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題 名 | 經皮穿肝膽道引流術初步治療急性膽管炎 |
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作 者 | 詹益銀; | 書刊名 | 中華民國外科醫學會雜誌 |
卷 期 | 19:2 1986.05[民75.05] |
頁 次 | 頁105-111 |
分類號 | 416.247 |
關鍵詞 | 經皮穿肝膽道引流術; 治療; 急性膽管炎; |
語 文 | 中文(Chinese) |
中文摘要 | 自1983年9月至1984年9月共使用經皮穿肝瞻遠引流術(PTBD)初步治療急性膽管炎56例;另37位女19位,年齡最小16歲最大85歲,平均49歲。引起急性膽管炎之病因以膽道結石最常見38例佔67.8%,惡性腫瘤次之14例佔25%及4例良性膽道狹窄。臨床上以典型Charcot's triad表現者50例佔89.2%,25%病人有休克現象。血液培養陽性率69.6%而膽汁培養94.7%有菌株生長。 急性膽管丸經PTBD減壓治療效果"良好"者(包括自覺症狀改善、腹痛減輕或消失、體溫恢復正常)46例(82.2%),而減壓效果"不良渚"者10例(17.8%)。急性膽管炎經PTBD減壓效果良好46例病人之進一步治療;22例接受確定性膽道手術,15例膽道結石經由PTBD瘻管使用膽道鏡取石治療,以PTBD完成治療或辜息性治療者7例。1例總膽管結石經由endoscopic papillotomy取石成功,另1例膽道腸吻合口狹窄經由PTBD瘻管使用氧球導管(balloon catheter)擴張術治療。 PTBD治療後有12例發生併發症佔21.4%,以出血7例(膽血在4例,穿刺口出血2例,內出血1例)最多。56例急性膽管炎經PTBD治療後有5例住院期間死亡佔8.9%;2例PTBD治療後有膽血症發生,一直內科保守性治療終因敗血性休克死亡。2例PTBD 減雇效果不良,隨卽接受緊急膽迫引流術,術後不治死亡。1例經PTBD減壓治療後情況大有進步,引流後2個星期接受常規性膽道手術,不幸術後發生急性肺水腫經急救無效。 經皮穿肝膽道引流術用來治療急性膽管炎,是一種非手術性、快速且有效的方法,它提供了詳細的膽道解剖、膽管阻塞的正確原因及位置有助於進一步的治療計劃。如能熟練或改進PTBD的技術使併發症降至最低程度,PTBD是緊急治療急性膽管炎可行辦法之一。 |
英文摘要 | Percutaneous transhepatic biliary drainage (PTBD) was performed from September 1983 to September 1984 in 56 patients, consecutively, who suffered from severe acute cholangitis and had been admitted to Chang Gung Memorial Hospital. Causes of obstruction of the biliary tract included biliary stones (38), periampullary tumor (9), hilar obstruction with cholangioma or hepatoma (5) and benign bi1iary strictures (4). Clinically, 50 patients (89.2%) presented with typical Charcot's triad and 14 patients (25%) had hypotension; 69.6% of the patients had positive blood cultures and 94.7% of their bile cultures had bacteria growth. Immediate decompression effect with good response was achieved in 46 patients (82.2%); they were usual1y afebrile within 24 to 72 hours. A"poor" response was noted in 10 (17.8%). Further treatment of 46 patients with good decompression response after PTBD were: 22 patients required a subsequent operation, 15 biliary stones were removed by fiberoptic choledochoscopy through PTBD fistula, seven patients was treated by PTBD only, endoscopic papillotomy was performed for one, and in another biliary stricture was dilated with ballon catheter through the PTBD fistula. Complications related to the procedure occurred in 12 of the 56 patients (21.4%). Bleeding problems (in 7) were most common; hemobilia was the major complication. Five patients die under subsequent treatment, but no mortality was directly associated with the use of PTBD. PTBD offers a rapid and effective decompression method for initial therapy of acute biliary sepsis. The procedure reveals anatomical detail that can be used to plan further management. In most patients, a definite surgical procedure can be delayed until the general condition is stabilized. In some patients, the disease can be rnanaged successfully by a non-operated method through the PTBD fistula. |
本系統中英文摘要資訊取自各篇刊載內容。