臨牀消化器内科 Vol.16 No.9(2)


特集名 総胆管結石に対する最新の治療戦略
題名 内視鏡的乳頭括約筋切開術(EST)による総胆管結石の治療と長期予後
発刊年月 2001年 08月
著者 増田 淳 群馬大学医学部第一内科
著者 樋口 次男 群馬大学医学部第一内科
【 要旨 】 総胆管結石に対してESTを第一選択として内視鏡的治療を行ってきた.24年間で1,808例中1,640例(90.7%)の結石除去に成功した.早期合併症は,出血35例,穿孔3例,膵炎9例,バスケット嵌頓6例,心停止1例の54例(3.0%)で,そのうち死亡例3例(出血2例,膵炎1例)を認めた.EST後の長期予後として,総胆管結石再発と胆嚢保有例における胆嚢炎発症につき検討した.総胆管結石再発は,65例(4.6%)89回認めた.3例を除き再度,内視鏡的に排石可能であった.胆嚢炎の発症は,胆嚢有石例で17.1%,胆嚢無石例で2.5%であった.ESTは,良好な治療成績だけでなく,長期予後の点からも,今後も総胆管結石治療の中心的役割を担っていくものと思われる.
Theme Current Treatment Strategies for Common Bile Duct Stones
Title Long-term Clinical Evaluation of Endoscopic Sphincterotomy (EST) for Treatment of Common Bile Duct Stones
Author Jun Masuda First Department of Internal Medicine, Gunma University School of Medicine
Author Tsugio Higuchi Internal Medicine, Saiseikai Maebashi Hospital
[ Summary ] EST was performed on 1,808 patients with common bile duct stones 1977 to 2000. Complete removal of common bile duct stones was achieved in 1,640 out of 1,808 patients (90.7%). Early complications occurred in 54 cases (bleeding, pancreatitis, basket impaction, perforation and cardiac arrest in 35, 9, 6, 3, and 1 case, respectively), and 3 of them died from bleeding and pancreatitis. The overall morbidity rates and mortality rate were 3.0% and 0.2%, respectively. The long-term clinical course was analyzed in 1,424 patients followed up for over 1 year after EST. Recurrent stones were found in 65 patients (4.6%), which were treated endoscopically in 62 cases and surgically in 3 cases. Cholesystitis ocurred in 4 out of 161 patients without gall stones (2.5%) and in 24 out of 140 patients with gall stones (17.1%). Cholesystectomy was performed in 13 cases (1 with out gall stones and 12 with gall stones). From this series of follow-up studies, it may be concluded that EST is the procedure of first choice for treatment of common bile duct stones.
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