應用雙氣囊小腸鏡取出膽管空腸吻合術空腸端移位的金屬支架－－病例報告

Double-Balloon Enteroscopy Through a Roux-En-Y Limb for Removal of Migrated Metallic Stent: Report of a Case

67歲男性病人因膽結石接受腹腔鏡膽囊摘除術不幸傷到總膽管造成斷裂，之後急做膽管空腸吻合術以空腸來接合膽管。病人術後2個月後即反覆膽管炎發作，長期以來均需經皮穿肝膽管引流來緩解症狀，膽道影像顯示膽管空腸吻合處明顯狹窄，故置入金屬支架緩解，但金屬支架在置入隔天即移位並造成膽管阻塞，在使用傳統小腸鏡取出失敗後我們改用雙氣囊小腸鏡成功的取出空腸端移位的金屬支架， 證明要用內視鏡進入膽管空腸吻合術空腸端，雙氣囊小腸鏡是唯一選擇，這也是使用雙氣囊小腸鏡成功取出空腸端移位金屬支架的第一個病例。

The self-expandable metallic stent is increasingly being used for management of malignant biliary strictures and sometimes for benign strictures. Although the migration rate of metallic stents is very rare, removal of migrated metallic stents is a technical challenge if patient has received a biliary Roux-en-Y operation. A patient who had received Roux-en-Y operation due to common bile duct transection received self-expandable metallic stents insertion for benign stricture of hilum. Unfortunately the self-expandable metallic stents migrated soon after insertion. We had tried push type enteroscopy for metallic stents removal but that failed. Finally we successfully removed the migrated metallic stents with double balloon intestinal endoscope. Migration of self-expandable metallic stents in the Roux-en-Y intestinal loop is a very rare condition and is difficult to resolve. We removed the migrated metallic stent with double balloon enteroscopy and found a new indication of double balloon enteroscopy.