Kochlef Asma, Gargouri Dalila, Kilani Afef, Ouakaa Asma, Elloumi Hela, Kharrat Jamel, Belhadj Najet, Romani Malika, Ghorbel Abdeljabbar
Service d'Hépato-Gastroentérologie.
Tunis Med. 2011 Apr;89(4):342-6.
Endoscopic extraction of biliary tract stones is safe and effective. When the procedure is not successful, the use of a biliary stent can be a solution.
To prospectively analyse the usefulness of a stenting in management of biliary obstruction due to choledocolithiasis.
All patients referred to our endoscopic unit from January 2005 to January 2008, for management of bile duct stone are studied. We included patients subjected to an endoscopic insertion of a biliary stent.
Of 414 patients with choledocolithiasis, 51 failed to have their ducts cleared with the first endoscopic retrograde cholangiopancreatography (ERCP): 25 patients (6%) were referred to surgical stone removal. Twenty six consecutive patients had endoscopic insertion of a 10 Fr biliary stent: There were 12 men and 14 women ranging in age from 35 to 102 years (median age 68 years). The indications for stent placement in common bile duct stone were mainly the endoscopic portal hypertension, elderly patients or with a short life expectancy. Twenty four patients (88%) are symptom free after stenting. Six patients (23%) had duct clearance after a median of 3 sessions at a mean of 13 months (range 3-48 months). In 3 patients endoprosthesis was inserted as a permanent therapy of biliary obstruction. Cholangitis occurred in 5 patients, early in two cases and later at a mean of 18 months (range 6-24 months) in 3 patients and was managed endoscopically by stent replacement and fluid antibiotics.
These data favor temporary use of biliary endoprostheses in patients with endoscopically irretrievable bile duct stones until the definitive treatment is carried out. However, as a permanent therapy, late complications occur in many patients and the risk increases proportionally in time. Therefore, permanent biliary stenting should preferably be restricted to patients unfit for elective treatment at a later stage and with a short life expectancy.
内镜下取胆道结石安全有效。若该操作不成功，使用胆道支架可能是一种解决办法。
前瞻性分析支架置入术在胆总管结石所致胆道梗阻治疗中的作用。
对2005年1月至2008年1月转诊至我们内镜科接受胆管结石治疗的所有患者进行研究。我们纳入了接受内镜下胆道支架置入术的患者。
414例胆总管结石患者中，51例首次内镜逆行胰胆管造影（ERCP）未能清除胆管结石：25例患者（6%）接受了手术取石。连续26例患者接受了10 Fr胆道支架的内镜置入：其中男性12例，女性14例，年龄35至102岁（中位年龄68岁）。胆总管结石支架置入的指征主要是内镜下门静脉高压、老年患者或预期寿命较短的患者。24例患者（88%）支架置入后无症状。6例患者（23%）在平均13个月（3至48个月）的中位时间内经过3次治疗后胆管结石清除。3例患者将内置假体作为胆道梗阻的永久治疗方法。5例患者发生胆管炎，2例为早期，3例为后期，平均发生时间为18个月（6至24个月），通过更换支架和使用液体抗生素进行内镜治疗。
这些数据支持在内镜下无法取出胆管结石的患者中临时使用胆道内支架，直至进行确定性治疗。然而，作为一种永久治疗方法，许多患者会出现晚期并发症，且风险随时间成比例增加。因此，永久性胆道支架置入术最好仅限于不适合后期择期治疗且预期寿命较短的患者。
