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
背景：胆道损伤发生后，需通过肝管空肠吻合术（hepaticojejunostomy）进行修复。当前最常用的术式为球囊扩张术，成功率达70%。采用可降解胆道支架（biodegradable biliary stents）的手术成功率则介于85%至95%之间，此类支架有望改变该类并发症的治疗方案。
目的：探究可降解胆道支架在肝管空肠吻合术狭窄患者群体中的应用价值。
方法：本前瞻性研究共为13例因胆道手术损伤行胆管修复术后出现肝管空肠吻合术狭窄的患者置入16枚可降解胆道支架。患者平均年龄为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胆道支架前均接受了经皮引流（percutaneous drainage）。
结果：1例患者出现一过性血性胆汁（haemobilia），需输血治疗；另有1例患者在支架置入后出现疼痛，需静脉给药缓解。其余11例患者均于支架置入次日出院。随访期间，前9个月内无患者出现相关症状。1例患者碱性磷酸酶（alkaline phosphatase）显著升高，经检查证实存在狭窄复发；另有1例患者在支架置入11个月后出现胆管炎（cholangitis）复发。84.6%的患者保持无症状状态，平均随访时长为20个月。
结论：置入可降解胆道支架是一项安全且可行的技术，未观察到由支架本身或其降解过程引发的狭窄病变。该技术有望替代球囊扩张术，用于治疗肝管空肠吻合术狭窄。