全覆膜自膨式金属支架在胆、胰疾病中的应用

目的探讨全覆膜自膨式金属支架(FCSEMS)在胆、胰疾病中的应用价值及其安全性和有效性。方法回顾性分析2008年1月至2012年6月接受内镜逆行胆胰管造影(ERCP)置入FCSEMS治疗的56例胆、胰管疾病患者临床资料,根据病情选择不同长度及类型的FCSEMS置入。内镜下择期拔除支架,随访患者终点疗效、支架移除率及相关并发症情况。结果使用FCSEMS治疗良性狭窄49例,包括肝移植术后吻合口狭窄32例、医源性胆管狭窄12例、慢性胰腺炎相关胰胆管狭窄5例;随访5～38个月平均(15±8.6)个月],支架放置时间1～15个月平均(8.4±5.3)个月],治疗有效率为89.8%(44/49)。FCSEMS治疗胆道并发症7例,包括内镜下乳头括约肌切开术(EST)术后难治性出血4例,EST术后穿孔1例,肝移植术后胆漏2例;随访1～12个月平均(5±3.7)个月],支架放置时间1～8个月平均(1.8±0.5)个月],治疗有效率为100%(7/7)。FCSEMS回收过程均顺利。与支架相关的不良事件包括:早期并发症5例(8.9%),包括ERCP术后胰腺炎2例、早期胆管炎2例、胆囊炎1例;远期并发症7例(12.5%),包括支架滑脱2例、支架移位3例、支架相关性胆管炎2例。结论 FCSEMS除了治疗传统意义上的胆、胰良性狭窄外,在处理胆道并发症方面也是潜在可替代手术的方法,且安全、有效。

Application of fully-covered self-expandable metallic stent for treatment of pancreatic-biliary diseases

Objective To investigate the value, safety and efficacy of fully-covered self-expandable metallic stent (FCSEMS) in endoscopic retrograde cholangiopancreatography (ERCP) procedures for pancreatic-biliary diseases. Methods The clinical data of 56 patients with pancreatic-biliary diseases, who underwent FCSEMS treatment via ERCP from January 2008 to June 2012, were retrospectively analyzed. The stents of different lengths and types were chosen according to the condition of patients. The stents were removed under endoscope. The therapeutic effects at end point, stent removing rate and associated complications were observed. Results FCSEMS was placed in 49 patients with benign stricture, including post-liver transplant stricture (32), iatrogenic biliary stricture (12) and chronic pancreatitis-associated stricture (5). The mean follow time was (15±8.6) months (range 5-38 months), the mean stent duration was (8.4±5.3) months (1-15 months), and the effective rate was 89.8% (44/49). FCSEMS was placed in 7 patients with biliary complications, including bleeding after endoscopic sphincterotomy (EST) (4), perforation after EST (1), and bile leakage following liver transplantation (2). The mean follow time was (5±3.7) months (range 1-12 months), the mean stent duration was (1.8±0.5) months (1-8 months), and the effective rate was 100%. All FCSEMS were successfully retrieved. The short-term complication rate associated with stent was 8.9% (5/56), including post-ERCP pancreatitis (2), early cholangitis (2) and cholecystitis (1). The long-term complication rate was 12.5% (7/56), including stent slip (2), stent translocation (3) and stent-associated cholangitis (2). Conclusion FCSEMS can not only be used to treat traditional benign pancreatic-biliary strictures, but alto serve as a potential substitute for safe and effective treatment of serious biliary complications.