全覆膜自膨式金属支架治疗难治性胰管良性狭窄的长期疗效观察(含视频)  

Long-term outcomes of fully covered self-expanding metal stent for benign refractory pancreatic stenosis(with video)

作　　者：曹俊[1] 沈永华[1] 郑汝桦 周晓亮[1] 秦争艳[1] 王雷[1] 邹晓平[1] Cao Jun;Shen Yonghua;Zheng Ruhua;Zhou Xiaoliang;Qin Zhengyan;Wang Lei;Zou Xiaoping(Department of Gastroenterology,Nanjing Drum Tower Hospital,The Affiliated Hospital of Nanjing University Medical School,Nanjing 210008,China)

机构地区：[1]南京大学医学院附属鼓楼医院消化内科,南京210008

出　　处：《中华消化内镜杂志》2022年第6期447-452,共6页Chinese Journal of Digestive Endoscopy

摘　　要：目的评价全覆膜自膨式金属支架治疗难治性胰管良性狭窄的安全性和长期疗效。方法收集南京鼓楼医院消化内镜中心2013年3月—2020年7月经全覆膜自膨式金属支架治疗的18例难治性胰管良性狭窄患者资料进行回顾性分析。主要观察指标包括技术成功率、临床成功率、全覆膜自膨式金属支架副作用及长期疗效。结果18例患者均成功置入全覆膜自膨式金属支架,技术成功率100.0%(18/18)。18例患者支架置入后的腹痛评分明显低于置入前[2.00(1.75,3.00)分比6.00(5.00,7.00)分,Z=-3.572,P<0.001]。支架置入后疼痛评分较置入前减少>50%的有15例,临床成功率83.3%(15/18)。支架置入后,出现不能忍受的腹痛3例,支架诱导的新狭窄2例,支架远端移位2例。所有患者成功拔除支架,支架置入时间137.5(59.0,417.0)d。拔除支架后狭窄上游扩张胰管直径[9.1(6.7,14.1)mm]比支架置入前[11.0(7.6,16.2)mm]明显减少(Z=10.508,P<0.001)。长期随访14例患者,随访时间37~1246 d,10例患者保持无临床症状,4例复发。结论全覆膜自膨式金属支架治疗难治性胰管良性狭窄安全有效且可维持长期疗效。Objective To investigate the safety and long-term outcomes of fully covered self-expanding metal stent(FCSEMS)placement in patients with benign refractory pancreatic stenosis.Methods Data of 18 patients with benign refractory pancreatic stenosis who underwent endoscopic treatment with FCSEMS in Nanjing Drum Tower Hospital between March 2013 and July 2020 were collected.The technical success,clinical success,adverse events and long-term outcomes were analyzed.Results FCSEMS placement was successful in all 18 patients,with technical success rate of 100.0%(18/18).After stenting,the visual analogue scale(VAS)significantly decreased[2.00(1.75,3.00)VS 6.00(5.00,7.00),Z=-3.572,P<0.001].The VAS decreased by more than 50%in 15 cases,and the clinical success rate was 83.3%(15/18).Stent-related adverse events included intolerable pain in 3 patients,stented-induced de novo stricture in 2 patients,and distal migration of stent in 2 patients.The stents were successfully removed in all patients after 137.5(59.0,417.0)days.There was significant reduction in terms of decreased upstream ductal dilatation after stent removal[9.1(6.7,14.1)mm VS 11.0(7.6,16.2)mm,Z=10.508,P<0.001].After stent removal,10 of the 14 patients maintained the response to pancreatic stenting and 4 recurred during the follow-up of 37-1246 days.Conclusion FCSEMS placement appears to be safe and effective in the treatment of benign refractory pancreatic stenosis and can provide persistent improvement in the stricture.

关 键 词：胰腺炎 慢性 难治性胰管良性狭窄 全覆膜自膨式金属支架 长期疗效 

分 类 号：R657.5[医药卫生—外科学]