Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Showa-ku, Nagoya, Japan.
Department of Endoscopy, Nagoya University Hospital, Showa-ku, Nagoya, Japan.
J Dig Dis. 2022 Jan;23(1):44-49. doi: 10.1111/1751-2980.13077. Epub 2022 Jan 18.
Migration of a fish bone to the bile duct or pancreatic duct is a possible complication after pancreaticoduodenectomy (PD). The aim of this study was to clarify the incidence and indications for intervention in such cases.
We reviewed the cases with fish bone migration after PD detected on computed tomography (CT) scan between October 2000 and October 2020 were reviewed and the incidence of fish bone migration, presence of symptoms and signs, therapeutic modalities and patient outcomes were analyzed.
Among the 1475 PD procedures performed at our institution during the study period, 14 cases of fish bone migration were noted on CT, the incidence of which was 0.95% (14/1475). The time duration from surgery to the detection of fish bone ranged from 88 to 5902 days (median 917 d). Ten patients remained asymptomatic without therapeutic intervention for up to 2919 days (median 509 d). Four patients were treated by endoscopy, either at the patient's request (n = 1) or because of their symptoms (n = 3), and removal was successful in three cases but failed in one case in which the fish bone migrated to the right intrahepatic bile duct. No surgical treatment was required in any case.
The incidence of fish bone migration on CT after PD was about 1%. Some cases resolved spontaneously, and most of the asymptomatic cases required no intervention. For symptomatic cases, endoscopic treatment should be considered first. It is important to confirm the location of the fish bone by CT and determine whether it can be removed.
在胰十二指肠切除术（PD）后，鱼骨迁移到胆管或胰管是一种可能的并发症。本研究旨在阐明这种情况下的发生率和干预指征。
我们回顾了 2000 年 10 月至 2020 年 10 月期间在 CT 扫描上检测到 PD 后鱼骨迁移的病例，并分析了鱼骨迁移的发生率、症状和体征的存在、治疗方式和患者结局。
在研究期间，在我们机构进行的 1475 例 PD 手术中，有 14 例在 CT 上发现鱼骨迁移，其发生率为 0.95%（14/1475）。从手术到发现鱼骨的时间间隔从 88 天到 5902 天（中位数 917 天）。10 例患者无症状，未进行治疗，最长随访时间为 2919 天（中位数 509 天）。4 例患者因症状或个人要求行内镜治疗，3 例成功取出鱼骨，1 例鱼骨迁移至右肝内胆管，内镜治疗失败。无一例需要手术治疗。
PD 后 CT 上鱼骨迁移的发生率约为 1%。一些病例自行缓解，大多数无症状病例无需干预。对于有症状的病例，应首先考虑内镜治疗。通过 CT 确认鱼骨的位置并确定是否可以取出非常重要。
