多支架植入治疗难治性胆总管结石的随机对照研究

目的评价不同方法胆道支架植入术对难治性胆总管结石的疗效。方法将137例难治性胆管结石患者随机分成4组，单根支架组（A组）32例；单根支架加药物治疗组（B组）35例；双根支架组（C组）33例；双根支架加药物治疗组（D组）37例。在ERCP成功后植入1根或2根支架，药物治疗组在病情平稳后应用熊去氧胆酸和（或）茴三硫，对所有患者进行密切随访。结果所有患者3个月后胆石均有缩小，C组、D组缩小的幅度显著超过A组、B组（P〈0．05）；支架通畅时间平均7．6个月，最长为20．0个月，其中D组的支架通畅时间最长，4组间两两比较均有统计学差异（P〈0．05）；对72例（52．6％）进行了第2次ERCP，其中84．7％患者（61／72）取净了结石；本组发生高淀粉酶血症41例（29．9％），以双支架组为多（P〈0．05）。结论对于难治性性胆总管结石，支架植入术是一种安全、有效的姑息疗法，尤以双支架加溶石药物疗效最佳。

Treatment of intractable choledocholithiasis with multiple biliary stent placements:a randomized controlled study

Objective To evaluate the efficacy of different methods of biliary stenting for intractable choledocholithiasis.Methods A total of 137 patients with intractable choledocholithiasis were randomly divided into 4 groups to receive different managements.The treatments included single biliary stent placement in group A (n=32),single stent placement plus oral medication in group B (n=35),double stents placement in group C (n=33) and double stents placements plus oral medication in group D (n=37).All biliary stents were placed via endoscopic retrograde cholangiopancreatography (ERCP).Oral medication included ursodeoxycholic acid and/or anethol trithione after the procedure.All patients were closely followed up.Results The size of stones in common bile duct (CBD) decreased in all cases at 3 months after stent placement,with most significant changes in groups C and D than in groups A and B (P＜0.05).The stents kept unobstructed for a mean time of 7.6 months (3.5-20 months),with a significant difference between every 2 groups (P＜0.05) and a longest duration time in group D.A second procedure of ERCP was performed in 72 patients (52.6%),with achievement of total choledocholithiasis clearance in 51 (84.7%).Hyperamylasemia (HA) occurred in 41 cases (29.9%),which were mainly observed in the groups C and D (P ＜0.05).Conclusion Biliary stent placement is a safe and effective palliative therapy for intractable choledocholithiasis,while double stents placements combined with pharmacotherapy is most effective.