胆道支架在内镜逆行胰胆管造影治疗肝移植术后胆道良性狭窄中的应用价值  

Application value of biliary stent in endoscopic retrograde cholangio pancreatography for treatment of benign bfliary stricture after liver transplantation

作　　者：郝杰[1] 李宇[1] 陶杰[1] 王铮[1] 杨雪[1] 于良[1] 吕毅[1] 孙昊[1] 

机构地区：[1]西安交通大学第一附属医院肝胆外科,710061

出　　处：《中华消化外科杂志》2017年第4期385-390,共6页Chinese Journal of Digestive Surgery

基　　金：陕西省科技统筹创新工程计划项目（2011KTCL03-21）

摘　　要：目的探讨胆道塑料支架及全覆膜自膨式金属支架在ERCP治疗肝移植术后胆道良性狭窄中的应用价值。方法采用回顾性横断面研究方法。收集2010年1月至2016年8月西安交通大学第一附属医院收治的54例行ERCP治疗肝移植术后胆道良性狭窄患者的临床资料。54例患者中，单纯吻合口狭窄44例，非吻合口狭窄10例。患者均行ERCP支架置入治疗。肝移植术后1个月内狭窄，初始选择置入单根塑料支架或行经内镜鼻胆管引流术（ENBD），在2次治疗更换支架时更换为多根支架支撑。术后1个月后发生狭窄，选择多根支架、球囊扩张后多根支架或全覆膜自膨式金属支架支撑。观察指标：患者ERCP治疗情况、支架置入情况、支架留置时间、术后并发症发生情况、支架脱落情况、治疗疗效及随访情况。采用电话及门诊方式进行随访。术后1个月内观察临床症状并复查肝功能、腹部超声检查，定期每3个月随访肝功能及评估胆道狭窄的缓解程度。随访时间截至2016年11月。计量资料以平均数（范围）表示。结果54例患者ERCP治疗均操作成功，53例完成ERCP治疗，1例因经济问题中断治疗。54例患者共行140次ERCP治疗，平均2．59次／例：行ENBD21次，置入全覆膜自膨式金属支架11次，置入塑料支架108次（其中单支架35次、双支架46次、3支架23次、4支架4次）。54例患者均获得随访，随访时间为3，143个月，平均随访时间为73个月。44例吻合口狭窄患者中，34例置入塑料支架，共行98次ERCP治疗，平均置入支架数目为2根（1～4根），平均支架留置时间为10．7个月（9．0～13．0个月）；术后发生急性胰腺炎4例次，胆道感染7例次，高淀粉酶血症10例次，支架位置不良或脱落3例次；治愈26例，好转5例，有效率为91．2％（31／34）；3例无效患者继续行ERCP治疗；随访期间3例患者吻合口狭窄复发。10例Objective To explore the application value of plastic biliary stent and fully covered self- expandable metallic stent （FCSEMS） in endoscopic retrograde eholangio pancreatography （ ERCP ） for treatment of benign biliary stricture after liver transplantation. Methods The retrospective cross-sectional study was conducted. The clinical data of 54 patients with benign biliary stricture after liver transplantation undergoing ERCP treatment who were admitted to the First Affiliated Hospital of Xi＇an Jiaotong University between January 2010 and August 2016 were collected. Among 54 patients, 44 had simple anastomotic stricture and 10 had non-anastomotic stricture. All the patients underwent stent implantation by ERCP. Patients with stricture within 1 month postoperatively initially selected single plastic stent or endoscopic nasobiliary drainage （ENBD） , and then changed into multiple plastic stents at the second stent replacement. Patients with stricture after 1 month postoperatively selected multiple plastic stents, multiple plastic stents after balloon dilation or FCSEMS. Observation indicators： ERCP situations, stent implantation, time of stent indwelling, postoperative complications, stent dislocation, treatment outcome and follow-up situations. Patients were followed up by outpatient examination and telephone interview up to November 2016. Clinical symptoms of patients were observed within 1 month postoperatively and liver function and abdominal ultrasound were retested. Liver function and remission degree of biliary stricture were monitored regularly once every 3 months. Measurement data were described as average （range）. Results All the patients underwent successful ERCP, of which 53 completed the process of ERCP and 1 rejected treatment due to economic problems. All the 54 patients received 140 times ERCPs with an average of 2.59 times per person, 21 times ENBDs, 11 times FCSEMSs and 108 times plastic stent implantations （including 35 times single stent implantations, 46 times double stents

关 键 词：胆道良性狭窄 肝移植术 胆道塑料支架 全覆膜自膨式金属支架 

分 类 号：R657.3[医药卫生—外科学]