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- Endoscopic Papillary Balloon Dilation for the Management of Common Bile Duct Stones in Patients of Subtotal Gastrectomy with Billroth Ⅱ Anastomosis
- The Role of Endoscopic Sphincterotomy in Management of Recurrent Common Bile Duct Stones
- Biliary Motility Following Endoscopic Sphincterotomy for Recurrent Common Bile Duct Stones
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題 名 | Endoscopic Papillary Balloon Dilation for the Management of Common Bile Duct Stones in Patients of Subtotal Gastrectomy with Billroth Ⅱ Anastomosis=內視鏡乳頭氣球擴張術在治療B-Ⅱ次全胃切除病人合併總膽管結石之應用 |
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作 者 | 劉裕財; 楊基滐; 葉永祥; 林家禮; 吳志昇; 方怡仁; 陳建華; | 書刊名 | 中華民國消化系醫學雜誌 |
卷 期 | 17:4 2000.12[民89.12] |
頁 次 | 頁25-30 |
分類號 | 416.243 |
關鍵詞 | 內視鏡乳頭氣球擴張術; 內視鏡乳頭切開術; Billroth-Ⅱ次全胃切除; Endoscopic papillary balloon dilation; Billroth Ⅱ gastrectomy; |
語 文 | 英文(English) |
中文摘要 | "內視鏡乳頭切開術"為治療總膽管結石的第一選擇,但對於B-Ⅱ次全胃切除病人 的治療,則有相當程度的困難性存在;使用針刀雖有其便性,卻也增加了穿孔或出血的危險 。故我們嘗試使用內視鏡乳頭氣球擴張術來治療這類病人。自 1997 年 10 月至 1998 年 6 月, 共有 4 位 B- Ⅱ次全胃切除病人接受內視鏡乳頭氣球擴張術的治療,4 例全為男性, 年齡在 53 至 72 歲之間。所有病患均因右上腹痛、發燒、黃疸等急性膽管炎之症狀求診, 腹部超音波發現總膽管擴張並有三例合併膽囊結石而接受內視鏡膽胰造影術進一步證實總膽 管結石。經過內視鏡乳頭氣球擴張術後皆能將總膽管結石清除。但術後有兩位病人併發胰臟 炎:其中一位因其結石本質為泥狀結石,故其總膽管結石實未完全清除很快即症狀復發必須 以內視鏡膽管引流來解除其症狀;另外一例則經禁食及點滴維持體液平衡即恢復正常。內視 鏡乳頭氣球擴張術的優點在於其所有治療均可沿著引導鋼絲進行,對於已接受 B- Ⅱ次全胃 切除病人合併總膽管結石而言只要內視鏡膽胰造影術能成功進入總膽管則經由放置並固定引 導鋼絲,所有的治療,包括乳頭氣球擴張術及取石網取石均可次第順利完成,不會受內視鏡 下乳頭方向與正常人剛好相反的問題所困擾。此外,由於內視鏡乳頭氣球擴張術實際並未破 壞俄狄氏括約肌的完整性,所以可預防內視鏡乳頭切開術易造成膽管上行感染的後遺症。不 過因為病例數不夠多,未來我們仍須做更大規模的前膽性研究,才能確立內視鏡乳頭氣球擴 張術在治療 B- Ⅱ次全胃切除病人合併總膽管結石時所扮演的角色,目前則可作為內視鏡乳 頭切開術外的另一選擇。 |
英文摘要 | Endoscopic sphincterotomy (EST) for the treatment of common bile duct stone is generally more difficult and hazardous in patients who had subtotal gastrectomy with Billroth Ⅱ anastomosis than in patients with normal anatomy. Endoscopic papillary balloon dilation (EPBD). which was also called "endoscopic sphincteroplasty", provides a useful alternative to sphincterotomy in such patients. Between October 1997 and June 1998, we performed EPBD in four male patients with a Billroth Ⅱ anastomosis, presenting the typical symptoms of acute cholangitis. EPBD was carried out with balloon dilators mounted on 0.035-inch guide wires. Immediate extraction of stones was achieved in all four patients. Transient mild pancreatitis occurred in two of the patients: one patient recovered with fasting and supportive measures, the other one required an endoprosthesis insertion due to retained muddy stone. We recommend that EPBD may be another way to remove CBD Stones endoscopically in patients with Billroth Ⅱ gastrectomy. |
本系統中英文摘要資訊取自各篇刊載內容。