Objective To investigate the influencing factors for stent obstruction after endoscopic retrograde biliary drainage(ERBD) forrefractory common bile duct stones.Methods A total of 126 patients who underwent ERBD for refractory common bile duct stones inRenmin Hospital of Wuhan University from January 2014 to May 2019 and were readmitted for stent removal at 6 months after surgery wereenrolled, and according to the condition of stent removal, they were divided into obstruction group and unobstructed group. General data andrelated indices were compared between the two groups. The independent samplest-test was used for comparison of normally distributed con-tinuous data between groups, and the Mann-WhitneyUtest was used for comparison of non-normally distributed continuous data betweengroups; the chi-square test was used for comparison of categorical data between groups; a multivariate logistic regression analysis was usedto investigate the influencing factors for stent obstruction after surgery.Results Among the 126 patients, 28 were found to have stent ob-struction during removal, with a stent obstruction rate of 22. 2%. The univariate analysis showed that there were significant differences be-tween the two groups in white blood cell count(WBC), percentage of neutrophils(Neu%), alkaline phosphatase(ALP), gamma-glu-tamyl transpeptidase, leucine aminopeptidase, endoscopic sphincterotomy(EST), infection, aspirin, and stent type(allP< 0. 05). Themultivariate logistic regression analysis showed that WBC[OR(95% CI):1. 232(1. 033-1. 470)], Neu% [OR(95% CI):1. 263(1. 021-1. 562)], ALP[OR(95% CI):1. 013(1. 004-1. 022)], EST[ OR(95% CI):5. 890(1. 114-31. 139)], infection[ OR(95% CI):17. 317(1. 349-222. 349)], and stent type[OR(95% CI):0. 144(0. 022-0. 937)] were independent influencing factors for postopera-tive stent occlusion(allP< 0. 05).Conclusion Patients with elevated WBC/Neu%/ALP, intraoperative EST, and preoperative secondaryinfection have a high risk of postoperative stent obstruction, and close follow-up and early prevention should be performed for such patients.The double pigtail stent can effectively reduce the rate of postoperative stent obstruction.
[1] MCHENRY L, LEHMAN G. Difficult bile duct stones[J]. Curr Treat Options Gastroenterol, 2006, 9(2):123-132.
|
[2] MIZUKAMI Y, SAITO H, OBARA T, et al. Temporary use of an accuflex stent for unextractable common bile duct stones[J].J Gastroenterol Hepatol, 2000, 15(6):680-683.
|
[3] ZHOU CH, ZHOU W, MENG YT, et al. An excerpt of endoscopic management of common bile duct stones:European Society of Gastrointestinal Endoscopy(ESGE)guideline(2019)[J]. J Clin Hepotal, 2019, 35(6):1237-1241.(in Chinese)周春华,周玮,孟雨亭,等.《2019年欧洲消化内镜学会临床实践指南:胆总管结石的内镜治疗》摘译[J].临床肝胆病杂志,2019, 35(6):1237-1241
|
[4] FRITZ E, KIRCHGATTERER A, HUBNER D, et al. ERCP is safe and effective in patients 80 years of age and older compared with younger patients[J]. Gastrointest Endosc, 2006,64(6):899-905.
|
[5] WANG J, CHEN W. Treatment strategies of complicated extrahepatic bileduct stones[J]. Chin J Dig Surg, 2019, 18(12):1113-1117.(in Chinese)王坚,陈炜.复杂肝外胆管结石的治疗策略[J].中华消化外科杂志,2019, 18(12):1113-1117.
|
[6] KATSINELOS P, PAROUTOGLOU G, KOUNTOURAS J, et al.Efficacy and safety of therapeutic ERCP in patients 90 years of age and older[J]. Gastrointest Endosc, 2006, 63(3):417-423.
|
[7] TRIKUDANATHAN G, NAVANEETHAN U, PARSI MA. Endoscopic management of difficult common bile duct stones[J].World J Gastroenterol, 2013, 19(2):165-173.
|
[8] LI JS, LIU F, LI ZS. An excerpt of endoscopic biliary stenting:indications, choice of stents, and results:European Society of Gastrointestinal Endoscopy(ESGE)clinical guideline-updated 2018[J]. J Clin Hepotal, 2018, 34(11):2311-2315.(in Chinese)李家速,刘枫,李兆申.《2018欧洲胃肠内镜学会指南更新:内镜下胆管支架置入的指征、支架选择和疗效》摘译[J].临床肝胆病杂志,2018, 34(11):2311-2315.
|
[9] MOESCH C, SAUTEREAU D, CESSOT F, et al. Physicochemical and bacteriological analysis of the contents of occluded biliary endoprostheses[J]. Hepatology, 1991, 14(6):1142-1146.
|
[10] GROEN AK, OUT T, HUIBREGTSE K, et al. Characterization of the content of occluded biliary endoprostheses[J]. Endoscopy, 1987, 19(2):57-59.
|
[11] CETTA F, RAPPUOLI R, MONTALTO G, et al. New biliary endoprosthesis less liable to block in biliary infections:Description and in vitro studies[J]. Eur J Surg, 1999, 165(8):782-785.
|
[12] VAISHNAVI C, SAMANTA J, KOCHHAR R. Characterization of biofilms in biliary stents and potential factors involved in occlusion[J]. World J Gastroenterol, 2018, 24(1):112-123.
|
[13] ZHANG RL, CHENG L, CAI XB, et al. Comparison of the safety and effectiveness of endoscopic biliary decompression by nasobiliary catheter and plastic stent placement in acute obstructive cholangitis[J]. Swiss Med Wkly, 2013, 143:w13823.
|
[14] MATSUDA Y, SHIMAKURA K, AKAMATSU T. Factors affecting the patency of stents in malignant biliary obstructive disease:Univariate and multivariate analysis[J]. Am J Gastroenterol, 1991, 86(7):843-849.
|
[15] EUM YO, KIM YT, LEE SH, et al. Stent patency using competing risk model in unresectable pancreatic cancers inserted with biliary self-expandable metallic stent[J]. Dig Endosc,2013, 25(1):67-75.
|
[16] BROUNTZOS EN, PTOCHIS N, PANAGIOTOU I, et al. A survival analysis of patients with malignant biliary strictures treated by percutaneous metallic stenting[J]. Cardiovasc Intervent Radiol, 2007, 30(1):66-73.
|
[17] LIN XH, TING PH, LUO JC, et al. Predictors of stent occlusion in patients with unresectable pancreatic cancer after biliary metal stents[J]. J Chin Med Assoc, 2019, 82(10):762-766.
|
[18] WEICKERT U, VENZKE T, KÖNIG J, et al. Why do bilioduodenal plastic stents become occluded? A clinical and pathological investigation on 100 consecutive patients[J]. Endoscopy, 2001, 33(9):786-790.
|
[19] KWON CI, KIM G, JEONG S, et al. Experimental study on the friction effect of plastic stents for biliary stone fragmentation(with video)[J]. Dig Endosc, 2018, 30(1):107-113.
|
[20] REY JF, MAUPETIT P, GREFF M. Experimental study of biliary endoprosthesis efficiency[J]. Endoscopy, 1985, 17(4):145-148.
|
1. | 王晨欢,孟科. 高危老年胆总管大结石患者塑料胆管支架置入后支架堵塞的影响因素分析. 现代消化及介入诊疗. 2024(05): 539-542 . ![]() | |
2. | 鲁为朋,孙礼侠,王晨,刘志刚. ERBD+LCBDE与ENBD+ERCP/EST在胆总管结石合并中重度急性胆管炎中的近期疗效对比. 肝胆胰外科杂志. 2023(01): 40-45 . ![]() | |
3. | 李慧华,吕日新,林树浩. 同期三镜联合偏弯双头尾翼胆道支架预防胆总管探查一期缝合术后并发症的临床应用. 齐齐哈尔医学院学报. 2023(02): 143-147 . ![]() | |
4. | 李昕锴,杨小李,方程,苏松,李波. 经ERCP胆道支架植入术与胆道取石术对高危患者胆总管结石疗效比较的Meta分析. 重庆医学. 2023(12): 1870-1875+1881 . ![]() | |
5. | 丁根华. 改良T管置入术在腹腔镜联合胆道镜胆总管切开取石患者中的应用研究. 中国医学创新. 2022(04): 141-144 . ![]() | |
6. | 柯绍标. 自动脱落内支架管在胆总管结石中的应用及对肝功能的影响. 中国卫生标准管理. 2022(11): 63-66 . ![]() | |
7. | 张卓良,谢贵林,朱锦龙,马骐,陈军民,魏文龙. 经肝胆道镜联合胆道支架治疗胆总管结石的临床观察. 浙江创伤外科. 2022(04): 731-733 . ![]() | |
8. | 钱鑫,叶小峰,王轶,王晶,苏菡,朱明花,卜玲玲,陶以理. 陷胸三金汤对于难治性胆总管结石内镜下逆行胰胆管造影+支架置入术后预防复发的价值探讨. 中华中医药学刊. 2022(09): 225-229 . ![]() | |
9. | 王奥,李宁. 经乳头胆道引流术在内镜治疗胆总管结石中的应用进展. 临床肝胆病杂志. 2022(12): 2868-2872 . ![]() | |
10. | 孙敏,陈光彬,胡郁之,代俭华,孙蕾,陶绍富. EPLBD联合SEST治疗胆总管结石的疗效及对胆道括约肌功能的影响. 中南医学科学杂志. 2021(04): 443-446 . ![]() | |
11. | 安代红,陶锐,周晓宏,陈聪,张祥,张超超,曾燕琴. 经口直视胆道内镜联合液电碎石对难治性胆总管结石的诊疗价值. 系统医学. 2021(22): 166-169 . ![]() | |
12. | 王建荣,徐顺福,王潇,彭鹏,李维,全俊,钱丽佳,史健敏,张华,徐晨. 单猪尾胰管塑料支架胆管引流在内镜下逆行胰胆管造影术治疗胆总管结石后的疗效观察. 中华保健医学杂志. 2021(06): 619-622 . ![]() |