背景IgG4相关性硬化性胆管炎(IgG4 related sclerosing cholangitis,IgG4-SC)是IgG4相关性疾病(IgG4-related disease,IRD)的胆道表现.IgG4-SC常有胆管壁局限性增厚、胆管扩张以及梗阻性黄疸等特点,其表现与胆胰恶性肿瘤类似,临床上容...背景IgG4相关性硬化性胆管炎(IgG4 related sclerosing cholangitis,IgG4-SC)是IgG4相关性疾病(IgG4-related disease,IRD)的胆道表现.IgG4-SC常有胆管壁局限性增厚、胆管扩张以及梗阻性黄疸等特点,其表现与胆胰恶性肿瘤类似,临床上容易延迟诊断甚至误诊.目的总结IgG4-SC的患者临床特征和诊治过程,提高临床医师对该病的认识,避免误诊.方法回顾性分析了2012年至2020年间入院影像学检查发现胆管炎同时伴有肝门、壶腹、胰腺疑似占位病变的5例IgG4-SC.采集患者基本信息,包括年龄、性别、症状、体征、既往病史、诊疗过程.结果4例表现为梗阻性黄疸,影像学提示胆道高位梗阻1例,低位梗阻3例,梗阻部位位于肝门、胰头部或壶腹部,疑似恶性占位;1例为体检发现胰颈部占位,恶性不除外.实验室检查可见胆红素升高、以直接胆红素为主,伴肝功能损伤,血清IgG4水平明显升高;肿瘤标志物正常或轻度升高.4例患者经多学科会诊确诊为IgG4-SC,1例手术后病理确诊.结论多学科会诊是认识IgG4-SC、避免误诊的重要经验.展开更多
In endoscopic placement of multiple plastic biliary stents (PBSs),we sometimes experience proximal dislocation of the first PBS at the time of subsequent PBS insertion.We describe the case of a 79-year-old male with o...In endoscopic placement of multiple plastic biliary stents (PBSs),we sometimes experience proximal dislocation of the first PBS at the time of subsequent PBS insertion.We describe the case of a 79-year-old male with obstructive jaundice caused by cholangiocarcinoma who needed to receive multiple PBS placements for management of cholangitis.Although proximal dislocation of the first PBS was observed,we prevented the dislocation via our technique of using guidewire inserted from the distal end of the first PBS to the side hole as the anchor-wire.We could complete this technique only by inserting guidewire through the side hole of the first PBS during the process of releasing the first PBS and pulling out the guidewire and the inner sheath.It did not matter whether the anchor-wire went towards the third portion of the duodenum or the duodenal bulb.Here we introduce this "anchor-wire technique",which is useful for the prevention of PBS proximal dislocation in placing multiple PBSs.展开更多
文摘背景IgG4相关性硬化性胆管炎(IgG4 related sclerosing cholangitis,IgG4-SC)是IgG4相关性疾病(IgG4-related disease,IRD)的胆道表现.IgG4-SC常有胆管壁局限性增厚、胆管扩张以及梗阻性黄疸等特点,其表现与胆胰恶性肿瘤类似,临床上容易延迟诊断甚至误诊.目的总结IgG4-SC的患者临床特征和诊治过程,提高临床医师对该病的认识,避免误诊.方法回顾性分析了2012年至2020年间入院影像学检查发现胆管炎同时伴有肝门、壶腹、胰腺疑似占位病变的5例IgG4-SC.采集患者基本信息,包括年龄、性别、症状、体征、既往病史、诊疗过程.结果4例表现为梗阻性黄疸,影像学提示胆道高位梗阻1例,低位梗阻3例,梗阻部位位于肝门、胰头部或壶腹部,疑似恶性占位;1例为体检发现胰颈部占位,恶性不除外.实验室检查可见胆红素升高、以直接胆红素为主,伴肝功能损伤,血清IgG4水平明显升高;肿瘤标志物正常或轻度升高.4例患者经多学科会诊确诊为IgG4-SC,1例手术后病理确诊.结论多学科会诊是认识IgG4-SC、避免误诊的重要经验.
文摘In endoscopic placement of multiple plastic biliary stents (PBSs),we sometimes experience proximal dislocation of the first PBS at the time of subsequent PBS insertion.We describe the case of a 79-year-old male with obstructive jaundice caused by cholangiocarcinoma who needed to receive multiple PBS placements for management of cholangitis.Although proximal dislocation of the first PBS was observed,we prevented the dislocation via our technique of using guidewire inserted from the distal end of the first PBS to the side hole as the anchor-wire.We could complete this technique only by inserting guidewire through the side hole of the first PBS during the process of releasing the first PBS and pulling out the guidewire and the inner sheath.It did not matter whether the anchor-wire went towards the third portion of the duodenum or the duodenal bulb.Here we introduce this "anchor-wire technique",which is useful for the prevention of PBS proximal dislocation in placing multiple PBSs.
