Cairns S R, Dias L, Cotton P B, Salmon P R, Russell R C
Department of Gastroenterology, Middlesex Hospital, London.
Gut. 1989 Apr;30(4):535-40. doi: 10.1136/gut.30.4.535.
One hundred and twenty seven patients were treated by nasobiliary drainage, or stenting, to prevent biliary obstruction after endoscopic failure to clear stones from the common bile duct. At presentation, 91 (72%) patients were jaundiced and 39 (31%) had cholangitis. Placement of either a nasobiliary drain or stent was successful in 124 (98%) patients. One hundred and twenty one (95%) patients were followed up. Clearance was ultimately achieved endoscopically in 52 and surgically in 25 patients after (mean) 2.4 months. Thirty day mortality was 3%. There were no complications of nasobiliary drainage, but two of 39 patients treated by temporary stents developed cholangitis, both successfully managed by endoscopic duct clearance. Forty two patients unfit for surgery or further endoscopic attempts at duct clearance were followed with stents in situ for a mean 15.9 months (range 2.5-37.5). Cholangitis developed in four patients and was successfully managed by stent change. These results indicate that longterm stenting can be useful for poor risk surgical patients and that nasobiliary drainage or temporary stenting permits further elective rather than urgent endoscopic or surgical treatment.
127例患者接受了鼻胆管引流或支架置入术，以预防内镜下无法清除胆总管结石后出现的胆道梗阻。就诊时，91例（72%）患者出现黄疸，39例（31%）发生胆管炎。124例（98%）患者成功置入鼻胆管引流管或支架。121例（95%）患者接受了随访。最终，52例患者经内镜清除结石，25例患者经手术清除结石，（平均）2.4个月后完成。30天死亡率为3%。鼻胆管引流无并发症，但39例接受临时支架治疗的患者中有2例发生胆管炎，均经内镜清除胆管结石成功处理。42例不适合手术或进一步内镜清除胆管结石的患者留置支架平均15.9个月（范围2.5 - 37.5个月）。4例患者发生胆管炎，经更换支架成功处理。这些结果表明，长期支架置入术对手术风险高的患者可能有用，鼻胆管引流或临时支架置入术可使进一步的治疗选择为择期而非急诊内镜或手术治疗。
