一体式可回收胆管内塑料支架在恶性胆道疾病中的应用效果

Analysis of the efficacy of one-piece retrievable bile duct plastic stent in treatment of malignant biliary disease

摘要:

目的 探讨一体式可回收胆管内塑料支架在恶性胆道梗阻疾病治疗中的应用时效性和安全性。方法 回顾性收集2019年1月－2022年5月于该院行内镜逆行胰胆管造影术（ERCP）治疗的恶性胆道梗阻患者81例。其中，25例置入一体式可回收胆管内塑料支架（一体支架组），23例置入普通塑料支架（普通支架组），33例置入金属覆膜支架（金属支架组）。比较3组患者的肝功能变化、支架通畅时间、反流发生率、术后胰腺炎发生率、单次住院时间和住院费用。结果 3组患者置入支架前肝功能比较，差异无统计学意义（P > 0.05）；一体支架组和金属支架组较普通支架组总胆红素（TBIL）、直接胆红素（DBIL）指标下降趋势更为明显，且一体支架组DBIL指标下降程度较金属支架组明显（P < 0.05）。金属支架组支架通畅时间最长，为（184.70±16.40）d，一体支架组次之，为（118.64±16.00）d，普通支架组通畅时间最短，为（96.43±15.85）d，3组患者比较，差异有统计学意义（P < 0.05）。一体支架组反流发生率最低，金属支架组其次，普通支架组反流发生率最高，3组患者比较，差异有统计学意义（P < 0.05）。3组患者胰腺炎发生率和单次住院时间比较，差异均无统计学意义（P > 0.05）。金属支架组住院费用较一体支架组和普通支架组高，3组患者比较，差异有统计学意义（P < 0.05）。结论 相比金属覆膜支架和普通塑料支架，一体式可回收胆管内塑料支架置入术后，肝功能恢复较好，支架通畅时间相对较长，反流发生率较低，住院费用少，且安全有效，是恶性胆道梗阻患者的最优选择。

Abstract:

Objective To investigate the timeliness and safety of the one-piece retrievable bile duct plastic stent in the treatment of malignant biliary obstruction.Methods 81 patients with malignant biliary obstruction who underwent ERCP from January 2019 to May 2022 were retrospectively selected. Among them, 25 patients were implanted with one-piece retrievable bile duct plastic stent (one-piece stent group), 23 patients were implanted with ordinary plastic stents (ordinary stent group), and 33 patients were implanted with metal-covered stent (metal stent group). The changes of liver function, stent patency time, incidence of reflux, incidence of postoperative pancreatitis, single hospitalization days and hospitalization costs were compared among the three groups.Results There was no significant difference in liver function among the three groups before stent implantation (P > 0.05). Compared with the ordinary stent group, the TBIL and DBIL indexes of the one-piece stent group and metal stent group had a more obvious decreasing trend, and the DBIL indexes of the one-piece stent group had a more obvious decreasing degree than that of the metal stent group (P < 0.05). The stent patency time in the metal stent group was the longest (184.70 ± 16.40) d, followed by the one-piece stent group (118.64 ± 16.00) d, and the ordinary stent group was the shortest (96.43 ± 15.85) d,the difference was statistically significant (P < 0.05). The incidence of reflux in the one-piece stent group was the lowest, followed by the metal stent group, and the incidence of reflux in the ordinary stent group was the highest, and the difference was statistically significant among the three groups (P < 0.05). There was no significant difference in the incidence of pancreatitis and the length of single hospital stay among the three groups (P > 0.05). The hospitalization cost of the metal stent group was higher than that of the one-piece stent group and the ordinary stent group, and the difference was statistically significant (P < 0.05).Conclusion Compared with the metal-covered stent and the ordinary plastic stent, the one-piece retrievable bile duct plastic stent has better liver function recovery after the stent implantation, the stent patency time is relatively long, the incidence of reflux is low, and the hospitalization cost is low. It is safe and effective, and is the best choice for patients with malignant biliary obstruction.