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題 名 | Follow-Up Study in Patients with No Stone Retrieval from the Bile Duct after Endoscopic Sphincterotomy=經內視鏡括約肌切開術後未發現膽管結石者之追蹤報告 |
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作 者 | 林俊宏; 黎國洪; 羅錦河; 鄭錦翔; 黃榮隆; 林俊谷; 黃嘉生; 姜洪霆; | 書刊名 | 中華醫學雜誌 |
卷 期 | 62:1 1999.01[民88.01] |
頁 次 | 頁6-12 |
分類號 | 416.247 |
關鍵詞 | 壼腹腫瘤; 膽道結石; 經內視鏡膽道括約肌切開術; 肝細胞癌; Ampullary tumor; Choledocholithiasis; Endoscopic sphincterotomy; Hepatocellular carcinoma; |
語 文 | 英文(English) |
中文摘要 | 背景 文獻曾報告有10-20%的病例,在懷疑有總膽管結石而作內視鏡膽道括約肌 切開取石術後,卻未發現膽管結石。本研究的目的是探討膽道括約肌切開術後,未發現結石 者之長期追蹤結果。 方法 從1990年10月至1996年10月,共有401位患者接受內視鏡膽道括約肌切開術。 將術後膽管未發現結石的患者列入研究,並進行定期隨訪及肝功能檢查;必要時還實施超音 波、電腦斷層、內視鏡逆行膽胰道攝影及膽道乳突內切片等檢查。 結果 42位患者被納入此研究。適合實施經內視鏡膽道括約肌切開術者,包括34位總 膽管經內視鏡逆行膽胰道攝影有填充缺損的患者;及8位懷疑有結石嵌入壼腹的影像學表現 的患者。這些患者平均追蹤28.6個月(範圍為1-61個月),其中6位其後產生膽管結石;4 位發現壼腹癌;1位發現為膽管內生型肝細胞癌;31位無病理改變。在6位膽管結石患者中, 2位膽囊還在,4位曾做過膽囊切除術;在4位壼腹癌患者中,3位於括約肌切開術後做乳 突內切片才得以確診,另1位切片為陰性,追蹤9個月後症狀復發,再經重複切片才診斷為 壼腹癌。 結論 本研究發現,之前有膽道症狀的患者,內視鏡膽道括約肌切開術檢查後雖無結石 取出,但追蹤檢查仍有26%的患者發現有膽道病灶,所以對這些患者必須定期追蹤,並提 高警惕。 |
英文摘要 | Background. No stones are retrieved from the bile duct in 10-20% of patients with suspected common bile duct (CBD) stones after endoscopic sphincterotomy (EST). The clinical outcome in these patients remains unclear. This study followed patients from whom no stones were retrieved, to discover their clinical outcome. Methods. From October, 1990, to October, 1996, 401 patients with suspected CBD stones received EST for stone removal. Only patients from whom no stones were retrieved from the bile duct were included in this study. All enrolled patients were regularly interviewed and received liver function tests. Sonography, computerized tomography, endoscopic retrograde cholangiopancreatography (ERCP), and/or intrapapillary biopsy were performed as indicated. Results. Forty-two patients were included in this study. The indications for EST included 34 cases with filling defects in the common bile duct on ERCP and eight cases with suspected impacted stones as seen by imaging studies. After a mean follow-up period of 28.6 months (range, 1-61 months), six patients developed biliary stones, four had carcinoma of the ampulla of Vater, one was found to have intrabiliary growth of hepatocellular carcinoma, and there was no pathologic change in 31 cases. Of the six patients with formation of biliary stones, two had an intact gallbladder and four had received previous cholecystectomy. Of the four patients with ampullary tumors, three were diagnosed by intrapapillary biopsy soon after EST, and one was diagnosed nine months later. Conclusions. Biliary problems were found in 26% of patients soon after EST, although no stones were retrieved from the bile dust. Regular follow-up is warranted. |
本系統中英文摘要資訊取自各篇刊載內容。