| Objective:1.To investigate the safety and efficacy of 5Fr biliary stent for endoscopic retro-grade cholangiopancreatography ERCP and bile duct drainage after stone removal.2.The spontaneous exfoliation rate and influencing factors of biliary stents of different diameters and sizes were discussed.Methods:From 2021.12 to 2022.12,103 patients who needed ERCP stone removal in Shaanxi Provincial People’s Hospital were selected,including 49 males and 54 females,with an average age of 56.69 years.Endoscopic Nasobiliary Drainage(ENBD)(40 cases),8.5Fr biliary stents(23 cases),and 5Fr biliary stents(40 cases)were randomized for biliary drainage after ERCP stone removal.By comparing the complications,liver function,drainage effect of stones of different sizes,and the spontaneous exfoliation rate and exfoliation time of 5Fr biliary stent and 8.5Fr biliary stent within 3 months after surgery,a safer and more effective bile duct drainage method after ERCP stone removal was explored.Secondly,the influencing factors of biliary stent shedding were explored through logistic regression analysis.Results:1.The total complication rate of the three groups was 10.78%(11/103),among which the postoperative complication rate was 7.5%(3/40)in the 5Fr biliary stent group,and 1 case(2.50%)each had hyperamylaseemia,acute pancreatitis and postoperative hemorrhage.The postoperative complication rate of 8.5Fr biliary stent group was 8.7%(2/23),and 1 case(4.35%)of hyperamylaseemia and bleeding did not occur pancreatitis.The postoperative complication rate in the ENBD group was 15.0%(6/40),including 2cases(5.00%)of hyperamylaseemia,1 case of acute pancreatitis(2.50%),and 3 cases(7.50%)of postoperative hemorrhage.There was no significant difference between the small and large stone groups in the choice of biliary drainage method after ERCP stone removal(χ2=3.716,P=0.156).2.The postoperative liver function(TBIL,ALP,Γ-GT)in the three groups decreased compared with the preoperative period,and there was no significant difference in preoperative and postoperative liver function(P>0.05).There were significant differences in preoperative and postoperative ALP in the 5Fr biliary stent group(P<0.001),while there were no significant differences between TBIL and γ-GT before and after surgery(P>0.05).There were no significant differences in preoperative and postoperative liver function(TBIL,ALP,Γ-GT)in the 8.5Fr biliary stent group(P>0.05).There were no significant differences in preoperative and postoperative liver function(TBIL,ALP,Γ-GT)in the ENBD group(P>0.05).3.Compared with the exfoliation rate of the two groups of stents within 3 months,the spontaneous exfoliation rate of the 5Fr biliary stent group was 80.0%,and the spontaneous exfoliation rate of the 8.5Fr biliary stent group was 39.1%,and there was a statistical difference in the spontaneous exfoliation rate of the two groups(χ2=10.733,P=0.001).Among them,the 5Fr biliary stent group had the highest frequency of exfoliation within 1 month of 35.0%(14/40),while the 8.5Fr biliary stent group did not lose any stents within 1 month.The exfoliation rate was 15%(6/40)in the 5Fr biliary stent group and 8.7%(2/23)in 1-2 months in the 8.5Fr biliary stent group.The expulsion rate was 30.0%(12/40)in the 5Fr biliary stent group and 30.4%(7/23)at 2-3 months in the 8.5Fr biliary stent group.The non-exfoliated rate of stents within 3 months accounted for 20.0%(8/40)in the 5Fr biliary stent group and 60.9%(14/23)within 3 months in the8.5Fr biliary stent group.4.Univariate analysis of gender,age,biliary stent and EST incision size and operation time showed that statistically significant influencing factors included EST incision size(χ2=4.103,P=0.040)and stent diameter(χ2=10.733,P=0.001).Further multivariate analysis of meaningful influencing factors in univariate analysis showed that the large EST incision group was 5.208 times higher than that in the small incision group,and the difference was statistically significant(OR=5.208,95%CI 1.241～21.867,P=0.024).Compared with 8.5Fr biliary stent,the probability of stent detachment increased by 8.839 times,and the difference was statistically significant(OR=8.839,95%CI 2.706～28.877,P<0.001).Conclusion:1.There is no difference in the incidence of postoperative biliary drainage of 5Fr biliary stents after ERCP stone removal and conventional ENBD and 8.5Fr biliary stents,and there is no difference in liver function before and after surgery,and 5Fr biliary stents can be excreted through the intestine,which proves that 5Fr biliary stents for postoperative biliary drainage are as safe and effective as conventional ENBD and 8.5Fr biliary stents,and can be further promoted and applied in clinical practice.2.Compared with 8.5Fr biliary stent,5Fr biliary stent has a high spontaneous exfoliation rate,spontaneous shedding within 1 month,and can be excreted spontaneously.3.The size of the stent diameter and the size of EST incision are the influencing factors of spontaneous loss of biliary stents. |
PDF Full Text Request