胆管内支架与骑跨十二指肠乳头支架治疗恶性胆道梗阻的比较研究  

Comparison of Suprapapillary Stent and Transpapillary Stent Placement for Malignant Biliary Obstruction

作　　者：卓奇峰 陈明良 忻畅 严焕军 马霁波 ZHUO Qi-feng;CHEN Ming-liang;XIN Chang(Department of Hepatobiliary Surgery,Yinzhou Hospital,Affiliated to Medical School of Ningbo University,Ninbo(315040),China)

机构地区：[1]宁波大学医学院附属鄞州医院肝胆外科,宁波315040

出　　处：《中国中西医结合外科杂志》2018年第4期417-421,共5页Chinese Journal of Surgery of Integrated Traditional and Western Medicine

摘　　要：目的:比较胆管内和骑跨十二指肠乳头两种不同位置放置自膨式金属支架(SEMS)治疗胆道恶性梗阻的并发症及支架通畅性。方法:回顾性分析95例恶性胆道梗阻病人,行经皮肝胆管引流(PTCD)并胆道SEMS支架植入,45例放置在胆管内(A组),50例支架骑跨乳头(B组),比较两组间的并发症及通畅情况。结果:A组中植入了32个覆膜支架和13个网状支架,B组植入39个覆膜支架和11个网状支架。早期并发症发生率A组与B组无差异(P=0.096)。B组并发胰腺炎高于A组(24.0%vs 4.4%P=0.029)。两组间支架梗阻发生率无差异(P=0.094)。组间梗阻原因有差异,肿瘤生长梗阻更多见于A组,胆泥梗阻更多见于B组(P=0.025)。网状支架再梗阻率高于覆膜支架(P=0.000)。结论:为了减少胰腺炎并发症及避免梗阻,对于离十二指肠乳头2 cm以上的胆道恶性梗阻,建议覆膜支架放置在胆管内。Objective To compare the complications and stent patency with self-expandable metal stents(SEMSs)placed above or across the sphincter of Oddi in malignant biliary obstruction.Methods Total of 95 patients with malignant biliary stenosis were treated with percutaneous transhepatic SEMS placement.The clinical data were retrospectively analyzed.Forty-five patients underwent suprapapillary stent placement(group A),and 50 patients underwent transpapillary stent placement(group B).Complication rates and stent patency were evaluated.Results In group A,32 covered and 13 uncovered SEMSs were placed,and in group B,39 covered and 11 uncovered SEMSs were placed.There was no difference in the incidence of early complications between two groups(P=0.096).The complication rate of pancreatitis in group B was higher than that in group B(24.0%vs 4.4%P=0.029).There was different on causation of stent occlusions between groups.Stent occlusions by tumor growth was more frequently observed in group A,whereas stent occlusion by sludge incrustation was more frequently observed in group B(P=0.025).The rate of recurrent occlusion with uncovered SEMSs was higher than that of covered SEMSs(P=0.000).Conclusion In order to decrease the incidence of pancreatitis and stent occlusion,suprapapillary placement of covered SEMSs is recommended for malignant biliary obstruction,but not in the lower 2 cm of the common bile duct.

关 键 词：胆道恶性梗阻 金属支架 经皮经肝胆道引流 

分 类 号：R657.4[医药卫生—外科学]