- 期刊
內視鏡逆行性膽管引流術：一例報告
Endoscopic Retrograde Biliary Drainage: A Case Report
摘要
術前降低黃疸可以減少術的死亡率，以往國內皆以經皮穿肝引流術為之，本文則介紹較新的技法，所謂內視鏡逆行性膽管引流術，更合乎生理、新陳代謝，實行後病人起居生活更方便，本文為臺灣地區首次成功病例報告。74歲男性工人，1年來主訴反覆性上腹痛，黃疸、體重減輕併發煤寒顫。入院時高燒但意識清楚，血清膽紅素10mg/dl，白血球15,125/cmm，腹部超音波及ERCP顯示有總膽管擴大及總膽管結石，總膽管下段呈區域性狹窄，由於體能狀態不佳必須延遲手術，住院1星期後實行仙視鏡逆行性膽管引流術(Endoscopic Retograde Biliary Drainage)，簡稱ERBD。ERBD2天後病人體溫及白血球皆回復正常，食慾增進，23天後血清膽紅素降至3.8mg/dl，實行總膽管截石術，術後情況良好。
並列摘要
The preoperative decompression in common bile duct can decrease postoperative mortality for the patient with obstructive jaundice. Percutaneous trans-hepatic cholangio-drainage (PTCD) is the method to be adopted in Taiwan in the past time. Now we introduce a new, more physiological method which is compatible with bile metabolism to achieve the same goal. It is called ”Endoscopic Retrograde Biliary Drainage” (ERBD). After drainage, the latter (ERBD) is more convenient than the former (PTCD) for daily life. This is the first successful case report in Taiwan. There is a 74-year-old male labor who has suffered from recurrent abdominal pain, jaundice, body weight loss, fever, chillness for one year. He has a high fever on admission, but the consciousness is clear. The laboratory data showed that serum total bilirubin is 10mg/dl, white count is 15/125/cmm. The abdominal sonography and endoscopic retrograde cholangiography showed dilatation of common bile duct with choledocholithiasis and segmental stricture at the lower end of common bile duct. Because of his poor general condition, the operation must be postponed. One week after admission he received endoscopic retro-grade biliary drainage (ERBD). Two days after ERBD, the body temperature and white count returned to the normal and his appetite increased. 23 days after the procedure, the serum total bilirubin declined to 3.8mg/dl, therefore he received choledocholithotomy. The postoperative condition is good.