Chick Jeffrey Forris Beecham, Roush Benjamin B, Khaja Minhaj S, Prohaska Dennis, Cooper Kyle J, Saad Wael E, Srinivasa Ravi N
Department of Radiology, Division of Vascular and Interventional Radiology, University of Michigan Medical Center, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA.
Western Michigan University School of Medicine, Kalamazoo, MI, USA.
Radiol Case Rep. 2017 Feb 2;12(2):323-326. doi: 10.1016/j.radcr.2017.01.002. eCollection 2017 Jun.
Percutaneous image-guided biopsies of pancreatic malignancies may prove challenging and nondiagnostic due to a variety of anatomic considerations. For patients with complex post-surgical anatomy, such as a Roux-en-Y gastric bypass, diagnosis via endoscopic ultrasound with fine-needle aspiration may not be possible because of an inability to reach the proximal duodenum. This report describes the first diagnostic case of transbiliary intravascular ultrasound-guided biopsy of a pancreatic head mass in a patient with prior Roux-en-Y gastric bypass for which a diagnosis could not be achieved via percutaneous and endoscopic approaches. Transbiliary intravascular ultrasound-guided biopsy resulted in a diagnosis of pancreatic adenocarcinoma, allowing the initiation of chemotherapy.
由于多种解剖学因素，经皮影像引导下的胰腺恶性肿瘤活检可能具有挑战性且无法得出诊断结果。对于有复杂术后解剖结构的患者，如 Roux-en-Y 胃旁路术后患者，由于无法到达十二指肠近端，通过内镜超声引导下细针穿刺抽吸进行诊断可能无法实现。本报告描述了首例经胆道血管内超声引导下对一名曾行 Roux-en-Y 胃旁路术患者的胰头肿块进行活检的诊断病例，该患者此前经皮和内镜途径均无法确诊。经胆道血管内超声引导下活检确诊为胰腺腺癌，从而得以开始化疗。
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