技术技巧慢性胰腺炎全覆膜自膨式金属支

Endoscopicmanagementofchronicpancreatitiswithafullycoveredself-expandingmetalstentandlaserlithotripsy

慢性胰腺炎的内镜管理：全覆膜自膨式金属支架+激光碎石

Thepatientwasa58-year-oldmanwithalong-standinghistoryofalcoholabuseandchronicpancreatitisleadingtomultiplehospitalizations.Hecontinuedtohavepaindespiteconservativemanagement,paincontrol,andalcoholcessation.Hischronicpancreatitisandpancreaticduct(PD)stonesresultedinatightPDstrictureattheheadofthepancreas.Multiplepriorattemptsatconventionalendoscopicretrogradecholangiopancreatography(ERCP)hadfailed.

患者，男性，58岁，有长期酗酒和慢性胰腺炎病史，并因此多次住院。尽管进行了保守治疗、疼痛控制和戒酒，患者仍然有疼痛。患者的慢性胰腺炎和胰管（PD）结石导致胰头部的PD狭窄。之前多次尝试常规经内镜逆行性胰胆管造影（ERCP），均失败。

Hepresentedtoourinstitutionseekingadvancedtherapyafterextracorporealshockwavelithotripsy(ESWL).AtourindexERCPwecouldnotgetconventionaltranspapillaryaccesstothePD.Instead,givenhisstoneburden,afterESWL,wechosetotreathimwithanEUS-guidedpancreaticogastrostomy,andplacementofafullycoveredself-expandingmetalstent(FCSEMS)followedbyapancreatoscopywithholmiumlaserlithotripsy([Fig.?1]and[Fig.?2]).Thepatientrespondedtotreatment,withresolutionofhispainat12monthsaftertheintervention.

患者接受了体外冲击波碎石（ESWL），到我院接受高级治疗。在我院的首次ERCP中，无法通过传统方式经乳头进入PD。我们的做法是，考虑到患者的结石负担，在ESWL之后，选择了EUS引导下胰腺胃造瘘术，并放置一个全腹膜自膨式金属支架（FCSEMS），然后进行胰管镜下钬激光碎石（[图1]和[图2]）。患者对治疗产生了响应，在干预后12个月，疼痛得到了缓解。

Fig.?1?Echoendoscopewithaguidewireinadilatedpancreaticductthatisbeinginjectedwithcontrast.Transpapillaryaccessforplacementofafullycoveredmetalstenthadnotbeensuccessfulinthispatientwithchronicpancreatitisandpancreaticductstones.

图1.带导丝的超声内镜在扩张的胰管中注入造影剂。此前，这位患有慢性胰腺炎和胰管结石的患者，经乳头置入全腹膜金属支架均以失败告终。

Fig.?2?Pancreatoscopyshowstwoofthepancreaticductstonesinsidethedilatedpancreaticduct,beforeinitiationoflaserlithotripsy.

图2.胰管镜检查显示，在启动激光碎石之前，扩张的胰管内有两个胰管结石。

Video?1?Endoscopicultrasound-guidedaccessintothemainpancreaticduct,withplacementofafullycoveredmetalstentcreatingapancreaticogastrostomy.Inarepeatprocedure,accessviathepancreaticogastrostomywasusedtoperformlaserlithotripsyofpancreaticstones.

视频1.在超声内镜引导下进入主胰管，放置一个全覆膜金属支架，并创建胰胃造瘘。在一次重复操作中，通过胰胃造瘘进行了胰管结石的激光碎石。

Inchronicpancreatitis,chronicinflammationcausesendocrineandexocrineinsufficiency,pancreaticatrophy,calcification,andmultiplepancreaticductstricturesthatleadtochronicpain.Thischronicdiseasehasmuchassociatedmorbidity.Currenttherapiesincludepaincontrolandsupportivemeasuresaimedattreatmentofendocrineandexocrineinsufficiencies.PDstricturesandPDstonesfrequentlyac

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