经内镜胆管放置改良胆道支架的临床应用  

Clinical application of improved biliary stent by endoscopic biliary stent insertion

作　　者：贺克俭[1] 程春生[2] 张岖[2] 吴雪飞[2] 邹群招[2] 郑燕萍[2] 胡冬煦[1] 

机构地区：[1]中南大学卫生部肝胆肠研究中心,湖南长沙410008 [2]广东医学院附属深圳市第六人民医院消化内科,广东深圳518052

出　　处：《中国内镜杂志》2011年第2期113-115,120,共4页China Journal of Endoscopy

基　　金：深圳市南山区科技计划;项目编号:2009029

摘　　要：目的通过研究ERCP放置胆管内支架和改良后胆管内支架解决梗阻性黄疸,判断改良后支架临床实用价值。方法对20例梗阻性黄疸患者进行常规ERCP,经ERCP将导丝插入胆管并超过梗阻部位,用推送导管将合适的常规支架或改良后支架,或用鼻胆管自制支架置于胆管适当位置,对比病变前后1周胆红素情况,观察术后3个月支架移位,堵塞情况,对比两种支架引流的效果。结果 20例梗阻患者均成功置入塑料支架,成功率100.0%。患者血清总胆红素从(137.8±15.6)μmol/L,术后1周下降到(30.8±5.2)μmol/L,显效16例(80.0%),有效3例(15.0%),总有效率95.0%,1例无效(5.0%)。常规支架中显效8例,有效2例,改良支架中显效9例,无效1例。3个月后改良支架未发生移位。常规支架中,2例移位,其中1例致肠壁损伤,1例支架脱落。结论改良胆管支架(自行对支架进行塑型、打孔、增加侧翼)更容易成功放置,引流更加通畅,并且不易发生移位。【Objective】 To determine improved biliary stent clinical value by biliary stent placement or biliary stent after reformation placement resolving obstructive jaundice by ERCP.【Methods】 20 cases of obstructive jaundice in patients with conventional ERCP,guide wire inserted through the bile duct and obstruction were put the appropriate stent,or improved biliary stent,or nasobiliary after transformation to proper position and bilirubin was compared before and after 1 week,the stent migration,blockage after 3 months and the effects of two stent drainage were compared.【Results】 20 cases of obstruction with plastic stents were successfully implanted,the success rate of 100.0%.Serum total bilirubin from（137.8±15.6） μmol/L decreased to 1 week after operation（25.8±5.2） μmol/L,markedly effective in 16 cases（80.0%）,effective in 3 cases（15.0%）,the total effective rate was 95.0%,one case of invalid（5.0%）.Biliary stent after reformation after 3 months did not shift,and conventional stents in two cases of displacement,one of them causes bowel injury,one case of stent loss.【Conclusions】 Improved biliary stent placement is a good way,Through support for drilling,increase the flank,or to change the curvature making it easier for successful stent placement,drainage is more smooth and less prone to shift,improving living quality and prolong survival can be achieved.

关 键 词：内镜下逆行性胰胆管造影 梗阻性黄疸 胆管支架 改良胆管支架 

分 类 号：R657.4[医药卫生—外科学]