經口膽道內視鏡

Peroral Cholangioscopy

宋皚峰(Kai-Feng Sung) ； 劉乃仁(Nai-Jen Liu)

《內科學誌》 27卷4期 (2016/08) Pp. 174-178

https://doi.org/10.6314/JIMT.2016.27(4).02

摘要

經口膽道的內視鏡檢查已經在臨床上使用四十餘年。起初在診斷方面，可以直接目視膽道黏膜來鑑別診斷不明原因的膽道狹窄或黏膜病變，提昇診斷的正確性。在治療方面，搭配雷射或高壓水槍碎石術，可以處理合併膽管狹窄困難的或巨大的膽管結石治療。近年來，良性肝門膽管狹窄病患隨著換肝人數增加而變多。經口膽道的內視鏡檢查術可以協助做選擇性的特定肝內膽管插入，做狹窄處氣球或通條導管擴張術及支架置放治療。在惡性肝門膽管狹窄病患，也可以協助置放金屬支架於特定的肝內膽管，做姑息性的膽道引流癌症治療。經口膽道內視鏡可以依操作時需要單一醫師獨立操作或兩位醫師合作，分為兩種系統。兩位醫師合作操作的膽道內視鏡檢查已經在臨床上使用四十餘年。此種膽道內視鏡有許多缺點，導致在臨床上逐漸淘汰不為人使用。一位醫師單獨操作的膽道內視鏡檢查已經在臨床上使用近十年，可以依照需要十二指腸內視鏡與否分為導管式膽道內視鏡檢查及細徑上消化道內視鏡膽管檢查。各有其優缺點。因為多樣化及新改良的內視鏡合併各種功能改善的內視鏡配件，期待未來對膽道疾病的診斷治療會有長足的進步。

關鍵字

膽管內視鏡術(Cholangioscopy) ； 膽管結石症(Choledocholithiasis) ； 膽管細胞癌(Cholangiocarcinoma) ； 碎石術(Lithotripsy) ； 膽血症(Hemobilia)

並列摘要

Peroral cholangioscopy has been used in clinical application for four decades. In diagnostic aspect, we can examine the bile duct mucosa directly with biopsy for unknown stricture etiology or lesions to improve diagnostic acuity. In therapeutic aspect, we can manage patients of difficult bile duct stones while pulsed laser or electrohydraulic lithotripsy is available. Patients of benign hilum bile duct stricture have increased recently as patients of liver transplantation increased. Peroral cholangioscopy can help cannulation of selective intrahepatic bile duct, making bile duct stricture treatment like balloon/bougie dilatation, temporary or permanent stents implantation possible. Peroral cholangioscopy is divided into two systems according to doctor numbers who operate the examination. The mother-baby cholangioscopy system need two endoscopists, one for duodenoscope and another for cholangioscope. Because of several limitations, this system is not applied to clinical use popularly. The single-operator catheter-based system has been developed for one decade. It has many advantages compared to the mother-baby system. In addition to catheter-based cholangioscope, single operator also can apply the ultra-slim standard upper gastrointestinal endoscope into dilated bile duct for diagnosis and treatment. However, it is limited to the thicker diameter of the scope and could only be applied to dilated bile duct. Because of the improved endoscope and accessories, we can expect more accurate diagnosis and effective management of bile duct diseases.