Pancreatic stone extraction using a pancreatoscopy-directed, thin-sheathed basket catheter.
Pancreatic stone extraction using a pancreatoscopy-directed, thin-sheathed basket catheter.
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使用胰管镜引导的薄鞘篮式导管取出胰腺结石。
DOI：
10.1111/den.13405
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发表时间：
2019
期刊：
影响因子：
--
通讯作者：
Hayashi K.
中科院分区：
文献类型：
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作者：
Miyabe K;Yoshida M;Hayashi K.
慢性胰腺炎导致的胰腺结石会阻塞主胰管（MPD），导致腹痛或感染，而且有时很难在不进行手术的情况下从胰管中取出。1，2我们介绍了一个令人印象深刻的病例，在该病例中，一种新的薄护套篮状导管通过数字经口胰管镜成功地取出了胰腺结石，该患者的传统篮状导管即使在最初的体外冲击波碎石术（ESWL）碎石后也未能取出材料。1例69岁男性原发性慢性胰腺炎患者，因胰体狭窄远端MPD感染引起的高热和上腹痛被收治入院，胰体狭窄因胰结石而加重（图1A）。4虽然在内镜下放置鼻胰引流管后给予抗生素缓解了他的症状，但仍需取出以防止复发感染。通过ESWL介导的33000次冲击波输送将结石破碎（图1B）;然而，使用常规篮状导管无法取出碎片。3个月后，患者再次入院接受内镜取石术（视频S1）。尽管内镜逆行胰管造影显示了一个小的充盈缺损，但通过侧视内镜使用常规篮状导管进行的四次扫描未能捕获MPD结石（图2A）。然后将SpyGlass DS（Boston Scientific，马尔伯勒，MA，USA）插入MPD，并在胰头和胰体处显示两个胰结石。通过胰镜检查将MicroCatch导管（MTW Endoscopie，Düsseldorf，德国）推进到MPD中，成功捕获并取出了两枚结石（图2B，C）。这是第一次使用胰腺镜导向的薄鞘篮状导管通过胰腺镜取出胰腺结石的报告。胰腺镜检查可以比在荧光镜引导下进行的胰腺造影更精确地检测胰腺结石，
PANCREATIC STONES AS a result of chronic pancre-atitis can obstruct the main pancreatic duct (MPD) causing abdominal pain or infection, and they are sometimes intractable to remove from the pancreatic duct without surgery. 1, 2 We present an impressive case in which a new, thin-sheathed basket catheter, introduced through digital peroral pancreatoscopy, successfully extracted pancreatic stones in a patient in whom a conventional basket catheter had failed to extract material even after stone fragmentation by initial extracorporeal shock wave lithotripsy (ESWL). 3 A 69-year-old man with idiopathic chronic pancreatitis was admitted to our hospital with high fever and epigastralgia caused by an MPD infection distal to a pancreatic body stricture strengthened by a pancreatic stone (Fig. 1A). 4 Although his symptoms were alleviated by antibiotics given after endoscopic placement of a nasal-pancreatic drain over the stone, extraction was indicated to prevent recurrent infection. The stone was fragmented by ESWL-mediated delivery of 33 000 shock waves (Fig. 1B); however, the fragments could not be extracted using a regular basket catheter. Three months later, the patient was re-admitted for endoscopic stone extraction (Video S1). Although endoscopic retrograde pancreatography showed a small filling defect, four sweeps with a regular basket catheter through a side-view endoscope failed to catch the MPD stones (Fig. 2A). A SpyGlass DS (Boston Scientific, Marlborough, MA, USA) was then inserted into the MPD and showed two pancreatic stones at the pancreatic head and body. A MicroCatch catheter (MTW Endoscopie, Düsseldorf, Germany) was advanced into the MPD through the pancreatoscopy and successfully caught and extracted both stones (Fig. 2B, C). This is the first report of pancreatic stone extraction by pancreatoscopy using a pancreatoscopydirected, thin-sheathed basket catheter. Pancreatoscopy can detect pancreatic stones more precisely than a pancreatogram carried out under fluoroscopic guidance, and use of