Diagnosis and Treatment of Choledochocele: Report of Three Cases

總膽管膨出的診斷及處理：三病例報告

魏克承(Keh-Cherng Wey) ； 牟聯瑞(Lein-Ray Mo) ； 林瑞昌(Ruey-Chang Lin) ； 郭振源(Jenn-Yuan Kuo) ； 張國寬(Kuo-Kuan Chang) ； 王俊雄(Chung-Hsiang Wang) ； 蔡建中(Chien-Chung Tsai)

《中華民國消化系醫學會雜誌》 12卷3期 (1995/09) Pp. 253-260

https://doi.org/10.6557/GJTa.199509_12(3).0005

摘要

總膽管膨出屬於總膽管囊腫的第三型，是一種罕見的先天性病症。我們提出三例具不同解剖構造之總膽管膨出，均使用經內視鏡逆行性胰膽道攝影術(ERCP)而確定診斷。這三例係因發燒、寒顫或腹痛而住院。腹部超音波檢查發現三例均有總膽管擴張的現象，再經ERCP確定診斷。頭兩例依序合併總膽管狹窄、結三石：第一例利用經內視鏡括的肌造型術，使症狀緩解；第二例利用內視鏡括約肌切開術(EST)，將結石取出。第三例合併總膽管及胰管擴張，病人接受內科療法後，症狀緩解，故拒絕更進一步的侵襲性治療。ERCP可確定診斷總膽管膨出，隨後可視情況進行EST及經內視鏡括約肌造型術。這些內視鏡治療技術，在處理有症狀的總膽管膨出時，扮演著極重要的角色，其有效性及安全性值得肯定。本文將計論總膽管膨出的診斷、解剖構造及處理方法。

關鍵字

總膽管膨出 ； 總膽管囊腫 ； 經內視鏡括約肌切開術 ； 經內視鏡括約肌造型術

並列摘要

We presented three cases of choledochocele with different anatomic variants as demonstrated by endoscopic retrograde cholangiopancreatography (ERCP). They were admitted due to fever, chills, and abdominal pain. Abdominal ultrasonography showed dilated common bile duct (CBD) in all three cases, and ERCP confirmed the diagnosis of choledochoceles. The association of choledochocele with common bile duct stones and stricture were seen in two cases, which were managed effectively by endoscopic sphincterotomy, stone extraction, and endoscopic balloon sphincteroplasty. ERCP study not only can definitely demonstrate the choledochocele, but sphincterotomy and balloon sphincteroplasty can be immediately performed. These endoscopic therapeutic interventions seem to be an effective and safe method in the treatment of symptomatic choledochocele. This article presents the different anatomic variants of choledochocele, and the role of endoscopic interventions in its diagnosis and management

並列關鍵字

choledochocele ； choledochal cyst ； endoscopic sphincterotomy ； endoscopic sphincteroplasty