱落支架在内镜逆行胰胆管造影中的临床应用

Clinical application of a C/S-J Type of biliary self-releasing stent during endoscopic retrograde cholangiopancreatography

目的探讨自制C／S-J型胆道自行脱落支架在预防内镜逆行胰胆管造影（ERCP）术后并发症中的安全性和有效性。方法研究入选宁夏自治区人民医院2013年10月至2015年5月收治的胆管结石患者118例，随机分为两组。实验组为ERCP＋EST＋C／S—J型胆道自行脱落支架内引流；对照组为ERCP＋EST＋ENBD。观察ERCP术后胰腺炎（PEP）和胆管炎发生情况；记录实验组支架排出情况。结果实验组PEP发生率为6．4％（5／78），对照组PEP发生率为7．5％（3／40），两组差异无统计学意义（P〉0．05）。两组患者术后均未见急性胆管炎的发生。实验组有2例术后第1天支架从胆道排出，1例术后3个月支架未排除，后经十二指肠镜成功取出。其余75例患者于术后9—14d支架脱落并经消化道自行排出体外，平均为11．4d，均无消化道梗阻、出血及穿孔等并发症发生。结论C／S—J型胆道自行脱落支架可用于ERCP术后内引流，能够安全且有效地预防ERCP术后急性胰腺炎和胆管炎的发生。

Objective To design and create a C/S-J type of biliary self-releasing stent, and to study its safety and efficacy in preventing post-ERCP complications. Methods 118 patients with common bile duct stones treated in our hospital were enrolled into this study from October 2013 to May 2015. These patients were randomly divided into two groups： the experimental group who underwent ERCP ＋ EST ＋ C/S-J type of self-releasing biliary stent drainage, while the control group underwent ERCP ＋ EST ＋ ENBD. The incidences of post-ERCP acute pancreatitis （PEP） and cholangitis in the two groups and the time the self-releasing stentt was dislodged from the biliary system in the experimental group were recorded. Results The incidence of PEP was 6.4% （5/78） and 7.5% （3/40） in the experimental and the control group, respectively （P 〉 0.05 ）. There were no patients who developed postoperative acute cholangitis in the two groups. The stents were dislodged from the biliary system on the first day after the procedure in 2 patients in the experimental group without any complications. One stent failed in self-releasing but was removed successfully with endoscopy 3 months later. In the other 75 patients, the stents were successfully dislodged and were excreted outside the patient＇ s body through the intestinal tract （ mean 11.4, range 9 - 14） days, without any complications. Conclusion The C/S - J type of biliary self-releasing stents is safe and efficacious in preventing post-ERCP pancreatitis and cholangitis.