Kuwamura Hiroshi, Suyama Yohsuke, Enjoji Yasuhiro, Einama Takahiro, Kishi Yoji, Shinmoto Hiroshi
Department of Radiology, National Defense Medical College, Saitama 359-8513, Japan.
Department of Hepato-Biliary-Pancreatic Surgery, National Defense Medical College, Saitama 359-8513, Japan.
BJR Case Rep. 2024 Aug 26;10(5):uaae031. doi: 10.1093/bjrcr/uaae031. eCollection 2024 Sep.
Superior mesenteric artery (SMA) invasion by a malignant tumour is a serious condition leading to intestinal ischaemia. Although SMA stenting has been reported to be useful for SMA dissection and stenosis caused by atherosclerotic plaque, SMA stenting for stenosis caused by malignant tumour invasion is rarely reported and uncertain. A 75-year-old woman presented intestinal ulcer and melena caused by SMA invasion of unresectable pancreatic cancer. The bare metal stent was implanted for the vessel stenosis, and a small intestinal ulcer was markedly improved after stenting. However, one and a half months after stenting the stent was occluded and a thrombectomy was performed. After thrombectomy, residual stenosis caused by tumour invasion was observed in the stent. The patient suddenly died 2 days after thrombectomy before additional covered stenting for residual stenosis. Stent implantation may be a treatment option for intestinal ischaemia caused by vessel invasion of malignant tumours. On the other hand, re-stenosis of the stent due to tumour ingrowth is a problem, and covered stenting is considered for long-term stent patency.
恶性肿瘤侵犯肠系膜上动脉（SMA）是一种导致肠缺血的严重情况。尽管已有报道称SMA支架置入术对动脉粥样硬化斑块引起的SMA夹层和狭窄有用，但对于恶性肿瘤侵犯所致狭窄的SMA支架置入术报道很少且疗效不明确。一名75岁女性因不可切除胰腺癌侵犯SMA出现肠道溃疡和黑便。为血管狭窄植入了裸金属支架，支架置入后小肠溃疡明显改善。然而，支架置入后一个半月支架闭塞，遂行血栓切除术。血栓切除术后，在支架内观察到由肿瘤侵犯导致的残余狭窄。患者在血栓切除术后2天，在为残余狭窄植入覆膜支架之前突然死亡。支架植入可能是恶性肿瘤侵犯血管所致肠缺血的一种治疗选择。另一方面，肿瘤长入导致支架再狭窄是一个问题，覆膜支架置入术被认为可维持支架长期通畅。
