胆管狭窄患者塑料支架移位致十二指肠损伤的危险因素研究  

Risk factors for duodenal injury caused by plastic stent malposition in patients with bile duct stenosis

作　　者：程思乐 沈红璋 谢璐 顾伟刚 张筱凤 Cheng Sile;Shen Hongzhang;Xie Lu;Gu Weigang;Zhang Xiaofeng(Department of Gastroenterology,Affiliated Hangzhou First People's Hospital,Zhejiang University School of Medicine Hangzhou Digestive Disease Research Institute Key Laboratory of Pancreatobiliary Disease of Zhejiang Integrated Chinese and Western Medicine,Hangzhou 310006,China)

机构地区：[1]浙江大学医学院附属杭州市第一人民医院消化内科,杭州市消化病研究所,浙江省中西医结合胆胰疾病重点实验室,杭州310006

出　　处：《中华消化内镜杂志》2023年第9期724-728,共5页Chinese Journal of Digestive Endoscopy

基　　金：浙江省卫生健康科技计划(2022KY934)。

摘　　要：目的研究胆管狭窄患者置入胆管塑料支架后发生移位致十二指肠损伤的危险因素。方法回顾性分析2017年1月—2021年12月在杭州市第一人民医院行胆管塑料支架置入术的1408例胆管狭窄患者(2607例次操作)的病例资料。统计术后出现胆管支架移位致十二指肠损伤的情况,将2607例次操作分为移位损伤组(n=23例次)和非移位损伤组(n=2584例次)两组,比较移位损伤组和非移位损伤组在基线资料和手术情况方面的差异,利用logistic回归分析探究胆管狭窄患者置入胆管塑料支架后支架移位致十二指肠损伤的独立危险因素。结果1408例胆管狭窄患者先后置入塑料支架2607例次,共发生23例次支架移位导致的十二指肠损伤。logistic回归分析提示,胃肠手术史(OR=4.278,95%CI:1.332~13.737,P=0.015)、经内镜乳头括约肌切开术(endoscopic sphincterotomy,EST)手术史(OR=8.128,95%CI:2.382~27.738,P=0.001)、高位胆管狭窄(OR=4.457,95%CI:1.722~11.539,P=0.002)、使用长度≥7 cm的塑料支架(OR=4.701,95%CI:1.708~12.938,P=0.003)和圣诞树型支架(OR=6.890,95%CI:1.540~30.830,P=0.012)是胆管塑料支架移位致十二指肠损伤的独立危险因素。结论高位胆管狭窄、使用长度≥7 cm的塑料支架和圣诞树型支架、有胃肠手术史及EST手术史会增加胆管狭窄患者置入塑料支架后支架移位致十二指肠损伤的危险。Objective To study the risk factors for duodenal injury caused by malposition of plastic bile duct stent for the treatment of biliary stricture.Methods Data of 1408 patients with biliary stricture(2607 procedures of plastic stent placement)who received plastic stent placement in Hangzhou First People's Hospital from January 2017 to December 2021 were retrospectively analyzed and duodenal injury caused by bile duct stent malposition after placement was recorded.The patients were divided into two groups:the malposition injury group(n=23 procedures)and the non-malposition injury group(n=2584 procedures).The differences in the baseline data and procedure-related condition between the malposition injury group and the non-malposition injury group were compared,and the independent risk factors for duodenal injury caused by bile duct plastic stent malposition were studied by using logistic regression analysis.Results A total of 2607 procedures of plastic stent placement were performed in 1408 patients with biliary stricture,and 23 cases of duodenal injury were caused by stent malposition.Logistic regression analysis revealed that a history of gastrointestinal surgery(OR=4.278,95%CI:1.332-13.737,P=0.015),a history of endoscopic sphincterotomy(EST)(OR=8.128,95%CI:2.382-27.738,P=0.001),and high-level bile duct stenosis(OR=4.457,95%CI:1.722-11.539,P=0.002),plastic stents with a length≥7 cm(OR=4.701,95%CI:1.708-12.938,P=0.003)and Christmas tree-shaped stent(OR=6.890,95%CI:1.540-30.830,P=0.012)were independent risk factors for duodenal injury caused by bile duct plastic stent malposition.Conclusion High-level bile duct stenosis,the use of plastic stents with a length≥7 cm and Christmas tree-shaped stent,a history of gastrointestinal surgery,and a history of EST could increase the risk of duodenal injury caused by bile duct plastic stent malposition in patients with bile duct stenosis.

关 键 词：支架 胆管 十二指肠 危险因素 移位 损伤 

分 类 号：R657.4[医药卫生—外科学]