采用全覆膜金属支架治疗良性胆管狭窄的远期疗效观察  

Long-term effect of fully covered metal stents on benign bile duct stenosis

作　　者：吴叶晨 郑晓[2] 吴军[2] 王田田[2] 夏明星[2] 高道键[2] 范婷婷 梁磊 李小勇 胡冰[2] 

机构地区：[1]苏州大学研究生院,苏州215123 [2]第二军医大学附属东方肝胆外科医院内镜科

出　　处：《中华消化内镜杂志》2018年第1期49-54,共6页Chinese Journal of Digestive Endoscopy

基　　金：上海市医学领军人才计划（2015-83）

摘　　要：目的探讨内镜下植入全覆膜金属支架治疗良性胆管狭窄的远期疗效。方法回顾性分析2008年6月至2013年9月在东方肝胆外科医院接受经内镜逆行胆胰管造影及全覆膜金属支架植入的68例良性胆管狭窄患者的临床资料，追溯相关内镜治疗情况，密切随访患者狭窄缓解及复发情况，并分析影响疗效的危险因素。结果68例患者均成功植入支架，支架在位维持中位时间9．0个月（0．2～37．1个月），支架成功移除率93．4％（57／61），狭窄缓解率74．2％（46／62）。46例狭窄缓解患者中位随访时间54．0个月（2．5-96．0个月），狭窄复发率16．7％（6／36）。经多因素分析，狭窄距离肝管汇合部长度≤1．5cm（P=0．034，OR=6．395，95％吖：1．153-35．464）及支架发生移位（P=0．024，OR=0．153，95％CI：0．030～0．782）是影响狭窄缓解的独立危险因素；狭窄长度≥1．0cm（P=0．028，HR=6．766，95％CI：1．233～37．122）是狭窄复发的危险因素。结论内镜下全覆膜金属支架治疗良性胆管狭窄具有较好的临床疗效，且远期狭窄复发率较低，狭窄部位和长度以及支架移位是影响疗效的危险因素。Objective To evaluate the long-term outcome of fully covered self-expandable metal stents（FCSEMS） for the treatment of benign biliary strictures （BBS）. Methods Between June 2008 and September 2013, 68 patients with BBS receiving endoscopic retrograde cholangiopancreatography and FCSEMS placement were retrospectively enrolled. Data of endoscopic treatment, stricture resolution and recurrence were collected, and related risk factors were analyzed. Results FCSEMSs were successfully placed in all patients and removed in 93.4% （ 57/61 ）. The median stent duration was 9. 0 （ range 0.2- 37.1 ） months. Stricture resolution occurred in 74. 2% （46/62） patients. During me：dian follow-up of 54. 0 （range 2. 5-96.0） months, stricture recurrences were seen in 16.7% （6/36） patients. Multivariate analysis revealed that distance between stricture and hepatic bifurcation of less than 1.5 cm （P = 0. 034, OR = 6. 395, 95%CI： 1. 153-35.464）, and stent migration （P = 0. 024, OR = 0. 153, 95% CI： O. 030-0. 782） were significant risk factors for stricture resolution. Meanwhile, the stricture length longer than 1.0 cm （P = 0. 028, HR = 6. 766, 95% CI： 1. 233-37. 122 ） was a significant risk factor for stricture recurrence. Conclusion Endoscopic treatment combined with FCSEMS can achieve excellent efficacy in resolving BBS with low recurrence rate. However, location and length of BBS, as well as stent migration may impair its effectiveness.

关 键 词：胆胰管造影术 内窥镜逆行 良性胆管狭窄 全覆膜金属支架 有效性 远期 

分 类 号：R575.7[医药卫生—消化系统]