胆道内支架治疗胆总管结石(文献回顾)

Александр Александрович Карпачев, Александр Валентинович Солошенко, Н. А. Линьков, А. В. Гнашко, Андрей Леонидович Ярош, A. A. Karpachev, A. V. Soloshenko, N. A. Linkov, A. V. Gnashko, A. Yarosh
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引用次数: 0

摘要

复杂形式的胆结石疾病的治疗仍然是现代外科的热门问题。内镜下乳头括约肌切开术联合取石术(取石术)是治疗胆总管结石的“金标准”。对于合并症严重、手术风险高的中老年患者,胆道内支架置入术是一种可替代的治疗方法。在进行EPST和胆总管支架置入时,发生上行感染和胆管炎的风险增加。和其他植入术一样,胆道内支架植入术也不是无害的。支架安装后几个小时内就会发生细菌污染。植入物表面生物膜的存在导致胆汁盐的快速包积和支架内腔的封闭,以及支架表面的混凝土。短期内永久更换支架,一方面经济上不可行,另一方面会给患者带来不适。所有这些都表明需要改进内镜支架本身。内引流的客观缺陷促使研究人员开发涂层材料和方法,以提高支架的使用寿命,降低并发症发生率。при
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THE USE OF ENDOBILIARY STENTS IN THE TREATMENT OF CHOLEDOCHOLITHIASIS (REVIEW OF LITERATURE)
The treatment of complicated forms of gallstone disease remains a topical issue in modern surgery. Endoscopic papillosphincterotomy with lithoextraction(stone extraction) is the “gold standard” for the treatment of choledocholithiasis. In elderly and senile patients with severe comorbidities and high operational risk, endobiliary stenting is an alternative treatment method. While performing EPST and stenting of the common bile duct, the risk of developing an ascending infection and cholangitis increases. Endobiliary stenting, like any other implantation, is not a harmless procedure. Bacterial contamination of the stent occurs in a matter of hours after installation. The presence of biofilms on the surface of the implant leads to rapid incrustation of bile salts and obturation of the internal lumen of the stent, as well as concrements on its surface. Permanent replacement of stent in a short period of time, on one hand it is not economically viable and on other hand it causes discomfort to patients. All this dictates need to improve the endobiliary stents themselves. Objective deficiencies of internal drainage are pushing researchers to develop materials and methods for coatings that could increase the service life of stents and reduce the complication rate. при
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