胆管支架近端移位的危险因素。
Risk factors for proximal migration of biliary tube stents.
作者信息
Kawaguchi Yoshiaki, Ogawa Masami, Kawashima Yohei, Mizukami Hajime, Maruno Atsuko, Ito Hiroyuki, Mine Tetsuya
机构信息
Yoshiaki Kawaguchi, Masami Ogawa, Yohei Kawashima, Hajime Mizukami, Atsuko Maruno, Hiroyuki Ito, Tetsuya Mine, Department of Gastroenterology, Tokai University School of Medicine, Isehara 259-1193, Japan.
出版信息
World J Gastroenterol. 2014 Feb 7;20(5):1318-24. doi: 10.3748/wjg.v20.i5.1318.
AIM
To analyze the risk factors for biliary stent migration in patients with benign and malignant strictures.
METHODS
Endoscopic stent placement was performed in 396 patients with bile duct stenosis, at our institution, between June 2003 and March 2009. The indications for bile duct stent implantation included common bile duct stone in 190 patients, malignant lesions in 112, chronic pancreatitis in 62, autoimmune pancreatitis in 14, trauma in eight, surgical complications in six, and primary sclerosing cholangitis (PSC) in four. We retrospectively examined the frequency of stent migration, and analyzed the patient factors (disease, whether endoscopic sphincterotomy was performed, location of bile duct stenosis and diameter of the bile duct) and stent characteristics (duration of stent placement, stent type, diameter and length). Moreover, we investigated retrieval methods for migrated stents and their associated success rates.
RESULTS
The frequency of tube stent migration in the total patient population was 3.5%. The cases in which tube stent migration occurred included those with common bile duct stones (3/190; 1.6%), malignant lesions (2/112; 1.8%), chronic pancreatitis (4/62; 6.5%), autoimmune pancreatitis (2/14; 14.3%), trauma (1/8; 12.5%), surgical complications (2/6; 33.3%), and PSC (0/4; 0%). The potential risk factors for migration included bile duct stenosis secondary to benign disease such as chronic pancreatitis and autoimmune pancreatitis (P = 0.030); stenosis of the lower bile duct (P = 0.031); bile duct diameter > 10 mm (P = 0.023); duration of stent placement > 1 mo (P = 0.007); use of straight-type stents (P < 0.001); and 10-Fr sized stents (P < 0.001). Retrieval of the migrated stents was successful in all cases. The grasping technique, using a basket or snare, was effective for pig-tailed or thin and straight stents, whereas the guidewire cannulation technique was effective for thick and straight stents.
CONCLUSION
Migration of tube stents within the bile duct is rare but possible, and it is important to determine the risk factors involved in stent migration.
目的
分析良性和恶性狭窄患者胆管支架移位的危险因素。
方法
2003年6月至2009年3月期间，在我院对396例胆管狭窄患者进行了内镜支架置入术。胆管支架植入的适应证包括胆总管结石190例、恶性病变112例、慢性胰腺炎62例、自身免疫性胰腺炎14例、创伤8例、手术并发症6例、原发性硬化性胆管炎（PSC）4例。我们回顾性检查了支架移位的频率，并分析了患者因素（疾病、是否进行内镜括约肌切开术、胆管狭窄部位和胆管直径）和支架特征（支架置入时间、支架类型、直径和长度）。此外，我们研究了移位支架的取出方法及其成功率。
结果
全部患者中胆管支架移位的频率为3.5%。发生胆管支架移位的病例包括胆总管结石（3/190；1.6%）、恶性病变（2/112；1.8%）、慢性胰腺炎（4/62；6.5%）、自身免疫性胰腺炎（2/14；14.3%）、创伤（1/8；12.5%）、手术并发症（2/6；33.3%）和PSC（0/4；0%）。移位的潜在危险因素包括慢性胰腺炎和自身免疫性胰腺炎等良性疾病继发的胆管狭窄（P = 0.030）；胆管下段狭窄（P = 0.031）；胆管直径>10 mm（P = 0.023）；支架置入时间>1个月（P = 0.007）；使用直型支架（P < 0.001）；以及10 Fr尺寸的支架（P < 0.001）。所有病例中移位支架的取出均获成功。使用网篮或圈套器的抓取技术对猪尾状或细直型支架有效，而导丝插管技术对粗直型支架有效。
结论
胆管内胆管支架移位虽罕见但有可能发生，确定支架移位的相关危险因素很重要。
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