胰管支架近端移位的原因分析及内镜下治疗  

Reasons and endoscopic management for proximally migrated pancreatic stents

作　　者：曾春艳[1] 李国华[1] 周小江[1] 朱勇[1] 刘丕[1] 曾皓[1] 吕农华[1] 陈幼祥[1] Zeng Chunyan;Li Guohua;Zhou Xiaojiang;Zhu Yong;Liu Pi;Zeng Hao;Lyu Nonghua;Chen Youxiang(Department of Gastroenterology,The First Affiliated Hospital of Nanchang University,Nanchang 330006,China)

机构地区：[1]南昌大学第一附属医院消化科,330006

出　　处：《中华消化内镜杂志》2020年第4期267-270,共4页Chinese Journal of Digestive Endoscopy

基　　金：江西省科技计划项目(2014BBG70020)。

摘　　要：目的探讨胰管支架近端移位的原因及内镜下治疗方式方法。方法2007年4月至2015年1月共967例胆胰疾病患者于南昌大学第一附属医院消化内镜中心置入胰管支架,10例出现胰管支架移位。比较胰管线状支架及胰管单猪尾支架移位发生率,并总结不同类型支架的取出方法。结果胰管线状支架移位率较单猪尾支架更高[3.23%(7/217)比0.40%(3/750)]。对于3例移位的单猪尾支架,2例用活检钳直接取出,另外1例未取出,改再置入一单猪尾支架,术后无不适。对于7例移位的胰管线状支架,2例在导丝引导下通过网篮和球囊将支架拖出乳头口,另外5例导丝引导下用球囊将支架拖出乳头口,后用圈套器一次性成功取出。结论胰管线状支架比单猪尾支架更容易移位,移位后的胰管线状支架可在导丝引导下通过球囊和(或)网篮直接取出,移位后的胰管单猪尾支架可通过活检钳直接取出。Objective To explore the reasons of the proximal migration of pancreatic stents and the endoscopic management.Methods From April 2007 to January 2015,of all 967 patients with biliopancreatic diseases implanted with pancreatic duct plastic stents at the First Affiliated Hospital of Nanchang University,proximal migration occurred in 10 cases.Migrated rates and endoscopic retrieval methods of pancreatic straight stents and single pigtail stents were compared.Results Pancreatic straight stents showed a higher migration rate than those single pigtail ones[3.23%(7/217)VS 0.40%(3/750)].For 3 migrated single pigtail pancreatic stents:2 were directly removed with biopsy forceps.Another failed in retrieval,and the same stent then was implanted.There was no discomfort after the operation.For 7 migrated pancreatic straight stents:2 were pulled out of duodenum papilla incision under wire-guided balloon and basket.Five others were pulled out of papilla under wire-guided balloon,and then the stents were removed by a snare.Conclusion Pancreatic straight stents are more likely to migrate compared with single pigtail stents.Migrated pancreatic straight stents can be removed with wire-guided balloon or basket and snare,while migrated single pigtail stents can be directly retrieved with biopsy forceps.

关 键 词：支架 移位 胰管单猪尾支架 胰管线状支架 近端取出 

分 类 号：R57[医药卫生—消化系统]