- 期刊
Successful Treatment of Disconnected Pancreatic Tail Syndrome with Percutaneous and Endoscopic Drainages
合併經皮引流術及內視鏡成功治療胰尾不連續症候群
摘要
胰尾不連續症候群(Disconnected pancreatic tail syndrome)乃指上行主胰管斷裂所致之臨床表現。此症候群與嚴重型急性胰臟炎所併發之胰廔管或胰液滲漏有關。本文報告－59歲男性於接受經內視鏡逆行性胰膽管造影術後，併發壞死性急性胰臟炎；其電腦斷層攝影發現原有之胰臟多爲液體所取代，胰臟組織僅剩20%，且集中於尾部。內視鏡下發現胰管開口萎縮，經此直接由內視鏡置入支架無法達成。現有報告之治療方式較多採手術清創及重建，惟本案例所剩胰臟組織過少，手術可能造成剩餘胰臟組織更爲不足，故吾人仍採用合併經皮引流術與內視鏡治療，期可解決患者之臨床症狀與保存剩餘之胰臟組織。內視鏡支架乃於適當之時機下，藉由針刀所創之造口置入；患者接受此療法後，解除腹痛，且最終成功拔除經皮引流管，雖然仍產生糖尿病，但可以低劑量口服降血糖藥控制。
並列摘要
Disconnected pancreatic tail syndrome (DPTS) is characterized by the lack of ductal continuity between upstream viable pancreatic tissue and the downstream. It is an increasingly recognized complication of severe acute pancreatitis and in association with a persistent pancreatic fistula or pancreatic-fluid collection. A 59-year-old man developed necrotizing acute pancreatitis after endoscopic retrograde cholangiopancreatography. Computed tomography scan showed that the viable pancreatic tissue was about 20% of the pancreas and mainly in the pancreatic tail, and a huge fluid collection along the location of the original pancreas was found. Endoscopy showed that the pancreatic duct orifice was atrophied and stenting through the nature orifice was impossible. Although debridement and reconstruction are generally the recommended treatments for DPTS, we do not consider operation since it will keep even less viable pancreatic tissue. Trying to preserve the residual pancreatic tissue, we treated the patient with combination of percutaneous drainage and endoscopic stenting through a duodenostomy that was created by a needle knife at an optimal timing. Abdominal pain subsided after the therapy and the percutaneous drainage tubes were removed uneventfully. Though diabetes did occur, the serum glucose could be well controlled with low dose oral anti-glycemic drug.
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