外科的乳頭切開術の長期予後―15年以上経過例の検討をもとに

Fifteen to Twenty Years' Results of Surgical Sphincterotomy

要旨　1965年より1970年まで外科的乳頭切開術を受けた74例のうち術後早期に死亡した2例を除く72例について1981年と1985年の2回，術後経過を調査した．第1回調査では53例（74％）が回答，うち10例が死亡，35例（81％）が無症状，8例が有愁訴であった．第2回は生存62例を対象とし，47例（76％）に回答を得た．新たに2例が死亡，無愁訴が38例（84％），有愁訴が7例であった．死因は脳卒中5，肝癌3，胃癌1，老衰1，不明2である．胆道由来と思われる症状を呈した例は第1回で4例（9.3％），第2回で3例（6.7％）と予想外に少なかった．外科的乳頭切開術の長期予後は，本術式が乳頭形成術へと変遷していった過程で主張されたほど悪いものではないようであり，このことは内視鏡的乳頭括約筋切開術の長期成績に明るい見通しを与えるものと言えよう．

　Seventy-four patients who had surgical sphincterotomy performed at the Department of Surgery Ⅰ, Kyushu University Hospital, from 1965 through 1970 were investigated to predict long-term results of endoscopic sphincterotomy. Indications for the procedure in these patients were listed in Table 1. Two patients died during the immediate postoperative period. A postal survey was conducted twice in 1981 and 1985 on the remaining 72 patients and endoscopic retrograde cholangiography was performed on selected cases. 53 patients (74%) replied to the 1981-survey; 35 (81%) were asymptomatic, 8 had some complaints and 10 had died. The 1985-survey on the 62 patients who were alive in 1981 yielded an information on 47 patients (76%); 38 (84%) gave a good result, 7 poor and 2 had died (Table2). The cause of death in this series was stroke in 5, hepatoma in 3, stomach cancer in 1, advanced age in 1 and unknown in 2. Three patients with complaints were unlikely to have recurrence of stones or stenosis of the sphincterotomy, since their mild symptom showed no progess during the 4-year interval between the two surveys, and retrograde cholangiography revealed no abnormality in the biliary tract in another. Thus, the number of patients with complaints presumably of biliary origin was only 4 (9.3%) in 1981 and 3 (6.7%) in 1985. The long-term results of surgical sphincterotomy seemed to be better than previously claimed by the creators and promotors of sphincteroplasty. This may give a good and favorable prospect as for the long-term consequences of endoscopic sphincterotomy.