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- Long-Term Effect of Large Biliary Endoprostheses in High-Risk Surgical Patients with Irretrievable Common Bile Duct Stones
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- The Role of Endoscopic Sphincterotomy in Management of Recurrent Common Bile Duct Stones
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| 題 名 | Long-Term Effect of Large Biliary Endoprostheses in High-Risk Surgical Patients with Irretrievable Common Bile Duct Stones=膽管支架對高手術危險性的總膽管結石患者之長期療效 |
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| 作 者 | 古明崑; 黎國洪; 羅錦河; 鄭錦翔; 許秉毅; 林俊谷; 陳海雄; 徐瑞宏; 林文娣; 王宣民; 彭南靖; | 書刊名 | 中華醫學雜誌 |
| 卷 期 | 62:10 1999.10[民88.10] |
| 頁 次 | 頁666-672 |
| 分類號 | 416.247 |
| 關鍵詞 | 膽管支架; 總膽管結石; 內視鏡乳突切開術; Biliary stent; Common bile duct stones; Endoscopic sphincterotomy; |
| 語 文 | 英文(English) |
| 中文摘要 | 背景 內視鏡乳突切開術取石法已被廣泛用於治療總膽管結石,此方式總膽管結 石的清除率約為85-90%。但有少數的膽道結石不易經由內視鏡法取出,或因年齡太大或具 有其它重大內科疾病而無法接受外科手術,這時使用支架引流不失為另一種可行的辦法。本 實驗探討使用支架引流對膽道結石病患之長期療效。 方法 自1990年12月至1998年11月,共有546位病患接受內視鏡乳突切開術取石 治療。其中12位病患因為內視鏡取石困難,且具有高手術危險性,而接受了大口徑(10 French 以上)膽管支架長期引流治療(5位女性,7位男性,平均年齡78歲)。術後,所有病患均 接受了有規則性的長期門診追蹤,其中4位於肝功能恢復正常後,接受核子醫學之膽道閃爍 造影檢查,以觀察膽汁排空的情形。 結果 所有病患於支架引流術後,其臨床症狀(發燒、黃疸及腹痛)均獲得滿意的改善, 且無早期併發症產生。只有1位病患(8.3%)於追蹤期內,有膽管炎復發。另外,於追蹤 期內,共有5位病患分別在第1、2、5、6及19個月死於非膽管相關疾病。支架的平均有效 期為14個月(1-38個月)。核子醫學之膽道閃爍造影檢查顯示,病患於支架引流術及肝功 能恢復正常後,膽汁的排空情形仍比正常人緩慢。 結論 對於內視鏡取石困難且具有高手術危險性之病患,大口徑膽管支架引流治療是另 一種安全的姑息療法。 |
| 英文摘要 | Background. Endoscopic sphincterotomy and basket extraction are currently used to remove bile duct stones, with a duct clearance rate of 85% to 90%. A biliary endoprosthesis (stent) is and alternative method to treat difficult cases, especially high-risk surgical patients. The aim of this study was to investigate the long-term effect of biliary endoprostheses in patients with irretrievable common bile duct stones. Methods. From December, 1990, to November, 1998, 546 patients were referred to the Veterans General Hospital-Kaohsiung for endoscopic removal of common bile duct stones. Of them, 12 received long-term biliary endoprosthesis because endoscopic removal or surgery was not suitable. Large-caliber stents (>10 French) were inserted into 12 patients (5 women and 7 men; mean age, 78.4 years) and they were followed up with regular clinical visits. Quantitative cholescintigraphy was performed in four patients to evaluate biliary emptying after liver function returned to nomal. Results. No early complications from stent insertion occurred and a satisfactory resolution of jaunidce, pain and fever were noted in all patients. One patient had repeated cholangitis due to stent occlusion and five died from unrelated causes. The median effective period of stent placement was 11 months (range, 1-38 months). Quantitative cholescintigraphy revealed delayed biliary drainage in four patients despite and sbsence of symptoms after their liver function returned to normal. Conclusions. Large-caliber stents are a safe and effective treatment for long-term palliation in high-risk patients with retained common bile duct stones. |
本系統中英文摘要資訊取自各篇刊載內容。