经内镜放置支架治疗医源性胆管狭窄33例  

Endoscopic intervention for operation injured biliary stricture： A report of 33 cases

作　　者：吴军[1] 胡冰[1] 高道键[1] 潘亚敏[1] 王田田[1] 

机构地区：[1]第二军医大学东方肝胆外科医院内镜科,上海200438

出　　处：《腹部外科》2012年第3期156-158,共3页Journal of Abdominal Surgery

摘　　要：目的探讨内镜支架治疗手术损伤性胆管狭窄的方法及疗效。方法因损伤性胆管狭窄接受ERCP治疗33例，分别采用气囊扩张加同期放置多根塑料支架和留置可回收式金属支架2种方法治疗，在拔除支架后观察相关疗效及并发症。结果21例接受多根塑料支架支撑治疗，10例已拔除支架，狭窄均消除，狭窄缓解率为100％（10／10）；7例目前仍在支架支撑治疗中；4例失访。12例接受可回收金属支架治疗；6例已拔除支架，其中5例狭窄消除，狭窄缓解率为83．3％（5／6）；6例目前仍在支架支撑治疗中。全组拔除支架后平均随访时间为23个月，随访期间无狭窄复发；治疗相关总的并发症发生率为9．1％（3／33）。结论对于手术损伤所致的胆管狭窄，内镜下采用充分扩张加多／大口径支架支撑的方法能有效消除狭窄，且方法创伤小，安全简便，复发率低，值得临床推广。Objective To investigate the methods and effectiveness of endoscopic interventional therapy for post-operation injured biliary stricture. Methods Thirty-three patients with injured biliary stricture undergoing ERCP from Jan. 2006 to Dec. 2011 were retrospectively analyzed. Two methods were used following aggressive balloon dilation： placement of multiple plastic stents （n = 21） or re- movable self-expanding metal stent （RSEMS） （n = 12）. The efficacy and safety were observed. Re- sults In 21 patients receiving multiple plastic stents placement, the stents were removed in 10 cases, and the biliary stricture disappeared; 7 patients were still in stenting and 4 patients lost follow-up. In 12 cases receiving RSEMSs, the stents were removed in 6 cases, and the stricture disappeared in 5 cases; 6 patients were still in stenting. The whole group underwent follow-up for mean duration of 23 months. There was no stenosis recurrence cturing the follow-up period. The total complications associated with treatment occurred in 3/33 （9.1 %）. Conclusion For patients with injured biliary stricture after surgery, endoscopic intervention with aggressive dilation folloWed by multipl（stents or large caliber stent placement is effective and safe.

关 键 词：胆管 胰胆管造影 内窥镜逆行 支架 

分 类 号：R657.460.5[医药卫生—外科学]