C/S-J型胆道自行脱落支架在经内镜逆行胰胆管造影术后胆道引流中应用

Application of C/S-J type self-releasing biliary stent for biliary drainage after endoscopic retrograde cholangiopancreatography

目的:探讨经内镜逆行胰胆管造影(ERCP)术后应用自制C/S-J型胆道自行脱落支架行胆道引流的安全性与有效性。方法:将2015年10月-2018年10月期间收治的184例的胆管结石患者分为3组,分别行ERCP+十二指肠乳头切口(EST)+C/S-J型胆道自行脱落支架内引流术(C/S-J组,104例),ERCP+EST+经内镜鼻胆管引流术(ENBD)(ENBD组,40例),ERCP+EST+经内镜胆道支架引流术(ERBD)(ERBD组,40例)。比较各组ERCP术后胰腺炎、胆管炎发生情况,并记录C/S-J组支架排出情况。结果:各组患者在性别、年龄、结石大小、结石数量、术前胆囊切除情况、术前胆管炎情况均无明显差异(均P>0.05);C/S-J组、ENBD组、ERBD组ERCP术后急性胰腺炎发生率分别是6.73%(7/104)、7.50%(3/40)、10.00%(4/40),急性胆管炎的发生率分别是0.96%(1/104)、0.00%(0/40)、2.50%(1/40),组间无统计学差异(均P>0.05)。C/S-J组2例术后第1天支架从胆道排出,1例术后3个月支架未排出,后经十二指肠镜成功取出,其余患者支架在9~14 d内脱落并经消化道自行排出体外,平均为10.2 d。无消化道梗阻、出血及穿孔等并发症发生。结论:采用自制C/S-J型胆道自行脱落支架行胆道引流安全、有效,能弥补ENBD与ERBD的不足之处。

Objective: To investigate the safety and efficacy of using the self-designed C/S-J type self-releasing biliary stent for biliary drainage after endoscopic retrograde cholangiopancreatography(ERCP). Methods: A total of 184 patients with common bile duct stones admitted from October 2015 to October 2018 were allotted to three groups, and underwent ERCP and endoscopic sphincterotomy(EST) plus internal drainage with C/S-J type self-releasing biliary stent(C/S-J group, 104 cases), ERCP and EST plus endoscopic nasobiliary drainage ENBD(ENBD group, 40 cases), and ERCP and EST plus endoscopic retrograde biliary drainage(ERBD)(ERBD group, 40 cases), respectively. The incidence rates of post-ERCP acute pancreatitis(PEP) and acute cholangitis among groups were compared, and the evacuation time of the self-releasing biliary stent in C/S-J group was observed. Results: There were no differences in sex, age, stone size, number of stones, previous cholecystectomy and presence or absence of cholangitis among the three groups(all P>0.05). In C/S-J group, ENBD group and ERBD group, the incidence rates of PEP were 6.73%(7/104), 7.50%(3/40) and 10.00%(4/40), and the incidence rates of cholangitis were 0.96%(1/104), 0.00%(0/40) and 2.50%(1/40) respectively, and the differences among groups showed no significance(both P>0.05). In C/S-J group, the stent in two cases was shed and evacuated on the first day after ERCP, the stent in one case failed to evacuate 3 months after ERCP and then was removed with duodenoscope, and the stent in the remaining cases evacuated through the digestive tract within 9–14 d with an average of 10.2 d after ERCP, and no complications such as obstruction, perforation and bleeding of the digestive tract occurred.Conclusion: Using the self-designed C/S-J type self-releasing biliary stent for post-ERCP biliary drainage is safe and effective, and it also can overcome the limitations of ENBD and ERBD.