Chan A C, Ng E K, Chung S C, Lai C W, Lau J Y, Sung J J, Leung J W, Li A K
Department of Surgery, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, New Territories.
Endoscopy. 1998 May;30(4):356-9. doi: 10.1055/s-2007-1001282.
Endoscopic biliary stenting is often used for large or difficult common bile duct (CBD) stones that cannot be extracted at one session. We compared the sizes of the CBD stones after a period of stenting.
Over a 6-year period, a total of 444 patients with large CBD stones (> 2 cm diameter) or difficult CBD stones were managed in our endoscopy unit, of which 46 were treated by endoscopic stenting. Twenty-eight had second ERCP for stone removal after a median period of 63 days (range 17-1002 days). The largest diameter of the stones and the CBD (after correction of magnification) before and after stenting were compared using the Wilcoxon signed test.
Before stenting the largest diameters of CBD stones were 11-46 mm (mean 24.9 mm) and decreased to 5-46 mm (mean 20.1 mm) after stenting. The difference in stone sizes was statistically significant although the CBD diameter pre- and post-stenting was not significantly different. The reduction in stone sizes was not significantly correlated with the duration of stenting.
CBD stones became smaller after stenting. As the difficulty of stone extraction increases with stone size, a period of stenting may make subsequent removal easier for patients with large or difficult CBD stones.
内镜下胆管支架置入术常用于一次无法取出的较大或难以取出的胆总管结石。我们比较了一段时间支架置入术后胆总管结石的大小。
在6年期间，我们内镜科共治疗了444例胆总管大结石（直径>2 cm）或难取性胆总管结石患者，其中46例接受了内镜支架置入术。28例患者在中位时间63天（范围17 - 1002天）后接受了第二次内镜逆行胰胆管造影术（ERCP）取石。使用Wilcoxon符号秩检验比较支架置入前后结石及胆总管的最大直径（校正放大倍数后）。
支架置入术前胆总管结石最大直径为11 - 46 mm（平均24.9 mm），支架置入术后降至5 - 46 mm（平均20.1 mm）。尽管支架置入前后胆总管直径无显著差异，但结石大小差异具有统计学意义。结石大小的减小与支架置入持续时间无显著相关性。
支架置入术后胆总管结石变小。由于结石取出难度随结石大小增加，对于胆总管大结石或难取性结石患者，一段时间的支架置入术可能使后续取出更容易。
