Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences.
Acta Med Okayama. 2023 Jun;77(3):291-299. doi: 10.18926/AMO/65494.
We investigated the efficacy and safety of endoscopic plastic stent (PS) placement for hilar benign biliary strictures (BBSs) and compared cases with PS placement above (inside stent, IS) and across (usual stent, US) the sphincter of Oddi. Patients who underwent initial endoscopic PS placement for hilar BBSs between August 2012 and December 2021 were retrospectively analyzed. Hilar BBSs in 88 patients were investigated. Clinical success was achieved in 81 of these cases (92.0%), including 38 patients in the IS group and 43 patients in the US group. Unexpected stent exchange (uSE) before the first scheduled PS exchange occurred in 18 cases (22.2%). The median time from first stent placement to uSE was 35 days. There was no significant difference in the rate and median time to uSE between the two groups. The rates of adverse events such as pancreatitis or cholangitis in the two groups did not significantly differ. However, the rate of difficult stent removal in the IS group (15.8%) was significantly higher than that in the US group (0%) (p=0.0019). US placement is preferable to IS placement for scheduled stent exchange, as it offers the same effectiveness and risk of adverse events with easier stent removal.
我们研究了内镜塑料支架（PS）置入治疗肝门良性胆管狭窄（BBS）的疗效和安全性，并比较了 PS 置于 Oddi 括约肌上方（内置支架，IS）和下方（常规支架，US）的情况。回顾性分析了 2012 年 8 月至 2021 年 12 月期间因肝门 BBS 初次接受内镜 PS 置入的患者。对 88 例肝门 BBS 患者进行了研究。这些患者中 81 例（92.0%）达到了临床成功，IS 组 38 例，US 组 43 例。18 例（22.2%）在首次计划 PS 更换前出现了意外支架更换（uSE）。从首次支架置入到 uSE 的中位时间为 35 天。两组间 uSE 的发生率和中位时间无显著差异。两组胰腺炎或胆管炎等不良事件的发生率无显著差异。然而，IS 组（15.8%）的支架取出困难率明显高于 US 组（0%）（p=0.0019）。对于计划的支架更换，US 放置优于 IS 放置，因为它具有相同的疗效和不良事件风险，且支架取出更容易。
