李攀　卢媛　张彦　张金卓

[摘 要] 目的：觀察全覆膜自膨式金属支架（Fully covered self-expandable metal stent，FCSEMS）治疗良性胆管狭窄（Benign biliary strictures，BBS）的临床效果，探讨其应用价值。方法：观察2013年3月至2017年2月43例接受内镜下FCSEMS置入的BBS患者治疗效果（症状、生化指标）及并发症发生情况，总结治疗体会。结果：43例患者FCSEMS均一次性置入成功，成功率为100.00%；术后随访期间3例患者支架未起效，支架有效率93.02%。有效患者随访期间均未见发热、黄疸、腹痛等症状复发，支架通畅性均良好；所有患者金属支架均成功回收；患者术前血清TBIL为（246.80±62.65）μmol/L，术后5～7 d降至（95.92±17.65）μmol/L，术前与术后血清TBIL比较，差异有统计学意义（P<0.05）。患者术后早期并发症以胰腺炎、高淀粉酶血症为主，均经对症治疗后好转，1例死亡患者死于急性肾功能不全加重继发多脏器功能衰竭。结论：FCSEMS治疗BBS安全、有效，是BBS治疗的可行选择。

[关键词] 全覆膜自膨式金属支架；良性胆管狭窄；内镜逆行胰胆管造影

中图分类号：R575.7 文献标识码：A 文章编号：2095-5200（2017）05-055-03

DOI：10.11876/mimt201705023

Clinical observation of fully covered self-expandable metal stent in the treatment of benign biliary strictures LI Pan， LU Yuan， ZHANG Yan， ZHANG Jinzhuo. （Department of Gastroenterology，Baoding First Central Hospital， Baoding 071000，china）

[Abstract] Objective： The objective of this study was to investigate the clinical effectiveness of fully covered self-expandable metal stent （FCSEMS） in the treatment of benign biliary strictures （BBS） and to explore its application values. Methods： A total sample of 43 cases of BBS patients who had accepted endoscopic FCSEMS from March 2013 to February 2017 were chosen as study objects. The treatment effectiveness （symptoms， biochemical indexes） and occurrence of complications were observed and the treatment experience was summarized. Results： FCSEMS was successfully implanted in all 43 patients at one time， with a success rate of 100%. During the follow-up period， 3 stents failed， and the stent efficiency was 93.02%. During the follow-up period of effective patients， no fever， jaundice， abdominal pain or other symptoms were recurred， and the patency of stent was good. All patients metal stents were successfully recovered. The preoperative serum TBIL was （246.80±62.65） μmol/L and the postoperative 5-7 d serum TBIL dropped to （95.92±17.65） μmol/L. The difference between preoperative and postoperative serum TBIL was statistically significant （P<0.05）. The early complications of these patients were mainly pancreatitis and amylase which were all improved after symptomatic treatments. 1 patient died from acute renal insufficiency aggravation and secondary multiple organ failure. Conclusions： FCSEMS is safe and effective in the treatment of BBS and is a viable option for BBS treatment.

[Key words] fully covered self-expandable metal stent； benign biliary strictures； endoscopic retrograde cholangiopancreatographyendprint

良性胆管狭窄（Benign biliary strictures，BBS）常继发于胆管炎症、慢性胰腺炎，随着腹腔镜微创手术的广泛开展，医源性损伤所致BBS发生率日益增多，而传统手术治疗BBS存在并发症发生风险大、复发率高的弊端，已逐渐被内镜治疗所取代[1]。内镜下球囊扩张或塑料单管支架放置是既往临床治疗BBS的首选方式，但需重复多次治疗，给患者带来了较大痛苦，且2年内支架取出后狭窄复发率超过30%[2]。全覆膜自膨式金属支架（Fully covered self-expandalbe metal stent，FCSEMS）良好的支撑性能够维持胆管的长期通畅[3]。我院将FCSEMS用于BBS患者，取得了较好的效果。

1 资料与方法

1.1 一般資料

43例BBS患者年龄≥18岁，于我院接受内镜逆行胰胆管造影（ERCP）[4]及FCSEMS置入治疗且临床资料保存完整，排除既往有胆管金属支架置入治疗史及经皮经肝胆管引流术治疗史者。43例患者中，男24例，女19例，年龄32～81岁，平均（48.55±11.26）岁，胆管狭窄长度1.3～5.7 cm，平均（2.81±0.55）cm；……