Raju G S, Gomez G, Xiao S-Y, Ahmed I, Brining D, Bhutani M S, Kalloo A N, Pasricha P J
Center for Endoscopic Research, Training, and Innovation (CERTAIN), Department of Medicine, Surgery and Pathology, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX 77555, USA.
Endoscopy. 2006 Mar;38(3):260-5. doi: 10.1055/s-2006-925052.
Attempts to address the problem of injury to the pancreas by indwelling pancreatic stents are limited by our lack of knowledge of the pathogenesis of stent-induced injury and its relationship to stent morphology and the duration of stenting. The aim of our study was to evaluate pancreatic injury induced by 1 week of stenting with a 5F indwelling pancreatic stent of novel design, the "wing stent."
Pancreatic stents (5F) were placed surgically in eight dogs; wing stents (WS-5F) were used in four dogs and conventional stents (CS-5F) in another four. Two dogs underwent duodenotomy without stent placement (controls). The pancreas was harvested for microscopy at 1 week. A pathologist who was unaware of the source of the specimens graded the pancreatic injury.
Although pancreatic injury was observed in both the CS-5F and WS-5F groups after 1 week of indwelling pancreatic stenting, it was considerably less severe in the WS-5F group compared with the CS-5F group (1.01 +/- 0.10 vs. 1.63 +/- 0.14, P < 0.01). All components of pancreatic injury were affected, with the most dramatic differences noted in inflammation, fibrosis, and edema. The differences were most marked in the stented segment ( P < 0.001) and in the upstream segment of the pancreas ( P < 0.05).
Indwelling conventional pancreatic stents can cause significant pancreatic injury even when left in place for only 1 week. A wing design can significantly ameliorate stent-induced changes.
由于我们对胰腺支架置入所致损伤的发病机制及其与支架形态和支架置入时间的关系缺乏了解，解决留置胰腺支架导致胰腺损伤问题的尝试受到限制。我们研究的目的是评估新型设计的5F留置胰腺“翼状支架”置入1周所引起的胰腺损伤。
通过手术将胰腺支架（5F）置入8只犬体内；4只犬使用翼状支架（WS-5F），另外4只犬使用传统支架（CS-5F）。2只犬接受十二指肠切开术但未置入支架（作为对照）。1周后取出胰腺进行显微镜检查。由一位不知道标本来源的病理学家对胰腺损伤进行分级。
在留置胰腺支架1周后，CS-5F组和WS-5F组均观察到胰腺损伤，但与CS-5F组相比，WS-5F组的损伤程度要轻得多（1.01±0.10对1.63±0.14，P<0.01）。胰腺损伤的所有成分均受到影响，在炎症、纤维化和水肿方面差异最为显著。这些差异在支架置入段最为明显（P<0.001），在胰腺上游段也较为明显（P<0.05）。
即使仅留置1周，传统的胰腺支架也可导致显著的胰腺损伤。翼状设计可显著减轻支架引起的变化。
