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同轴双猪尾支架置入术：一种降低与管腔贴合金属支架相关出血风险的简单解决方案？

Coaxial Double-Pigtail Stent Placement: A Simple Solution to Decrease Bleeding Risk Associated With Lumen-Apposing Metal Stent?

作者信息

Aslam Shehroz, Ansari Zaid, Alani Mustafa, Srinivasan Indu, Chuang Keng-Yu

机构信息

Internal Medicine, Creighton University School of Medicine, St. Joseph's Hospital and Medical Center, Phoenix, USA.

Gastroenterology, Creighton University School of Medicine, St. Joseph's Hospital and Medical Center, Phoenix, USA.

出版信息

Cureus. 2021 Jun 28;13(6):e15981. doi: 10.7759/cureus.15981. eCollection 2021 Jun.

DOI:10.7759/cureus.15981
PMID:34336472
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8318618/
Abstract

Endoscopic cystogastrostomy using lumen-apposing metal stent (LAMS) is considered the first-line therapy for symptomatic pancreatic fluid collections (PFCs). Routine coaxial placement of a double-pigtail stent (DPS) through LAMS is debated. We report the case of a patient with delayed massive gastrointestinal bleed eight weeks after LAMS placement due to splenic artery pseudoaneurysm leading to a complicated hospitalization. Theoretically, coaxial placement of DPS through LAMS can prevent the relatively sharp LAMS from eroding into the mucosa of the collapsed cavity of PFCs, decreasing the risk of bleeding. Our case adds to the growing need to further explore the utility of this combined intervention.

摘要

使用管腔对接金属支架（LAMS）的内镜下囊肿胃造口术被认为是有症状的胰腺液体积聚（PFC）的一线治疗方法。关于是否常规通过LAMS同轴放置双猪尾支架（DPS）存在争议。我们报告了一例患者，在放置LAMS八周后因脾动脉假性动脉瘤导致大量胃肠道出血延迟，从而导致复杂的住院治疗。从理论上讲，通过LAMS同轴放置DPS可以防止相对尖锐的LAMS侵蚀到PFC塌陷腔的黏膜中，降低出血风险。我们的病例进一步表明越来越有必要进一步探索这种联合干预措施的效用。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d038/8318618/a965f0980c2f/cureus-0013-00000015981-i06.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d038/8318618/e6c515d74a7d/cureus-0013-00000015981-i01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d038/8318618/bcfede3b2a4d/cureus-0013-00000015981-i02.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d038/8318618/007ae317ee3f/cureus-0013-00000015981-i03.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d038/8318618/d686a9414d11/cureus-0013-00000015981-i04.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d038/8318618/20ea71fbedc0/cureus-0013-00000015981-i05.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d038/8318618/a965f0980c2f/cureus-0013-00000015981-i06.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d038/8318618/e6c515d74a7d/cureus-0013-00000015981-i01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d038/8318618/bcfede3b2a4d/cureus-0013-00000015981-i02.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d038/8318618/007ae317ee3f/cureus-0013-00000015981-i03.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d038/8318618/d686a9414d11/cureus-0013-00000015981-i04.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d038/8318618/20ea71fbedc0/cureus-0013-00000015981-i05.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d038/8318618/a965f0980c2f/cureus-0013-00000015981-i06.jpg

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本文引用的文献

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2
Increased Incidence of Pseudoaneurysm Bleeding With Lumen-Apposing Metal Stents Compared to Double-Pigtail Plastic Stents in Patients With Peripancreatic Fluid Collections.与双猪尾塑料支架相比， lumen- 吻合金属支架在胰周积液患者中假性动脉瘤出血的发生率增加。
Clin Gastroenterol Hepatol. 2018 Sep;16(9):1521-1528. doi: 10.1016/j.cgh.2018.02.021. Epub 2018 Feb 21.
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用于胰液积聚引流的管腔贴壁金属支架不良事件分析
Endosc Int Open. 2023 Dec 12;11(12):E1153-E1160. doi: 10.1055/a-2197-3731. eCollection 2023 Dec.
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Endoscopic Treatment of Complex Walled-Off Necrosis in Necrotizing Pancreatitis With Two Simultaneous Lumen-Apposing Metal Stents: A Case Report.应用两个同步管腔贴壁金属支架内镜治疗坏死性胰腺炎复杂包裹性坏死：病例报告
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