Department of Internal Medicine, Saku Central Hospital, Usuda 197, Saku, Nagano 384-0301, Japan.
Pancreatology. 2013 Jul-Aug;13(4):452-4. doi: 10.1016/j.pan.2013.03.012. Epub 2013 Mar 29.
Pancreaticoenteric anastomotic stricture can occur as a late complication of pancreatic head resection and is difficult to manage. The surgically altered anatomies of patients that have undergone pancreatic head resection make it difficult to perform pancreatic duct drainage using conventional endoscopes, and it is especially difficult to endoscopically identify stenotic pancreaticojejunal anastomoses. A 40-year-old woman was referred to our department for the treatment of symptomatic multiple pancreatic stones and anastomotic stricture after end-to-side pancreaticojejunostomy. Endoscopic ultrasound-guided pancreaticogastrostomy was performed in an attempt to avoid re-surgery. At 18 days after the initial procedure, a guidewire was successfully placed in the jejunum through the anastomotic stricture. The anastomotic stricture was dilated using a dilation balloon, and all of the stones were pushed into the jejunum using a retrieval balloon. No complications were experienced during the procedure. At 22 months after the stone removal, the main pancreatic duct displayed a decreased diameter, and no stone recurrence was detected.
胰肠吻合口狭窄是胰头切除术后的一种晚期并发症，且难以处理。胰头切除术后患者的解剖结构发生改变，使用传统的内镜进行胰管引流较为困难，尤其难以在内镜下识别狭窄的胰肠吻合口。一名 40 岁女性因胰肠侧侧吻合术后出现症状性多发性胰石和吻合口狭窄，被转至我科治疗。为避免再次手术，我们尝试进行了内镜超声引导下的胰胃吻合术。初次手术后 18 天，导丝成功穿过吻合口狭窄部位进入空肠。使用扩张球囊扩张吻合口狭窄部位，并使用取石球囊将所有结石推入空肠。手术过程中未出现任何并发症。在取石后 22 个月，主胰管直径减小，未发现结石复发。
