胆管支架的临床应用及其生物相容性

目的：介绍胆管支架的国内外治疗研究进展，分析支架置入并发症的原因，并探讨各类胆管支架与宿主间的生物相容性。 方法：应用计算机检索Medline database(1989/2009)和中国期刊全文数据库(CNKI: 1989/2009)，由第一作者按纳入和排除标准，对文献进行筛选，资料收集和质量评价。从胆管支架置入的治疗进展，支架置入的治疗的并发症和胆管支架的生物相容性3方面进行描述和整理，探讨各种胆管支架的治疗现状、并发症和生物相容性。 结果：总结归纳文献内容，胆管支架临床应用较多为塑料支架、金属支架，此外还有硅胶管支架及可降解聚乳酸支架。支架置入并发症主要包括渗出、出血、穿孔和狭窄。在各种胆管支架中，塑料支架生物相容性差、易堵塞，但价格便宜、易取出，金属支架扩张后直径可达7~10 mm，通畅时间长，但价格远贵于塑料支架。硅胶管支架生物相容性较好，硅胶管具有耐腐力强，质地柔韧等特点，可以使肿瘤切除范围更广，并提高疗效，且未出现胆道感染和胆道狭窄等并发症。镍钛合金胆管网状支架生物相容性明显优于其他支架产品，未见并发症。除价格因素外应广范应用，可降解聚乳酸支架生物相容性最好，但对于胆泥的形成，支架的移位和堵塞，以及支架降解产物等问题尚需要进一步的观察和研究。 结论：胆管支架置入治疗可作为胆管狭窄的重要治疗方法之一，在治疗过程中，要根据临床症状不同，进行充足的置入前准备，选择合适的支架类型，严格遵循适应证，避免出现并发症。胆管支架中的硅胶支架、镍钛合金支架的生物相容性较好，其他支架生物相容性有待提高。

Clinical application and biocompatibility of the biliary tract stents

OBJECTIVE: To introduce the research progress of biliary tract prosthesis, to analyze the reason of complication following stent implantation, and to explore the biocompatibility of various biliary tracts and host. METHODS: We retrieved Medline database (1989/2009) and CNKI (1989/2009) using the computer. According to inclusion and exclusion criteria, the literatures were screened by the first author, and the data were collected, and the quality was evaluated. We described and arranged the treatment progress of biliary tract prosthesis implantation, complication of stent implantation and biocompatibility of biliary tract prosthesis to investigate treatment state, complication and biocompatibility of the biliary tract prosthesis. RESULTS: The literatures were summarized. The bilitary tract prosthesis contains plastic stent, mental stent, silica gel tract stent and degradable polylactic acid stent. The complications of stent implantation included transudation, hemorrhage, perforation and stenosis. Among various stents, the biocompatibility of plastic stent was poor, easy to be blocked, but the price was low, and easy to be taken out. The diameter of mental stent following distension could reach 7-10 mm, with long unobstructed time, but the price was higher compared with the plastic stent. The biocompatibility of silica gel tract stent was good. The silica gel tract had strong decay resistance and pliable texture, which could extend tumor excision range and elevate curative effects. Moreover, complications did not occur such as infection and stenosis of the biliary tract. Biocompatibility of nickel-titanium alloy biliary ducts was significantly better than the stent products, without complications. With the exception of price factor, the biocompatibility of degradable polylactic acid stent was the best, but further studies were needed to observe and study the formation of biliary sludge, stent displacement and blockage, stent degradation products. CONCLUSION: Biliary tract prosthesis implantation can be an important treatment method for stenosis of biliary tract. During treatment, enough preparation is needed prior to implantation according to various clinical symptoms to select suitable stent type. Indications are followed strictly to avoid the occurrence of complications. The biocompatibility of silica gel stent and Ni-Ti alloy stent is good, but the biocompatibility of other stents should be enhanced.