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中华胃肠内镜电子杂志 ›› 2023, Vol. 10 ›› Issue (03) : 209 -212. doi: 10.3877/cma.j.issn.2095-7157.2023.03.014

病例报告

双气囊小肠镜辅助下小肠金属支架置入术1例并文献复习
乔璐, 赵刚(), 陈芬荣, 李路, 宋亚华, 王进海   
  1. 710004 西安,西安交通大学第二附属医院消化内科
  • 收稿日期:2023-02-24 出版日期:2023-08-15
  • 通信作者: 赵刚
  • 基金资助:
    陕西省重点研发计划一般项目(2021SF-224)

Double balloon enteroscopy-assisted enteral stent placement by for palliation of malignant small bowel obstruction: A case report and literature review

Lu Qiao, Gang Zhao(), Fenrong Chen   

  • Received:2023-02-24 Published:2023-08-15
  • Corresponding author: Gang Zhao
引用本文:

乔璐, 赵刚, 陈芬荣, 李路, 宋亚华, 王进海. 双气囊小肠镜辅助下小肠金属支架置入术1例并文献复习[J]. 中华胃肠内镜电子杂志, 2023, 10(03): 209-212.

Lu Qiao, Gang Zhao, Fenrong Chen. Double balloon enteroscopy-assisted enteral stent placement by for palliation of malignant small bowel obstruction: A case report and literature review[J]. Chinese Journal of Gastrointestinal Endoscopy(Electronic Edition), 2023, 10(03): 209-212.

恶性小肠梗阻是晚期胃肠道肿瘤、妇科肿瘤等的常见并发症[1,2],患者常表现为恶心、呕吐和腹痛、腹胀等。外科手术是其首选的治疗方式,文献报道有14.5%的死亡率和32.2%的并发症发生率,且部分患者因一般状况较差,无法耐受手术[3]。目前,自膨式金属支架(self-expandable metallic stent, SEMS)在临床上广泛应用于胃流出道梗阻和结直肠梗阻的治疗,而在恶性小肠梗阻应用的报道极少。本文旨在报道,双气囊小肠镜辅助下经外套管金属支架置入治疗恶性小肠梗阻1例,并进行系统文献回顾。

图1 术前患者上腹部增强CT结果:肝内多发结节考虑转移瘤,胃潴留注:A:动脉期(门静脉层面);B:动脉期(胰腺层面);C:延迟期(门静脉层面);D:延迟期(胰腺层面)
图2 肝脏及小肠病理诊断结果注:A:肝脏病理诊断结果:中分化管状腺癌,考虑转移性(消化道来源);B:小肠病理诊断结果:空肠上段腺癌
图3 小肠镜辅助下小肠支架置入过程注:A~B:小肠镜进镜至狭窄段;C:金属钛夹标记病变位置;D:ERCP专用拉式切开刀在导丝引导下在狭窄部插管及造影;E:X线下显示狭窄段大约6 cm;F:保留导丝及外套管并退出小肠镜;G:X线透视下可见外套管结构;H:X线透视下导丝在空肠肠腔内盘曲,并可见标记的钛夹;I:沿导丝送入支架推送器后释放支架;J:释放支架后造影显示支架通过顺利
图4 外套管体外示意图
图5 A、B:术后2周复查消化道钡餐透视提示造影剂通过顺利
表1 小肠镜辅助下小肠支架置入术患者总结
作者 发表年份(年) 年龄(岁) 性别 原发肿瘤 手术治疗史 狭窄位置 小肠镜(型号,厂家)
Sasaki等[7] 2014 64 胰腺神经内分泌肿瘤 Roux-en-Y术 输入襻 双气囊,EN-450T5/W,日本富士能公司
Hayashi等[8] 2006 65 空肠肿瘤 距屈氏韧带30 cm处空肠 双气囊,EN-450P5,日本富士能公司
Espinel等[14] 2011 73 胰腺癌 十二指肠水平段 单气囊,SIF Q180,日本奥林巴斯公司
Shugo等[9] 2015 76 胰腺癌 胰十二指肠切除术 输入襻 双气囊,GIF Type 2T240,日本奥林巴斯公司
Ross等[11] 2006 59 小细胞肺癌 十二指肠降段 双气囊,EN450T5,日本富士能公司
Lennon等[16] 2010 53 胰腺癌 屈氏韧带处 螺旋式,SIF-Q180,日本奥林巴斯公司
    48 直肠癌 近端空肠 螺旋式,SIF-Q180,日本奥林巴斯公司
Kida等[10] 2013 68 胰腺癌 保留幽门的胰十二指肠切除术 输入襻 双气囊,EN-450T5/W,日本富士能公司
    81 胰腺癌 远端十二指肠 双气囊,EC450-BI5,日本富士能公司
Fujii等[12] 2015 60+ 胆管癌 Roux-en-Y术 输入襻 双气囊,EC-450BI5,日本富士能公司
    60+ 壶腹癌 胰十二指肠切除术 输入襻 双气囊,EC-450BI5,日本富士能公司
Popa等[15] 2014 80 胰头癌 保留幽门的胰十二指肠切除术 输入襻 双气囊,-
Tsuboi等[13] 2016 87 胰头癌 远端十二指肠 双气囊,CF-H260AI,日本奥林巴斯公司
    60 胰腺癌 远端回肠 双气囊,CF-H260AI,日本奥林巴斯公司
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