内镜下柱状球囊扩张联合多支架一期治疗合并十二指肠球部侵犯的晚期胰头癌症候群1例(含视频)

Endoscopic cylindrical balloon dilation with multiple stents placement in a single procedure for the treatment of disseminated pancreatic head cancer with duodenal obstruction (with video)

摘要:

晚期胰头恶性肿瘤除胆、胰管受累外,常因侵犯十二指肠致肠腔狭窄导致患者无法进食。内镜下胆胰管支架置入术是缓解梗阻性黄疸及胰源性腹痛的最佳治疗手段之一。然而,此类患者常因进镜困难而导致内镜治疗失败。报道1例合并十二指肠球部受侵狭窄的晚期胰头癌患者,经内镜联合柱状球囊扩张,同期置入胆道金属覆膜支架、胰管塑料支架及肠道支架,术后患者黄疸、腹痛及呕吐症状明显好转,经口进半流食无不适后出院。

Abstract:

Advanced pancreatic head malignancy often leads to intestinal lumen narrowing due to duodenal invasion, in addition to the involvement of the bile and pancreatic ducts, resulting in the patient’s inability to eat. Endoscopic placement of biliary and pancreatic duct stents is one of the most effective therapeutic approaches to relieve obstructive jaundice and pancreatitis-related abdominal pain. However, patients often experience difficulties during endoscopic access, which can result in treatment failure. We report a case of a patient with advanced pancreatic head cancer complicated by stenosis of the duodenal bulb, who underwent endoscopic balloon dilation and simultaneous placement of a covered metallic stent in the bile duct, a plastic stent in the pancreatic duct, and an intestinal stent. Postoperatively, there was a significant improvement in the patient"s symptoms of jaundice, abdominal pain, and vomiting, and the patient was discharged after tolerating a soft diet without discomfort.