Pozsár József, Sahin Péter, László Ferenc, Forró Györgyi, Topa Lajos
2nd Department Medicine, Szent Imre Hospital, Budapest, Hungary.
J Clin Gastroenterol. 2004 Feb;38(2):118-23. doi: 10.1097/00004836-200402000-00007.
The goal of this study was to evaluate our medium-term results on common bile duct stenting with increasing numbers of stents on strictures due to chronic calcifying pancreatitis.
Common bile duct strictures frequently complicate the course of chronic calcifying pancreatitis. The effectiveness of endoscopic stenting to resolve definitely these strictures is still debated.
Twenty-nine patients with common bile duct stricture due to chronic calcifying pancreatitis were stented and followed up. Biliary sphincterotomy, dilation of the stricture, and insertion of plastic biliary stents (7.5-10 F) were performed. Patients were scheduled for elective stent changing/restenting at 3-month intervals or any time when it was urgently indicated. Our basic intention was to insert the maximum possible number of stents to reach as large diameter as the stricture allowed. All stents were removed after the disappearance of common bile duct dilatation or left in place in cases of persisting strictures.
Eighteen patients (60%) had complete radiologic and serologic recovery after a mean of 21.1 months overall stenting time and had a stent free follow-up period for a mean of 12.1 months without recurrence of stricture. Five patients (16%) still have stents in place after 26 months. Three patients (13%) required surgery. There were 3 deaths (10%): 1 for unrelated cause and 2 with septic shock of biliary origin.
Most chronic calcifying pancreatitis patients with common bile duct strictures respond to the increasing numbers of endoscopic stents, and remain stent free for medium term periods. Less patients (30%) does not benefit of biliary stenting, who are candidates for surgery.
本研究的目的是评估我们在慢性钙化性胰腺炎所致狭窄处增加支架数量进行胆总管支架置入术的中期结果。
胆总管狭窄常使慢性钙化性胰腺炎的病程复杂化。内镜支架置入术明确解决这些狭窄的有效性仍存在争议。
对29例因慢性钙化性胰腺炎导致胆总管狭窄的患者进行支架置入并随访。进行了胆管括约肌切开术、狭窄扩张术及塑料胆管支架（7.5-10F）置入术。患者计划每3个月或在紧急指征出现时择期更换支架/再次置入支架。我们的基本意图是尽可能多地置入支架，以使狭窄处达到允许的最大直径。在胆总管扩张消失后取出所有支架，或在狭窄持续存在的情况下将支架留在原位。
18例患者（60%）在平均总支架置入时间21.1个月后实现了影像学和血清学完全恢复，且在平均12.1个月的无支架随访期内狭窄未复发。5例患者（16%）在26个月后仍有支架在位。3例患者（13%）需要手术治疗。有3例死亡（10%）：1例因无关原因死亡，2例因胆源性感染性休克死亡。
大多数患有胆总管狭窄的慢性钙化性胰腺炎患者对增加内镜支架数量有反应，并在中期保持无支架状态。较少患者（30%）不能从胆管支架置入术中获益，这些患者是手术的候选对象。
