Опыт применения саморасправляющихся металлических стентов в билиарной хирургии

Abstract

The article presents the indications, technique, and results of using self-expanding metal stents in treatment of 129 patients with blastomatous biliary obstruction: 124 (96.1%) cases – endoscopically transpapillary, 5 (3.9%) cases – from cholangiostomy access. The possibility of placement of transpapillary stent was determined primarily by the level of bile duct obstruction. In the above observation, obstruction of the bile ducts at the level of their terminal part, the major duodenal papilla, occurred in 17 (13.2%) patients, at the distal level – in 73 (56.6%), at the central level – in 29 (22.5%), at the proximal level – in 10 (7.7%).

The correct location of the stent in the bile ducts is provided by X-ray monitoring of its installation and opening behind the zone of obstruction, formation of the “waist” of the stent. Endoscopic criteria of adequacy of the stent are the following: the bile flow through it, and the presence of 1.0 cm of the stent in the lumen of the duodenum (to ensure its recanalization). Carrying out bile duct stenting under general anesthesia promotes its effectiveness. Carrying out bile duct stenting under general anesthesia promotes its effectiveness.

Assessment of the long-term results of endobiliary stenting highlights problematic issues of this method and offers the ways to solve them.