A Case of Pancreatic Pseudocyst With Thickened Hard Wall Successfully Treated by EUS-Guided Drainage

症例は53歳女性．慢性膵炎の急性増悪と膵仮性嚢胞内の出血，増大にて入院となり，内視鏡的ドレナージ術を施行した．膵頭部の60mm大の仮性嚢胞に対し胃前庭部から超音波内視鏡（EUS）下に穿刺し，0.035inchのガイドワイヤーを挿入後，5Frのテーパードカテーテルから段階的な穿刺ルートの拡張を試みた．しかし，嚢胞壁は慢性炎症性変化で12mmと著明に肥厚，硬化しており，拡張が困難であった．そこでガイドワイヤーチャンネル付きのニードルナイフを用いて胃壁および嚢胞壁を通電切開したところ，嚢胞内へのアプローチが可能となった．これによりカテーテル径5Frの拡張用バルーンカテーテルが嚢胞内へ挿入可能となり，嚢胞壁を拡張して6.5Fr経鼻外瘻チューブを留置しえた． 今回われわれは12mmの厚い嚢胞壁を有する膵仮性嚢胞に対しEUSガイド下ドレナージを施行したところ，穿刺後，肥厚，硬化した嚢胞壁のため瘻孔拡張に難渋したが，ガイドワイヤー式ニードルナイフおよび細径拡張用バルーンカテーテルの併用が有用であった．

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