胆管支架的理论研究及临床应用  

Theoretical study and clinical application of the biliary tract prosthesis

作　　者：李秀丽[1] 孔德娟[2] 王梅[3] 刘红波[4] 

机构地区：[1]哈尔滨医科大学附属肿瘤医院妇放科,黑龙江省哈尔滨市150040 [2]哈尔滨医科大学附属肿瘤医院内九科,黑龙江省哈尔滨市150040 [3]哈尔滨医科大学附属肿瘤医院内五科,黑龙江省哈尔滨市150040 [4]哈尔滨医科大学附属第二医院血液科,黑龙江省哈尔滨市150086

出　　处：《中国组织工程研究与临床康复》2009年第35期6935-6938,共4页Journal of Clinical Rehabilitative Tissue Engineering Research

摘　　要：目的:熟悉胆管支架的常用类型,评价胆管支架治疗各种原因造成胆管梗阻的临床效果。方法:以胆管支架,梗阻,金属为检索词,检索中国期刊全文数据库(1999-01/2009-06),文献检索语种限制为中文。以胆管支架治疗胆管梗阻生化指标改善情况和黄疸减退率为评价指标。纳入胆管支架置入治疗胆管梗阻的临床研究,排除动物实验。结果:计算机初检得到188篇文献,根据纳入排除标准,对胆管支架治疗胆道梗阻的临床研究进行分析。胆管支架包括塑料内涵管和金属支架,临床短期疗效显著,但长期疗效受到支架移位、再狭窄等的困扰;目前设计的新型覆膜支架,依靠覆膜阻挡肿瘤生长,抑制胆泥淤积和结石形成,以延缓支架的再狭窄;可降解支架的研制也取得了一定进展,特别对良性胆管狭窄,避免了再取出的麻烦,但肿瘤可以突破降解的覆膜长入胆管造成再狭窄或闭塞。经皮肝穿刺胆道造影途径胆道金属支架置入操作成功率高,安全有效,可有效地保持胆道引流通畅,减轻黄疸,改善患者生活质量,延长患者生命。结论:相对于塑料支架,金属胆管支架在保持胆管长期开通率、减少移位、改善患者生活质量以及减少总体费用方面具有优势。临床应根据患者的局部及全身情况选择不同的种类和置入方式,提高安全性及有效性,尽可能减少并发症的发生。OBJECTIVE： To understand the common types of biliary tract prosthesis, and to evaluate clinical effects of biliary tract prosthesis in treatment of various reasons-induced bile duct obstruction. METHODS： We retrieved Chinese Journal Full-text Database （1999-01/2009-06） with the Key words of ＂biliary tract prosthesis, obstruction, mental＂ in Chinese. Biochemical indicator improvement of biliary tract prosthesis in treatment of bile duct obstruction and jaundice decrease rate were used as assessment index. Clinical studies addressing biliary tract prosthesis implantation for treating bile duct obstruction were included, and animal studies were excluded. RESULTS： A total of 188 literatures were primarily obtained by computer. According to inclusion and exclusion criteria, clinical studies concerning biliary tract prosthesis in treatment of bile duct obstruction were analyzed. Biliary tract prosthesis comprised plastic internal prosthesis and mental stent. Short-term outcomes were significant in the clinic, but long-term outcomes were affected by stent displacement, restenosis and so on. Presently designed novel stent-graft could block tumor growth by the tectorial membrane, prevent the formation of biliary silt and calculus to delay stent restenosis. Studies on degradable stent had obtained some progresses, especially on benign biliary stricture, which avoided the trouble of taking out again. However, the tumor could break through degradable tectorial membrane and grew into the biliary duct, finally resulting in restenosis or occlusion. Using percutaneous transhepatic cholangiography, biliary tract mental stent implantation had obtained high success rate, was safe and effective, could effectively keep drainage smooth in the biliary tract, reduce jaundice, improve quality of life of patients, and prolong patient＇s life. CONCLUSION： Compared with plastic stent, mental biliary tract prosthesis has advantages in keeping long-term opened rate of the bile duct, decreasing displacement, improving quality

关 键 词：胆管支架 梗阻 金属 

分 类 号：R318[医药卫生—生物医学工程]