支架胆管引流在内镜下逆行胰胆管造影术治疗胆总管结石中的应用  

Application of biliary drainage with single pigtail plastic pancreatic stent after ERCP treating choledocholithiasis

作　　者：李景泽 张文佳 胥明[1] 唐庆贺[1] 

机构地区：[1]同济大学附属东方医院内镜中心,上海200123

出　　处：《中国临床医学》2017年第4期601-604,共4页Chinese Journal of Clinical Medicine

摘　　要：目的:探讨单猪尾胰管塑料支架胆管引流在内镜下逆行胰胆管造影术(endoscopic retrograde cholangiopancreatography,ERCP)治疗胆总管结石中的应用效果。方法:回顾性分析同济大学附属东方医院2014年10月至2016年10月ERCP治疗的胆总管结石患者105例的临床资料。根据胆管引流方式的不同分为支架组(n=38)和常规组(n=67)。支架组患者采用ERCP+十二指肠乳头括约肌切开术(endoscopic sphincterotomy,EST)/内镜下十二指肠乳头气囊扩张术(endoscopic papillary balloon dilatation,EPBD)+取石+单猪尾胰管支架胆管内引流;常规组患者采用ERCP+EST/EPBD+取石+ENBD。比较两组患者术后急性胰腺炎(post-ERCP acute pancreatitis,PEP)的发生情况;观察支架组胰管支架脱落、内镜下支架取出等情况。结果:支架组患者PEP发生率为13.1%(5/38),常规组患者PEP发生率为14.9%(10/67),差异无统计学意义。支架组中有3例患者术后第1天支架从胆道脱落,1例因上腹部不适于术后3d拔除支架,8例术后2周仍未脱落,遂经内镜成功取出;其余26例患者于术后2周内支架脱落并经消化道自行排出体外,未发生消化道梗阻、出血及穿孔等严重并发症。结论:胆总管结石行ERCP治疗后,可应用单猪尾胰管塑料支架行胆管内引流以预防PEP的发生,降低PEP的严重程度。胰管支架多可自行脱落,安全排出,无严重并发症。Objective：To discuss the clinical efficacy of biliary drainage with single pigtail plastic pancreatic stent after endoscopic retrograde cholangiopancreatography（ERCP）treating choledocholithiasis.Methods：Clinical data of 105 patients with common bile duct stones treated by ERCP from October 2014 to October 2016 in Shanghai East Hospital were analyzed retrospeoctively.These patients were divided into stenting group（n=38）and control group（n=67）.The stenting group received ERCP＋endoscopic sphincterotomy（EST）/endoscopic papillary balloon dilatation（EPBD）＋calculus removed ＋single pigtail plastic pancreatic stent for biliary drainage,while the control group underwent ERCP＋EST/EPBD＋calculus removed＋ENBD.The incidences of post-ERCP acute pancreatitis（PEP）in the two groups were compared.The stent fall and dislodging in stenting group were observed.Results：The incidence of PEP was 13.1% （5/38） in stenting group and 14.9%（10/67） in control group.In the stenting group,3 patients had stent dislodged on the first day after ERCP.One patient got stent removed from bile duct on the third day due to upper abdomen discomfort.The stents in 8 patients were removed successfully by endoscopy while they failed in self-releasing in 2 weeks.In the other 26 patients,without complications,the stents dislodged successfully and were excreted outside through the digestive tract.Conclusions： After ERCP treating choledocholithiasis,the application of single pigtail plastic pancreatic stent bile duct drainage can prevent the incidence of PEP,reduce the severity degree of PEP,and the stent can successfully dislodged without complications.

关 键 词：内镜下逆行胰胆管造影 内镜鼻胆管引流 胰管支架 急性胰腺炎 

分 类 号：R576[医药卫生—消化系统]