ENDOSCOPIC REMOVAL OF A SPONTANEOUSLY FRACTURED BILIARY UNCOVERED SELF‐EXPANDABLE METAL STENT
ENDOSCOPIC REMOVAL OF A SPONTANEOUSLY FRACTURED BILIARY UNCOVERED SELF‐EXPANDABLE METAL STENT
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内镜下切除自发断裂的胆管未覆盖的自膨胀金属支架
DOI：
10.1111/j.1443-1661.2011.01189.x
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发表时间：
2012
影响因子：
5.3
通讯作者：
K. Koike
中科院分区：
文献类型：
--
作者：
K. Kawakubo;H. Isayama;T. Tsujino;Y. Nakai;N. Sasahira;H. Kogure;T. Hamada;R. Nagano;K. Miyabayashi;Keisuke Yamamoto;D. Mohri;Takashi Sasaki;Yukiko Ito;N. Yamamoto;K. Hirano;M. Tada;K. Koike
自膨式金属支架（SEMS）广泛用于姑息治疗不可切除的恶性胆道梗阻。然而，SEMS在胆道狭窄中的长期耐久性尚不清楚。我们描述了一个自发性破裂的未覆盖的胆管SEMS内镜下切除的情况。一名59岁女性因1年复发性胆管炎病史来我院就诊。她的病史包括直肠癌的直肠切除术和10年前肝转移的右半肝切除术。这些手术后五年，她出现了良性肺门狭窄，并在另一家医院放置了未覆盖的SEMS。内镜逆行胰胆管造影显示SEMS被撕成两半，支架远端部分漂浮在扩张的胆总管中。使用15 mm导丝球囊导管通过内镜下乳头大球囊扩张术（EPLBD）扩张乳头口。随后，我们将活检钳插入胆管，并在X线透视下抓住断裂SEMS的远端。我们成功地从胆管中取出了SEMS碎片，沿着使用内窥镜。患者出院，无并发症。放置未覆盖的胆管SEMS不是良性胆管狭窄的首选治疗方法。自发性破裂的一个未被发现的胆道SEMS是一个极其罕见的并发症。我们应该意识到，在预期寿命较长的患者中放置未覆盖的胆道SEMS时可能发生支架断裂。EPLBD对于取出SEMS骨折碎片非常有用。
Self‐expandable metal stents (SEMS) are widely used for the palliative treatment of unresectable malignant biliary obstruction. However, the long‐term durability of SEMSs in biliary strictures is not clear. We describe a case of endoscopic removal of spontaneously fractured uncovered biliary SEMS. A 59‐year‐old woman presented to our institution with a 1‐year history of recurrent cholangitis. Her medical history included a proctectomy for rectal cancer and right hemihepatectomy for liver metastasis 10 years earlier. Five years after these operations, she developed a benign hilar stricture and had an uncovered SEMS placed in another hospital. Endoscopic retrograde cholangiopancreatography demonstrated that the SEMS was torn in half and the distal part of the stent was floating in the dilated common bile duct. The papillary orifice was dilated by endoscopic papillary large balloon dilation (EPLBD) using a 15‐mm wire‐guided balloon catheter. Subsequently, we inserted biopsy forceps into the bile duct and grasped the distal end of the broken SEMS under fluoroscopy. We successfully removed the fragment of the SEMS from the bile duct, along with the endoscope. The patient was discharged without complications. Placement of an uncovered biliary SEMS is not the preferred treatment for benign biliary strictures. Spontaneous fracture of an uncovered biliary SEMS is an extremely rare complication. We should be aware that stent fracture can occur when placing uncovered biliary SEMSs in patients with a long life expectancy. EPLBD is very useful for retrieving the fractured fragment of SEMS.
影响因子：
24.5
作者：
Isayama, H;Komatsu, Y;Omata, M
通讯作者：
Omata, M