Pisello Franco, Geraci Girolamo, Li Volsi Francesco, Modica Giuseppe, Sciumè Carmelo
Section of General and Thoracic Surgery, University Hospital of Palermo, Palermo, Sicily, Italy.
Langenbecks Arch Surg. 2008 Nov;393(6):857-63. doi: 10.1007/s00423-008-0388-1. Epub 2008 Aug 5.
Endoscopic sphincterotomy (ES) and stone extraction is the treatment of choice for bile duct stones. Therefore, if ES and conventional stone extraction fail, further treatment is mandatory. Insertion of a biliary endoprosthesis is an effective option.
We treated 30 high-risk patients (17 women and 13 men, mean age 82 years) affected by difficult common bile duct stones. The patients were randomly assigned preoperatively using closed envelopes (blind randomization) into two groups to receive insertion of polyethylene or hydrophilic hydromer-coated polyurethane stent, respectively. Follow-up was achieved by contacting referring physicians and patient's relatives.
Biliary drainage was established in all patients. Early minor complications occurred in 28%. In all these patients, the stent was a definitive measure. Median follow-up was 38 months. Late complications occurred in 34%. Cholangitis was the most frequent. During follow up, 11 patients died, two as result of a biliary-related cause. No statistically significant difference was observed on different stents patency.
Endoprosthesis insertion as a permanent therapy is an effective alternative to surgery or dissolution therapy. Therefore, biliary stenting should preferably be restricted to high-risk patients unfit for operative treatment and with a short life expectancy.
内镜括约肌切开术（ES）及取石术是胆管结石的首选治疗方法。因此，如果ES及传统取石术失败，进一步治疗是必要的。插入胆道内支架是一种有效的选择。
我们治疗了30例患有复杂胆总管结石的高危患者（17例女性和13例男性，平均年龄82岁）。术前使用密封信封将患者随机分组（盲法随机化），分别接受插入聚乙烯或亲水性水凝胶涂层聚氨酯支架。通过联系转诊医生和患者亲属进行随访。
所有患者均建立了胆道引流。28%的患者发生早期轻微并发症。在所有这些患者中，支架是一种确定性措施。中位随访时间为38个月。34%的患者发生晚期并发症。胆管炎最为常见。随访期间，11例患者死亡，2例死于与胆道相关的原因。不同支架通畅情况未观察到统计学显著差异。
插入内支架作为一种永久性治疗方法是手术或溶石治疗的有效替代方案。因此，胆道支架置入术应最好仅限于不适合手术治疗且预期寿命较短的高危患者。
