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- Routine Endoscopic Retrograde Gholangiopancre Atioegraphy in Laparoscopic Cholecystectomy: Indication or Contraindication﹖
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題名 | Routine Endoscopic Retrograde Gholangiopancre Atioegraphy in Laparoscopic Cholecystectomy: Indication or Contraindication﹖=經腹腔鏡膽囊摘除術前常規性經內視鏡逆行性胰膽管攝影術:其適應與否﹖ |
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作者 | 劉曉東; 劉思源; 張子明; 曹為霖; 許重得; 陳之凱; 沈國樑; |
期刊 | 醫學研究 |
出版日期 | 19951100 |
卷期 | 16:3 1995.11[民84.11] |
頁次 | 頁177-181 |
分類號 | 416.247 |
語文 | eng |
關鍵詞 | 經腹腔鏡膽囊摘除術; 總膽管結石; Laparoscopic cholecystectomy; LC; Endoscopic retro-grade; Cholangiopancreaticography; ERCP; Choledocholithiasis; |
中文摘要 | 本研究在評估經腹腔鏡膽囊摘除術前常規使用經內視鏡逆行性胰膽管攝影術的適應性。76位病人(男:女=23:53,平均年齡55.4歲)均將接受經腹腔鏡膽囊摘除術,被包含在此前瞻性研究當中。腹部超音波,血清肝功能測驗,以及詳盡之病史,用來臆測有總膽管結石的跡象者全被記錄數集。術前經內視鏡逆行性胰膽管攝影術成功者有58例(76.3%),其中47例(81%)被判讀為正常;另外11例(18.9%)則有總膽管結石或都接受經內視鏡括約肌切開術,並且完全擴清總膽管。另兩位病人則因壺腹部狹窄而接受經內視鏡括約肌切開術。原先擬使用腹腔鏡行膽囊摘除術者,有4例因解剖構造異常而改變手術方式。餘54例中行腹腔鏡手術失敗者佔5.5%。術前憑腹部超音波,血清肝功能測驗,以及病史臆為總膽管結石者,只有一例(20%)確有總膽管結石。經內視鏡逆行性胰膽管攝影術後,血中澱粉酶昇高且有症狀者有4例(6.9%)。術前常規性使用經內視鏡逆行性胰膽管攝影術後,在本研究群中可偵知17.2%的異常發現,且此異常不能單憑腹部超音波,血清肝功能測驗,以及病史所得知。雖然經腹腔鏡膽囊摘除術行經內視鏡逆行性胰膽管攝影術及經內視鏡括約肌切開術,來治療總膽管結石仍為可行性,但經腹腔鏡膽囊摘除術前行經內視鏡逆行性胰膽管攝影術,對降低手術當中膽道傷害的危險性更可能達成。由於術中腹腔鏡膽囊造影術亦可提供相當成功率的膽道造影,故我們建議經腹腔鏡膽囊摘除術前行經內視鏡逆行性胰膽管攝影術應於術前有臨床癥兆的病人中選擇性行之,而非現行的例行檢查。 |
英文摘要 | This study was conducted to evaluate the routine use of endoscopic retrograde cholangiopancreaticography (ERCP) in laparoscopic cholecystectomy (LC). Seventy-six patients (M;F=23:53, age average 55.4 yrs) eligible for LC were included in this prospective study. Ultrasonography (US), liver function test (LFT), & details of history suggesting common bile duct (CBD) stone were obtained. Preoperative ERCP was successful in 58 cases (76.3%). Forty-seven (81%) were interpreted as normal. Eleven patients (19%) had either CBD stones or anomalous-biliary tract anatomy. Five patients (8.6%) had CBD stone, & clearance of the CBD with endoscopic sphincterotomy (EST) was achieved in all. Another 2 patients received EST for strictured papill. Attempts of LC were changed in the other 4 patients with anomalous anatomy. Conversion rate in the remaining 54 patients was 5.5%. Only one of CBD stone cased (20%) could be sorted out with either US, LFT, or history suggesting CBD stone. Post-ERCP hyperamylasemia developed in 4 patients (6.9%). The routine use of preperative ERCP in this group detected 17.2% of abnormalities which could be missed with US, LFT, or history only. Although post-LC ERCP with EST is feasible for CBD stone, risk of biliary tract injury is minimized when pre-LC ERCP suggest this possibility. |
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