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題名 | 使用經皮穿肝膽道鏡術治療膽道結石之經驗 |
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作者姓名(中文) | 詹益銀; 陳敏夫; | 書刊名 | 中華民國外科醫學會雜誌 |
卷期 | 18:4 1985.12[民74.12] |
頁次 | 頁359-366 |
分類號 | 416.247 |
關鍵詞 | 經皮穿肝膽道鏡術; 治療; 膽道結石; |
語文 | 中文(Chinese) |
中文摘要 | 經皮穿肝膽迫鏡術(Percutaneous transhepatic cholangioscopy PTC S)是使用膽道纖維鏡經由已擴大之經皮穿膽膽道引流瘻管來診斷或治療膽道疾病的方法。長庚紀念醫院一般外科自1983年10月至1984年8月共使用經皮穿肝膽道鏡治療16例膽道結石,男10例女6例。年齡最小24歲最大85歲,平均48歲。87.5%(14/16)的病人以前有膽道手術之病史。93.75% (15/16)的病人因急性膽管炎(腹痛、發燒、畏冷、黃疸)而入院;其中5例急性膽管炎的症狀經抗生素治療而消失,另10例的症狀由經皮穿肝膽道引流(Percutaneous transhepatic biliary drainage PTBD)治療所控制。膽道結石的位置;總膽管(5位)、總膽管及肝內膽管(2位)、肝內膽管(9位)。94% (15/16)的膽道結石經由PTCS治療成功。使用膽進鏡的次數自1回至1回悶不等,平均4.5回。有1例使用PTCS取石治療過程中發生敗血症經入院給予抗生素治療而癒。另1例(PTCS失敗例)因膽石位于右前下枝肝管經選擇性肝管穿刺引流失敗而發生右橫隔膜下血腫接受剖腹引流治療。 使用經皮穿肝膽道鏡術治療膽道結石是一種非手術性且有效的方法,尤其對于健康情況欠佳,再次膽道手術,膽管形態異常或手術不易之肝內結石病例提供了另一種治療法。唯一的缺點是準備時間較長需時4個星期左右。 |
英文摘要 | Percutaneous transhepatic cholangioscopy (PTCS)is a technique to diagnose and treat biliary diseases with a choledochofiberscope inserted through a dilated percutaneous transhepatic biliary fistula. Sixteen cases of biliary stones were treated by the PTCS from Oct. 1983 to Aug. 1984 in Chang Gung Memorial Hospital; 10 were males and 6, females. Age distribution ranged from 24 to 85, with a mean of 48 years old. 87.5% (14 cases) of patients had a history of previous biliary operation for biliary calculi. Of the 16 cases, 15 (93.75%) were associated with acute cholangitis; 5 of these were controlled by medical treatment, followed selectively by PTCS; another 10 received PTBD initially, then followed by PTCS. One of 16 cases was treated by PTCS electively. The locations of the stones in 16 cases were: CBD in 5, CBD and IHD in 2 and IHD in 9. Complete removal of biliary stones in 15 cases resulted in a success rate of 93.75%. The sessions of PTCS ranged from 1 to 12, or a mean of 4.5; 12.5% (2/16) had complications during the course of PTCS: one case had septicemia and another, subphrenic hematoma. PTCS is effective and safe for nonsurgical management of biliary stones. It is a rational treatment to the following particular situations which are not suitable for surgery; post-operative retained biliary stones, intrahepatic stones with post-biliary enteric anastomosis, old age or high risk patients. |
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