改进型胰胆管支架在全覆膜金属支架治疗良性胆管狭窄中的应用价值

Improved pancreatic and biliary stents in treatment of benign biliary stricture by full-covered self-expanding removable metal stents

目的探讨改进型胰管支架在全覆膜自膨式可回收金属支架(FCSERMS)治疗良性胆管狭窄(BBS)中的应用价值。方法回顾性分析2012年1月-2017年12月采取内镜逆行胰胆管造影(ERCP)置入FCSERMS治疗的59例BBS患者的临床资料,比较改进型胰胆管支架(试验组)与单猪尾胰管支架+鼻胆引流管(对照组)在FCSERMS置入及取出术后出现急性胰腺炎(AP)、高淀粉酶血症(HP)和一般淀粉酶升高(GAE)等胰腺损伤情况。结果 59例BBS患者均成功置入FCSERMS及胰管支架。其中,试验组23例,对照组36例。两组术后均无AP发生,HP及GAE的发生率差异均无统计学意义(4.3%vs 5.6%,P=0.516;26.1%vs 22.2%,P=0.508)。术后1周均成功拔除改进型胰胆管支架及鼻胆管,两组均未发生FCSERMS移位及胰腺损伤。FCSERMS平均留置(7.88±1.29)个月(7~12个月),两组无AP、FCSERMS或胰管支架移位发生,试验组HP及GAE的发生率低于对照组(0.0%vs 2.7%,P=0.246;0.0%vs 8.3%,P=0.007)。59例FCSERMS及36例胰管支架均成功取出,未发生出血、肠穿孔和AP等并发症,对照组胰管支架均为蛋白栓堵塞,两组术后GAE的发生率差异无统计学意义(13.0%vs 8.3%,P=0.249)。结论早期取出用于预防FCSERMS治疗BBS术后胰腺炎的胰管支架是安全的,可以避免支架堵塞引起的胰腺损伤。

Objective To investigate the value of improved pancreatic and biliary stents in treatment of benign biliary stricture(BBS)by full-covered self-expanding removable metal stents(FCSERMSs).Methods Clinical data of 59 patients with BBS treated by FCSERMS from January 2012 to December 2017 was analyzed retrospectively.They were divided into single pigtail pancreatic stent group(experimental group)and improved pancreatic and biliary stent group(control group)to observe the pancreatic damage of acute pancreatitis(AP),hyperamylase(HP),general amylase elevation(GAE).Results FCSERMSs and pancreatic stents were successfully implanted in 59 patients with BBS including 23 cases in experimental group and 36 cases in the control group.There was no AP occurred in the two groups.The incidence of HP and GAE were not statistically different(4.3%vs 5.6%,P=0.516;26.1%vs 22.2%,P=0.508).The integrated pancreatic and biliary stents and naso-biliary drainage tubes were successfully removed without FCSERMS displacement or pancreas injury.The average placement time of FCSERMSs was(7.88±1.29)months(7 to 12 months).There was no AP,FCSERMS or biliary stent displacement in the two groups,but the incidence of HP and GAE in the experimental group was lower than that in the control group(0.0%vs 2.7%,P=0.246;0.0%vs.8.3%,P=0.007).59 cases of FCSERMSs and 36 cases of pancreatic stents were successfully removed without hemorrhage,bowel perforation,AP or other complication.All of the pancreatic stents in the control group were blocked by protein plugs.The incidence of GAE between the two groups had no statistically significant difference(13.0%vs 8.3%,P=0.249).Conclusions Early removal of the pancreatic stents used to prevent post-ERCP pancreatitis in treatment of BBS with FCSERMS is safe,which can prevent the damage of pancreas injury caused by the obstruction of the pancreas stents.