多支架植入治疗难治性胆总管结石的随机对照研究  

Treatment of intractable choledocholithiasis with multiple biliary stent placements： a randomized controlled study

作　　者：张志坚[1] 李达周[1] 王雯[1] 林克荣[1] 乐桥良[1] 吴秋萍[1] 文小冬[1] 

机构地区：[1]南京军区福州总医院福建医科大学福总临床医学院消化科,350025

出　　处：《中华消化内镜杂志》2010年第1期23-27,共5页Chinese Journal of Digestive Endoscopy

摘　　要：目的评价不同方法胆道支架植入术对难治性胆总管结石的疗效。方法将137例难治性胆管结石患者随机分成4组，单根支架组（A组）32例；单根支架加药物治疗组（B组）35例；双根支架组（C组）33例；双根支架加药物治疗组（D组）37例。在ERCP成功后植入1根或2根支架，药物治疗组在病情平稳后应用熊去氧胆酸和（或）茴三硫，对所有患者进行密切随访。结果所有患者3个月后胆石均有缩小，C组、D组缩小的幅度显著超过A组、B组（P〈0．05）；支架通畅时间平均7．6个月，最长为20．0个月，其中D组的支架通畅时间最长，4组间两两比较均有统计学差异（P〈0．05）；对72例（52．6％）进行了第2次ERCP，其中84．7％患者（61／72）取净了结石；本组发生高淀粉酶血症41例（29．9％），以双支架组为多（P〈0．05）。结论对于难治性性胆总管结石，支架植入术是一种安全、有效的姑息疗法，尤以双支架加溶石药物疗效最佳。Objective To evaluate the efficacy of different methods of biliary stenting for intractable choledoeholithiasis. Methods A total of 137 patients with intractable choledocholithiasis were randomly divided into 4 groups to receive different managements. The treatments included single biliary stent placement in group A （n = 32 ） , single stent placement plus oral medication in group B （n = 35 ） , double stents placement in group C （n = 33） and double stents placements plus oral medication in group D （n = 37）. All biliary stents were placed via endoscopic retrograde cholangiopancreatography （ERCP）. Oral medication included ursodeoxycholic acid and/or anethol trithione after the procedure. All patients were closely followed up. Results The size of stones in common bile duct （CBD） decreased in all cases at 3 months after stent placement, with most significant changes in groups C and D than in groups A and B （ P 〈 0. 05 ）. The stents kept unobstructed for a mean time of 7. 6 months （ 3.5-20 months） , with a significant difference between every 2 groups （ P 〈 0. 05 ） and a longest duration time in group D. A second procedure of ERCP was performed in 72 patients （52. 6% ）, with achievement of total choledoeholithiasis clearance in 51 （84. 7% ）. Hyperamylasemia （HA） occurred in 41 cases （29. 9% ）, which were mainly observed in the groups C and D （P 〈 0. 05 ）. Conclusion Biliary stent placement is a safe and effective palliative therapy for intractable choledocholithiasis, while double stents placements combined with pharmacotherapy is most effective.

关 键 词：胆总管结石 胰胆管造影术 内窥镜逆行 支架 

分 类 号：R657.4[医药卫生—外科学]