- 期刊
胰十二指腸切除術後之膽石症
Gallstone Formation after Pancreaticoduodenectomy
摘要
總膽管末端壺腹周圍及胰臟頭部的腫瘤或嚴重損傷時，往往需要做胰十三指腸切除術才能治癒，而早期術後併發症以出血、腎衰竭、敗血症、膽道及胰臟瘻管等居多，而術後引起膽道結石鮮有報告。 本院外科近十二年經歷三例因做胰十二指腸切除術後引起膽石，3例均屬男性，第1例因胰臟癌接受手術，術後九年發生總膽管及膽囊結石，第2、3例因外傷接受手術，第2例於術後十年發生總膽管及膽囊結石，第3例於術後七個月發生膽囊炎合併結石，3例結石均屬膽色素鈣石。 3例結石的發生，其原因有二，我們推測以正常直徑大小之總膽管與空腸吻合處狹窄，再引起膽汁鬱積，而且3例之膽囊均未切除，此其一，另一原因則因空腸內容物的逆流，增加膽汁感染機會，亦是促進膽石形成的原因。所以我們認為在做胰十二指腸切除時，必需同時做膽囊切除術及對空腸膽道吻合處之考慮，可以免除術後膽囊炎或膽囊結石併發症。
關鍵字
無資料並列摘要
The pancreaticoduodenectomy is a curative procedure for periamullary carcinoma, pancreatic head carcinoma and severe injury of the pancreaticoduodenal area. The complications and mortality rate vary considerably from series to series. Hemorrhage, sepsis, renal failure and biliary fistula were the most common post-operative complications leading to death. The cholecystitis with stone is rarely a postoperative complication. In the past 12 years, we had experienced 3 male cases. The first case had developed gallstones postoperatively 9 years after treatment for pancreatic carcinoma. The second case had gallstones 10 years after a sever injury of the pancreas. The third case had cholecytitis with stone 7 months after treatment. The main composition of this kind of stone is calcium bilirubinate. The causes of gallbladder stones are con sidered to be: 1) refleux of the jejunal contents in the biliary tree, 2) bile stasis due to the stenosis of stenosis of choledochojejunostomy, especially in normal caliber common bile duct. So, we advocate a cholecystectomy during the performance of a pancreaticoduodenectomy.