Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan.
Dig Endosc. 2012 May;24 Suppl 1:43-8. doi: 10.1111/j.1443-1661.2012.01263.x.
The patient was a 73 year old man for whom surgery under general anesthesia was difficult to perform because of pulmonary emphysema. In April 2003, he visited our hospital complaining of epigastralgia and dorsal pain, and was admitted under a diagnosis of acute exacerbation of chronic pancreatitis. In 2005, acute cholangitis concomitantly developed with acute exacerbation of chronic pancreatitis, for which a plastic stent was placed in the common bile duct. Cholangitis repeatedly developed every 2-3 months thereafter, and admission was required each time to exchange the stent. Surgery was considered but not applicable because of his poor respiratory function, and a partially covered self-expandable metallic stent was inevitably placed in the bile duct. Ten months later, an aberration of the metallic stent in the bile duct occurred, but it was dealt with by placing an additional metallic stent, and no cholangitis or pancreatitis developed until the patient died of respiratory insufficiency 3 years later. Placement of a covered self-expandable metallic stent might be an option for the treatment of benign biliary stricture, especially in patients at high risk from surgery.
患者为 73 岁男性，因肺气肿难以接受全身麻醉下的手术。2003 年 4 月，因上腹和背部疼痛到我院就诊，诊断为慢性胰腺炎急性发作而入院。2005 年，在慢性胰腺炎急性发作的同时并发急性胆管炎，在胆总管内置入塑料支架。此后，每隔 2-3 个月胆管炎反复发作，每次都需要入院更换支架。由于患者呼吸功能不佳，考虑手术但不适用，因此不可避免地在胆管内放置了部分覆膜自膨式金属支架。10 个月后，胆管内金属支架出现异常，但通过放置额外的金属支架进行处理，此后直到患者因呼吸功能不全 3 年后死亡，都未再发生胆管炎或胰腺炎。覆膜自膨式金属支架的放置可能是治疗良性胆管狭窄的一种选择，尤其是对于手术风险较高的患者。
