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胰管支架置入术及其并发症概述

Authors
Marc F Catalano, MD, FACG, FACP, FASGE, AGAF
Vivek Kaul, MD, FACG
Section Editor
Douglas A Howell, MD, FASGE, FACG
Deputy Editor
Anne C Travis, MD, MSc, FACG, AGAF
Translators
丁震, 副主任医师，副教授

引言

胰腺内镜现已越来越多地用于治疗多种胰腺疾病，其中包括：慢性胰腺炎(chronic pancreatitis, CP)、特发性急性复发性胰腺炎、胰漏或胰管中断、假性囊肿引流，还用于预防内镜下逆行胰胆管造影(endoscopic retrograde cholangiopancreatography, ERCP)后胰腺炎。

胰腺内镜治疗最常见的术式之一是胰管支架置入术。主胰管支架置入术已被用于解除胰管梗阻，通常用于由胰管狭窄、胰管结石或十二指肠乳头狭窄引起的难治性疼痛。此外，十二指肠小乳头支架置入术现已用于治疗继发于小乳头狭窄的症状性胰腺分裂[1]。本文将总结胰管支架置入术的适应证、疗效及并发症。胰管支架对ERCP诱发性胰腺炎的预防作用将单独详细讨论。 (参见“预防性胰管支架置入防止ERCP所致胰腺炎：应用时机”)

器械与技术

有多种类型的导丝、扩张器和支架可以使用。器械的选择取决于临床情况。

导丝 — 现有不同直径(0.018"、0.021"、0.025"和0.035")及长度的导丝，它们可能是亲水性导丝、直型导丝、J型端导丝或圆环端导丝。这些导丝有不同的不透光标记，以尽量减少透视定位时间。有些导丝有聚四氟乙烯涂层，可为支架的放置及附件的换置提供最强的稳定性。绝缘导丝在括约肌切开术中可放置在位。Glidewire导丝和Roadrunner导丝是特殊导丝，用于ERCP中插管和进入困难的情况。

扩张器 — 有两种扩张器最常用：扩张球囊和扩张导管。扩张球囊是装在导管上的充气装置，用于为狭窄区域施加特定的压力。有数种直径及长度的球囊可以使用。充气装置必须以可控制的速度为球囊加压。

                          

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Literature review current through: 2017-06 . | This topic last updated: 2017-06-28.
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