- 期刊
Endoscopic Sphincterotomy Using Modified Techniques
經內視鏡乳頭切開術之改良法
摘要
近十個月內，本院經歷十二例內視鏡電灼括約肌切開術。其中十一例爲總膽管結石，另一例爲外在壓迫性引起之阻塞性黃疸。十二例中，十例成功，兩例失敗；失敗原因爲：其中一例因電刀無法插入總膽管，另一例因括約肌切開術中出血而停止。在切開成功十例中，一例因總膽管結石太大，而無法取出。我們使用經鼻膽管引流術(E.N.B.D)，使總膽管結石合併有膽道炎之症狀得以緩解消失後，再利用針刀型電灼刀(needle knife sphincter-tome)於韋達乳頭背部直接做括約肌切開術。因有E.N.B.D.管子在底下，而可避免胰管之損傷。此方法安全且簡單。在電灼刀插入總膽管失敗之病例，也可利用E.N.B.D．之引線插入總膽管後再用以上方法做括約肌切開術。在外在壓迫性阻塞性黃疸之病例中，於括約肌切開術後，放置二條E.N.B.D.管子，一爲生理鹽水灌溉，一爲引流，其目的在減少E.N.B.D.管子阻塞。
並列摘要
Twelve cases receiving endoscopic sphincterotomy (EST) were examined, including 11 cases of common bile duct stones (CBDS), 1 case of obstructive jaundice due to extrinstic compression of the common bile duct (CBD) which was secondary to distant metastasis of spindle cell tumor. Eight cases of CBDS were successfully removed, with 1 failed cannulation, 1 failed extraction of CBDS, and in] case, the procedure had to be terminated because of bleeding. EST for extrinsic CBD compression was performed successfully for double endoscopic nasobiliary drainage (ENBD). Complications included] pancreatitis, which was eliminated by conservative treatment, and 1 bleeding which had to be operated on. Alternately using an ENBD catheter and a needle knife sphincterotome (NKS) can help to relieve the preexisting cholangitis and facilitate the following sphincterotomy in some difficult cases.