全覆膜金属支架在胆总管囊肿切除术后胆总管残端结石治疗中的应用  

Application of fully covered metal stent in the treatment of stones in residual end of common bile duct after choledochal cyst resection

作　　者：黄安华 张诚 张博森 杨玉龙 何川琦 徐美东 HUANG Anhua;ZHANG Cheng;ZHANG Bosen;YANG Yulong;HE Chuanqi;XU Meidong(Center of Gallstone Disease,Shanghai East Hospital Affiliated to Tongji University,Shanghai 200120,China;Endoscopic Center,Shanghai East Hospital Affiliated to Tongji University,Shanghai 200120,China)

机构地区：[1]同济大学附属东方医院胆石病中心/同济大学医学院胆石病研究所,上海200120 [2]同济大学附属东方医院内镜中心,上海200120

出　　处：《肝胆胰外科杂志》2024年第8期472-475,共4页Journal of Hepatopancreatobiliary Surgery

基　　金：浦东新区临床特色学科基金项目(PWZzk2022-17)。

摘　　要：目的 评估全覆膜金属支架(FCMS)在胆总管囊肿切除术后胆总管残端结石治疗中的应用价值。方法 回顾性分析2019年1月至2022年12月同济大学附属东方医院采取内镜逆行胰胆管造影(ERCP)置入FCMS治疗的22例胆总管囊肿切除术后胆总管残端结石患者的临床资料,观察FCMS首次置入成功率、FCMS二次置入成功率、FCMS留置时间、并发症发生率、胆总管狭窄解除率、FCMS取出成功率,胆总管残端结石消失率、溶解率及清除率,以及结石复发率。结果 FCMS首次置入成功率为72.7%(16/22)、二次置入成功率为100.0%(6/6),FCMS留置92~205 d,中位时间176 d,术后未发生急性胰腺炎、出血、支架移位等并发症,狭窄解除率为90.9%(20/22),FCMS取出成功率为100%(22/22),胰管结石消失率为68.2%(15/22),胰管结石溶解率为85.7%(6/7),胰管结石清除率为100%(7/7)。随访16~50个月,胆总管残端结石复发率为4.5%(1/22),再次行ERCP成功取出结石。结论 FCMS治胆总管囊肿切除术后胆总管残端结石安全、有效,在解除胆总管狭窄的同时可引起结石的溶解、消失,进而提高结石清除率。objective To evaluate the application value of fully covered metal stent(FCMS)in the treatment of stones in residual end of common bile duct stones after choledochal cyst resection.Methods A retrospective analysis was conducted on the clinical data of 22 patients underwent endoscopic retrograde cholangiopancreatography(ERCP)and placement of FCMS for stones in residual end of common bile duct after choledochal cyst resection in Shanghai East Hospital between Jan.2019 to Dec.2022.The success rate of FCMS initial insertion,success rate of FCMS secondary insertion,retention time of FCMS,incidence of complications,stenosis relief rate of common bile duct,success rate of FCMS removal;disappearance rate,dissolution rate,and clearance rate of residual bile duct stones,as well as stone recurrence rate were observed.Results The success rate of FCMS initial insertion was 72.7%(16/22),and the success rate of FCMS secondary insertion was 100.0%(6/6).FCMS was left for 92-205 d,the median time was 176 d,and there was no complication(acute pancreatitis,bleeding,or stent displacement).The stenosis relief rate was 90.9%(20/22),the success rate of FCMS removal was 100%(22/22),the disappearance rate of pancreatic duct stones was 68.2%(15/22),the dissolution rate of pancreatic duct stones was 85.7%(6/7),and the clearance rate of pancreatic duct stones was 100%(7/7).With 16-50 months of follow-up,the recurrence rate of residual stones was 4.5%(1/22),and successful removal of ERCP was achieved again.Conclusion FCMS for the treatment of stones in residual end of common bile duct after choledochal cyst resection is safe and effective.It can promote the dissolution and disappearance of residual stones while relieving common bile duct stenosis,thereby can improve the stone clearance rate.

关 键 词：内镜逆行胰胆管造影 全覆膜金属支架 胆总管囊肿切除术 胆总管残端结石 胆总管狭窄 

分 类 号：R657.4[医药卫生—外科学]