BIODEGRADABLE BILIARY STENTS: A NEW APPROACH FOR THE MANAGEMENT OF HEPATICOJEJUNOSTOMY STRICTURES FOLLOWING BILE DUCT INJURY. PROSPECTIVE STUDY

ABSTRACT Background: Once a biliary injury has occurred, repair is done by a hepaticojejunostomy. The most common procedure is to perform a dilatation with balloon with a success of 70 %. Success rates range using biodegradable stents is from 85% to 95%. Biodegradable biliary stents should change the treatment of this complication. Aim: To investigate the use of biodegradable stents in a group of patients with hepaticojejunonostomy strictures. Methods: In a prospective study 16 biodegradable stents were placed in 13 patients with hepaticojejunostomy strictures secondary to bile duct repair of a biliary surgical injury. Average age was 38.7 years (23-67), nine were female and four male. All cases had a percutaneous drainage before at the time of biodegradable stent placement. Results: In one case, temporary haemobilia was present requiring blood transfusion. In another, pain after stent placement required intravenous medication. In the other 11 patients, hospital discharge was the next morning following stent placement. During the patient´s follow-up, none presented symptoms during the first nine months. One patient presented significant alkaline phosphatase elevation and stricture recurrence was confirmed. One case had recurrence of cholangitis 11 months after the stent placement. 84.6% continued asymptomatic with a mean follow-up of 20 months. Conclusion: The placement of biodegradable stents is a safe and feasible technique. Was not observed strictures caused by the stent or its degradation. It could substitute balloon dilation in strictures of hepaticojejunostomy.

摘要
研究背景：胆道损伤（biliary injury）发生后，需通过肝管空肠吻合术（hepaticojejunostomy）进行修复。临床最常用的术式为球囊扩张术（balloon dilatation），成功率为70%。采用可降解支架（biodegradable stent）时，成功率可达85%~95%。可降解胆道支架有望改变此类并发症的治疗方案。
研究目的：本研究旨在探讨可降解支架在肝管空肠吻合术吻合口狭窄患者中的应用价值。
研究方法：本前瞻性研究共纳入13例因胆道手术损伤后胆管修复继发肝管空肠吻合术吻合口狭窄的患者，共置入16枚可降解支架。患者平均年龄38.7岁（23~67岁），其中女性9例，男性4例。所有患者在置入可降解支架前均接受了经皮引流（percutaneous drainage）。
研究结果：1例患者出现一过性胆道出血（haemobilia），需输血治疗；1例患者术后出现疼痛，需静脉药物治疗（intravenous medication）；其余11例患者均于支架置入次日即可出院。随访期间，前9个月无患者出现相关症状。1例患者碱性磷酸酶（alkaline phosphatase）显著升高，经检查确诊为吻合口狭窄复发；1例患者在支架置入后11个月出现胆管炎（cholangitis）复发。本研究中84.6%的患者随访期间无相关症状，平均随访时长为20个月。
研究结论：置入可降解支架是一项安全且可行的治疗技术，未观察到由支架或其降解产物引发的吻合口狭窄。该技术有望替代球囊扩张术，用于肝管空肠吻合术吻合口狭窄的治疗。