抗反流胆管支架的研究进展  

Research progress of anti-reflux biliary stents

作　　者：刘一璠 薛冬冬[1] 脱红芳[1] 彭彦辉[1] LIU Yifan;XUE Dongdong;TUO Hongfang;PENG Yanhui(Department of Hepatobiliary Surgery,Hebei General Hospital,Shijiazhuang 050051,China;Graduate School,Hebei Medical University,Shijiazhuang 050000,China)

机构地区：[1]河北省人民医院肝胆外科,河北石家庄050051 [2]河北医科大学研究生学院,河北石家庄050000

出　　处：《中国普通外科杂志》2022年第2期259-267,共9页China Journal of General Surgery

基　　金：河北省2016年政府资助临床医学优秀人才培养和基础课题研究基金资助项目(361003)。

摘　　要：内镜逆行胰胆管造影术和支架置入术已逐渐成为远端恶性胆道梗阻患者的标准姑息治疗方式。但是随着各类材质支架的置入,废弃了Oddi括约肌的功能,改变了胆道正常解剖结构,致使十二指肠内容物易反流入胆管,患者发生胆管炎的概率明显升高,严重影响生活质量。为了减少胆管反流等相关不良事件的出现,抗反流支架应运而生。其大部分是通过在支架末端加装抗反流阀起到抗反流作用。根据支架材质不同可分为塑料抗反流支架与金属抗反流支架,而根据抗反流阀的不同形状,又可分为风向袋形、漏斗形、鸭嘴形等。在多项临床研究中,大部分抗反流支架不仅可以减少胆管炎的发生,还能延长支架平均通畅时间,取得了较好的临床效果。但是,由于各类支架的材质与设计存在差异,支架阻塞、支架移位等问题仍需进一步解决。笔者通过汇总相关文献,对不同材质结构抗反流胆管支架的研究进展及临床应用情况进行综述。Endoscopic retrograde cholangiopancreatography with stent implantation have gradually become the standard palliative care for patients with distal malignant biliary obstruction.Nevertheless,the function of the sphincter of Oddi is eliminated and the normal anatomical structure of the biliary tract is changed with the placement of stents of various materials.As a result,the duodenal contents will likely flow back into the bile duct,leading to a significantly increased probability of cholangitis in patients and seriously affecting the patients’ quality of life.In order to reduce the occurrence of associated adverse events such as bile duct reflux,anti-reflux stents have appeared.Most of them are designed by adding an anti-reflux valve at the end of the stent to function as an anti-reflux barrier.They can be categorized into anti-reflux plastic stents and anti-reflux metal stents according to the material,and also can be named by the shape of the anti-reflux valve such as the windsock anti-reflux stents,funnel anti-reflux stents and duckbill antireflux stents.A number of clinical studies demonstrated that most anti-reflux stents can not only reduce the occurrence of cholangitis,but also prolong the average patency time of the stent,with favorable clinical results.However,due to differences in the material and design of different types of stents,problems such as stent clogging and stent displacement still require to be further resolved.Here,the authors address the research progress and clinical application of anti-reflux biliary stents with different materials and structures by review of the relevant literature.

关 键 词：胆汁淤积 肠胆反流 抗反流支架 综述 

分 类 号：R657.4[医药卫生—外科学]