CAJ | 학술논문

目的探讨术中十二指肠镜下乳头切开术(IEPT)治疗胆石症合并的胆总管末端狭窄或细径胆总管结石的手术方法和适应证.方法腹腔镜下或开腹下完成胆囊切除术.粗径胆总管:胆总管切开探查并取净结石,经胆总管切口插入输尿管导管或斑马导丝至十二指肠腔,经口插入十二指肠镜至十二指肠乳头,针式刀或弓式刀在输尿管导管或斑马导丝指引下施行乳头切开术以治疗合并的胆总管末端狭窄.细径胆总管:经胆囊管残端插入输尿管导管或斑马导丝至十二指肠腔,经口插入十二指肠镜施行乳头切开术和取石术,用十二指肠镜取石网或球囊取石以治疗细径胆总管结石.结果粗径胆总管:施行腹腔镜下IEPT 47例,45例乳头狭窄切开成功,2例中转为其他术式.施行开腹下IEPT5例,5例乳头狭窄切开成功.细径胆总管:施行腹腔镜下IEPT和取石术74例,68例乳头切开和取石成功,5例乳头切开成功,1例中转为其他术式.施行开腹下IEPT和取石术2例,2例乳头切开和取石成功.结论只要选择合适的病例,1EPT在腹腔镜下或开腹下均是可行、有效和安全的.
목적 탐토술중십이지장경하유두절개술(IEPT)치료담석증합병적담총관말단협착혹세경담총관결석적수술방법 화괄응증.방법 복강경하혹개복하완성담낭절제술.조경담총관:담총관절개탐사병취정결석,경담총관절구삽입수뇨관도관혹반마도사지십이지장강,경구삽입십이지장경지십이지장유두,침식도혹궁식도재수뇨관도관혹반마도사지인하시행유두절개술이치료합병적담총관말단협착.세경담총관:경담낭관잔단삽입수뇨관도관혹반마도사지십이지장강,경구삽입십이지장경시행유두절개술화취석술,용십이지장경취석망혹구낭취석이치료세경담총관결석.결과 조경담총관:시행복강경하IEPT 47례,45례유두협착절개성공,2례중전위기타술식.시행개복하IEPT5례,5례유두협착절개성공.세경담총관:시행복강경하IEPT화취석술74례,68례유두절개화취석성공,5례유두절개성공,1례중전위기타술식.시행개복하IEPT화취석술2례,2례유두절개화취석성공.결론 지요선택합괄적병례,1EPT재복강경하혹개복하균시가행、유효화안전적.
Objective To explore the operative methods and indications of duodenoscopic papillotomy during the course of operation(IEPT)for cholelithiasis.Methods Cholecystectomy was firstly conducted under the condition of laparoscopy or open laparotomy.For the gross choledochus,the common bile duct was cut open to clear the stones.The ureteric catheter and zebra guidewire were inserted into the common bile duct and duodenum.Then they were inserted via duodenoscopy into thepapillum of duodenum.The papillary stenosis was removed with electro-knife by pin-head-like and arch-like to track along the ureteric catheter and zebra guidewire.For the tiny choledochus,the ureterie catheter and zebra guidewire were inserted via the cholecystic duct remnant into the common bile duct and duodenum.Then they were inserted via duodenoscopy to perform papillotomy to clear the stones of the common bile duct with the reticulation and the balloon of duodenoscopy.Results Forthe gross choledochus,IEPT in laparoscopy was successful in 45 cases and the other 2 received other operation.IEPT in open laparotomy was successful in 5 cases.For the tiny choledochus,IEPT in laparoscopy was successful in 73 cases and the other 1 underwent other operation.IEPT in open laparotomy was successfulin 2 cases.Conclusion If patients are suitable,IEPT is safe and effective in the hands of skilled endoscopiests for laparoscopy and open laparotomy.