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Stomach and Intestine(Tokyo) Volume 20, Issue 11 （November 1985）

胃と腸 20巻11号（1985年11月発行）

Japanese English

今月の主題内視鏡的乳頭括約筋切開術の長期成績

主題

内視鏡的乳頭括約筋切開術の長期成績 Long-term Results after Endoscopic Sphincterotomy 藤本荘太郎 ¹ , 中島正継 ¹ , 吉田俊一 ¹ , 今岡渉 ¹ , 安田健治朗 ¹ , 小林正夫 ¹ , 趙栄済 ¹ , 西村和彦 ¹ , 向井秀一 ¹ , 清田啓介 ¹ , 山口勝通 ² , 木本邦彦 ³ Sotaro Fujimoto ¹ ¹京都第二赤十字病院消化器科 ²京都五条病院内科 ³大阪鉄道病院消化器内科 ¹Department of Gastroenterology, Kyoto Second Red Cross Hospital pp.1181-1193

発行日 1985年11月25日 Published Date 1985/11/25

DOI https://doi.org/10.11477/mf.1403109701

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要旨　1973年8月より1985年5月までの約12年間に，776例の内視鏡的乳頭括約筋切開術（EST）を行い，726例（93.6％）に目的とする種々の臨床的効果を得た．早期合併症は32例（4.1％）にみられ，2例（0.26％）の死亡例を経験した．1年以上の追跡調査ができた良性疾患326例（胆管結石および乳頭狭窄症）について長期成績を検討した．腹痛・発熱・黄疸などの自覚症状は61例（18.1％）にあり，その中で後期合併症が証明されたのは24例（7.4％）であった．再発胆管結石15例，胆囊炎6例，胆管炎3例であり，再発結石の5例と胆囊炎の5例に外科的治療がなされた．再発結石および胆管炎は，切開範囲の小さい症例に多い傾向がみられた．また，有石胆囊残存群70例中6例（8.6％）に胆嚢炎発生がみられたのに対し，無石胆囊残存群55例では胆囊病変は認めなかった．後期合併症症例に死亡例はなく，ESTの臨床的有用性と安全性は高く評価しえた．

　From August 1973 to May 1985, we performed 776 cases of endoscopic sphincterotomy (EST). In 762 cases (98.2%) of successful incision of the papilla of Vater, 726 cases (93.6%) showed a remarkable clinical effects. In our series, 32 early complications occurred in 776 cases (morbidity rate: 4.1%), and 2 fatalities were recognized (mortality rate: 0.26%).

　In this apper, we mainly discussed the propriety of EST by long-term follow-up study. In 326 cases with benign biliary diseases (biliary tract stone and papillary stenosis), we were able to analize a minute clinical course over one year after EST. Sixty-one cases (18.1%) in them complained of some symptoms (abdominal pain, fever or jaundice) after EST. Among them, 24 cases(7.4%) were found to have some late complications. The symptoms of remaining 37 cases were temporary and slight. Twenty-four cases with late complications consisted of 15 cases of recurrent stones after EST, six of cholecystitis and three of cholangitis. Five cases of recurrent stones and five cases of cholecystitis underwent a surgical treatment. The incision of the papilla of Vater at the initial EST was not full in 13 cases of recurrent stones and all cases of cholangitis. In 326 cases, there were 125 with the gallbladder with stone (70cases) or without stone (55 cases), and 201 who had been cholecystectomized. Six cases with cholecystitis after EST were leaving stones in the gallbladder, amounting to 8.6% of 70 cases with gallbladder stone. All the late complication occurred within five years after EST, and not involved a fatal case.

　EST gives the sufficient result in diagnosis and treatment for various diseases of biliary tract. Furthermore,EST was found to be a safe procedure from the low rates of comlications and fatalities.