全覆膜自膨式金属支架和多根塑料支架治疗良性胆管狭窄的对比研究  

Comparison of fully covered self-expanding metal stents and multiple plastic stents for benign biliary strictures

作　　者：毛易燊 贾慧 沈红璋 陆磊[1] 张筱凤[1] Mao Yishen;Jia Hui;Shen Hongzhang;Lu Lei;Zhang Xiaofeng(Department of Gastroenterology,Hangzhou First People's Hospital,Hangzhou 310000,China)

机构地区：[1]杭州市第一人民医院消化内科,杭州310000

出　　处：《中华消化内镜杂志》2022年第3期192-197,共6页Chinese Journal of Digestive Endoscopy

基　　金：浙江省自然科学基金(LY17H030003);杭州卫生科技计划(2016ZD01)。

摘　　要：目的比较全覆膜自膨式金属支架(fully covered self-expanding metal stents,FCSEMS)和多根塑料支架(multiple plastic stents,MPS)治疗良性胆管狭窄的有效性、安全性和成本效益。方法回顾性分析2013年1月—2019年6月在杭州市第一人民医院通过经内镜逆行胰胆管造影术(endoscopic retrograde cholangiopancreatography,ERCP)置入FCSEMS或MPS的107例良性胆管狭窄患者的临床资料,其中FCSEMS组54例,MPS组53例。患者由CT、磁共振胰胆管成像术(magnetic resonance cholangiopancreatography,MRCP)或内镜超声证实患有良性胆管狭窄。主要研究指标为狭窄缓解率,次要研究指标为狭窄复发率、ERCP相关并发症发生率、支架迁移率、住院时间和费用等。结果FCSEMS组和MPS组中位随访时间分别为10.0(6.5,18.0)个月和12.0(9.0,20.0)个月(P>0.05)。两组患者的狭窄缓解率分别为87.0%(47/54)和83.0%(44/53),狭窄复发率分别为14.6%(6/41)和23.5%(8/34),ERCP相关并发症发生率分别为14.8%(8/54)和11.9%(13/109),差异均无统计学意义(P均>0.05)。两组患者的支架迁移率分别为22.9%(11/54)和2.8%(3/109),差异有统计学意义(P<0.001)。成本效益分析表明,两组患者中位ERCP干预次数分别为2(2,2)次及3(2,4)次(P<0.001),中位住院时间分别为6.0(4.0,11.0)d和9.0(6.5,16.0)d(P=0.009)。两组患者中位住院费用分别为44646元和51355元,差异无统计学意义(P>0.05)。结论FCSEMS在良性胆管狭窄中的有效性、安全性和治疗费用与MPS相似,但减少了ERCP干预次数和治疗周期,即使有一定的迁移率,仍可成为一线治疗方案。Objective To compare the fully covered self-expanding metal stents(FCSEMS)and multiple plastic stents(MPS)in the effectiveness,safety and cost-effectiveness for benign bile duct strictures.Methods A single-center retrospective study was conducted to analyze the clinical data of 107 patients with benign biliary strictures who underwent FCSEMS or MPS implantation through endoscopic retrograde cholangiopancreatography(ERCP)in Hangzhou First People's Hospital from January 2013 to June 2019.There were 54 cases in group FCSEMS and 53 cases in group MPS.Benign biliary stricture was confirmed by computed tomography(CT),magnetic resonance cholangiopancreatography(MRCP)and endoscopic ultrasonography.The primary index was the rate of stricture remission,and the secondary indices were the incidence of stricture recurrence,ERCP-related complications,the rate of stent migration,hospital stay and charges.Results The median follow-up times were 10.0(6.5,18.0)months and 12.0(9.0,20.0)months in group FCSEMS and in group MPS respectively(P>0.05).The rates of stricture remission in the two groups were 87.0%(47/54)and 83.0%(44/53),the incidences of stricture recurrence were 14.6%(6/41)and 23.5%(8/34),and the incidences of ERCP-related complications were 14.8%(8/54)and 11.9%(13/109),respectively.And the differences were not statistically significant(all P>0.05).But the stent migration rates of the two groups were 22.9%(11/54)and 2.8%(3/109)with significant difference(P<0.001).Cost-effectiveness analysis showed that the median numbers of ERCP intervention in the two groups were 2(2,2)times and 3(2,4)times(P<0.001),and the median hospital stays were 6.0(4.0,11.0)days and 9.0(6.5,16.0)days respectively(P=0.009).The median hospitalization expenses of the two groups were 44646 yuan and 51355 yuan without significant difference(P>0.05).Conclusion The effectiveness,safety and cost of FCSEMS for benign bile duct stenosis are similar to those of MPS,but it reduces ERCP intervention and treatment cycles.Even with a certain migration rate,it can

关 键 词：支架 胆管疾病 胰胆管造影术 内窥镜逆行 全覆膜自膨式金属支架 塑料支架 

分 类 号：R657.4[医药卫生—外科学]