鼻胆引流管改制高位悬挂超长胆管支架预防十二指肠胆管反流的疗效（含视频）

Clinical efficacy of suspended overlength biliary stents reformed from nasobiliary tubes for prevention of duodenobiliary reflux （with video）

目的评估鼻胆引流管改制高位悬挂超长胆管塑料支架，预防十二指肠胆管反流的临床疗效。方法本研究采用自身前后对照方法，纳入2014年2月至2016年5月因肝外胆管狭窄在北京大学第三医院行一次或多次普通支架（包括胆管塑料支架或金属支架）置入后堵塞的患者18例，之后置人高位悬挂超长胆管塑料支架。置人后随访至2017年6月30日，将高位悬挂超长胆管支架与患者最后一次普通支架的通畅时间进行比较，并记录超长支架并发症发生率。结果纳入的18例患者中1例患者失访，17例纳入分析。9例为胆管恶性狭窄，8例为良性狭窄。17例患者超长胆管塑料支架中位通畅时间为210d，相比普通支架139d明显延长（P=0．015）。恶性狭窄患者3例曾置入金属支架，此3例患者超长胆管塑料支架和金属支架的中位通畅时间分别为278d和205d，差异无统计学意义（P=1．000），余6例患者高位悬挂超长胆管支架和普通塑料支架中位通畅时间分别为156d和65d（P=0．049）。良性狭窄患者超长支架中位通畅时间为254d，明显比普通塑料支架143d延长（P=0．025）。仅有1例患者出现术后轻度胰腺炎，无其他严重并发症发生。结论鼻胆引流管改制高位悬挂超长胆管塑料支架，有效延长支架保持通畅的时间，且不增加术后并发症的发生率，值得临床推广。

Objective To evaluate the efficacy of the suspended overlength biliary stents modified from nasobiliary tube for prevention of duodenobiliary reflux. Methods Suspended overlength bihary stents were placed in the intrahepatic bile duct of 18 patients with extrahepatic bile duct stricture who underwent biliary stents implantation once or more via ERCP from February 2014 to May 2016. Data of these patients were followed up to June 30, 2017 with self-control method. The patency time of suspended overlength biliary stents was compared with the ordinary biliary stents which were implanted in the last ERCP. Incidence of complications was recorded. Results Eighteen patients were enrolled in the study, but one patient lost followup. Finally 17 patients were enrolled in the analysis. Nine patients were malignant and 8 benign biliary stricture. The median patency time of suspended overlength biliary stents was 210 days, which was much longer than that of ordinary stents with median patency time of 139 days （P = 0. 015）. The median patency time of overlength biliary stents and metal stents in 3 patients with malignant stricture were 278 days and 205 days （P= 1. 000）. The median patency time of overlength biliary stents and traditional plastic stents in 6 patients with malignant stricture were 156 days and 65 days, respectively（P=0. 049）. The median patency time of this innovative stents was prolonged in benign biliary stricture patients （254 days VS 143 days, P = 0. 025）. Only one patient developed mild pancreatitis after ERCP. Conclusion Suspended overlength biliary stents can prolong the patency time without increasing postoperative complications, which is worth popularization.