Yamazaki Shintaro, Kuramoto Kenmei, Itoh Yutaka, Watanabe Yoshika, Ueda Toshisada
Third Department of Surgery, Nihon University School of Medicine, 30-1 Ohyaguchi kamimachi, Itabashi-ku, Tokyo 173-8610, Japan.
Cardiovasc Intervent Radiol. 2003 Nov-Dec;26(6):580-2. doi: 10.1007/s00270-003-0086-x.
Pancreas fistula is a well-known and severe complication of pancreaticoduodenectomy. It is difficult to control with conservative therapy, inducing further complications and severe morbidity. Until now, re-operation has been the only way to resolve pancreatic fistula causing complete dehiscence of the pancreatic-enteric anastomosis (complete pancreatic fistula). Percutaneous transgastric fistula drainage is one of the treatments for pancreatic fistula. This procedure allows both pancreas juice drainage and anastomosis re-construction at the same time. This is effective and minimally invasive but difficult to adapt to a long or complicated fistula. In particular, dilatation of the main pancreatic duct is indispensable. This paper reports the successful resolution of a postoperative pancreatic fistula by a two-way-approach percutaneous transgastric fistula drainage procedure. Using a snare catheter from the fistula and a flexible guidewire from the transgastric puncture needle, it can be performed either with or without main pancreatic duct dilatation.
胰瘘是胰十二指肠切除术一种广为人知的严重并发症。保守治疗难以控制，会引发进一步的并发症和严重的发病率。到目前为止，再次手术一直是解决导致胰肠吻合口完全裂开的胰瘘（完全性胰瘘）的唯一方法。经皮经胃瘘引流是胰瘘的治疗方法之一。该手术可同时实现胰液引流和吻合口重建。这一方法有效且微创，但难以适用于长瘘或复杂瘘。特别是，主胰管扩张是必不可少的。本文报告了通过双向经皮经胃瘘引流术成功解决术后胰瘘的案例。使用来自瘘管的圈套导管和经胃穿刺针的柔性导丝，无论是否进行主胰管扩张均可实施该手术。
