- 期刊
Endoscopic Retrieval of an Upstream-Migrated Pancreatic Stent: A Case Report
以內視鏡拔除上行移位之單端捲尾胰臟支架：一案例報告
摘要
48歲女性因急性膽囊炎接受腹腔鏡膽囊切除術，術後7日因總膽管阻塞併急性胰臟炎接受治療性內視鏡逆行性胰膽管攝影術，術中因導管多次進入主胰管，故置入一單端捲尾細徑胰管支架(single pigtail, 3 French, 6 cm)以避免惡化胰臟炎。文獻及使用經驗顯示，此類支架大多會自動脫落至腸道再排出，然而此案例之胰管支架卻發生往上移行，且完全包埋於胰管之情況。吾人以內視鏡於上行胰管內置入小型取石氣囊順利將已移行入上行胰管內之支架完整取出。此般案例極爲稀少，以外科手術取出胰管支架有較高之術後併發症；若以內視鏡治療，則須有技術純熟之內視鏡醫師及完善的設備。因爲胰管支架置入於國內外之使用率隨著技術及治療方式的進步，有日浙提高的趨勢，故於此提出建議：胰管支架置入時應注意其大小及深度，置入後應追蹤其位置，實施內視鏡胰管支架置入術之單位最好應具備取出移行支架之相關設備及技術。
並列摘要
A 48 year-old woman received laparoscopic cholecystectomy due to acute cholecystitis. Biliary pancreatitis developed 7 days after the surgery and endoscopic retrograde cholangiopancreatography was conducted to clear the bile duct. However, repeated cannulation of the pancreatic duct was encountered and a 3 French, 3/4 pigtail pancreatic stent (6 cm) was inserted to avoid worsening pancreatitis. Such stent is expected to pass into intestine spontaneously in 30 days and another endoscopy to retrieve it is usually not necessary. However, the pancreatic stent migrated to the upstream with total embedding after resolution of the pancreatitis. Endoscopic retrieval was conducted with withdrawing a deep-threaded retrieval balloon and the pancreatic stent was successfully extracted. Such a case is rare, and surgical retrieval of the stent carries high complication rate. To achieve successful endoscopic retrieval, skillful endoscopist and full-equipped facility are needed. With the progression of pancreatic therapy, pancreatic stent implantation is expected to be increased and clinicians might face more complications of that. Thus we suggest careful manipulation to insert a prophylactic pancreatic stent in optimal depth and length, following up position of the stent after procedure and preparing equipments for rescue once upstream migration of a pancreatic stent happens.
延伸閱讀
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