Fujita Naotaka, Noda Yutaka, Kobayashi Go, Ito Kei, Obana Takashi, Horaguchi Jun, Takasawa Osamu, Nakahara Kazunari
Department of Gastroenterology, Sendai City Medical Center, 5-22-1, Tsurugaya, Sendai, Miyagi 983-0824, Japan.
World J Gastroenterol. 2007 Nov 7;13(41):5512-5. doi: 10.3748/wjg.v13.i41.5512.
Endosonography-guided biliary drainage (ESBD) is a new method enabling internal drainage of an obstructed bile duct. However, the histological conditions associated with fistula development via the duodenum to the bile duct have not been reported. We performed ESBD 14 d preoperatively in a patient with an ampullary carcinoma and histologically confirmed changes in and around the fistula. The female patient developed no complications relevant to ESBD. Levels of serum bilirubin and hepatobiliary enzymes declined quickly, and pancreatoduodenectomy was carried out uneventfully. The resected specimen was sliced and stained with hematoxylin-eosin. Histological evaluation of the puncture site in the duodenum and bile-duct wall, and the sinus tract revealed no hematoma, bile leakage, or abscess in or around the sinus tract. Little sign of granulation, fibrosis, and inflammatory cell infiltration was observed. Although further large-scale confirmatory studies are needed, the findings here may encourage more active use of ESBD as a substitute for percutaneous transhepatic drainage in cases with failed/difficult endoscopic biliary stenting.
内镜超声引导下胆道引流（ESBD）是一种实现梗阻性胆管内引流的新方法。然而，经十二指肠至胆管形成瘘管相关的组织学情况尚未见报道。我们对一名壶腹癌患者在术前14天进行了ESBD，并对瘘管及其周围组织学变化进行了确认。该女性患者未出现与ESBD相关的并发症。血清胆红素和肝胆酶水平迅速下降，胰十二指肠切除术顺利完成。将切除的标本切片并用苏木精-伊红染色。对十二指肠和胆管壁穿刺部位以及窦道进行组织学评估，结果显示窦道内及周围无血肿、胆漏或脓肿。观察到极少有肉芽、纤维化和炎性细胞浸润的迹象。尽管需要进一步的大规模验证性研究，但此处的研究结果可能会促使在内镜下胆道支架置入失败/困难的病例中更积极地使用ESBD来替代经皮经肝胆道引流。
