EST後における総胆管末端部の形態の検討  [in Japanese] Examination of the shapes of the end of the common bile ducts after endoscopic sphincterotomy (EST)  [in Japanese]

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ESTを用いた総胆管結石の採石術において,小結石にもかかわらず採石困難な例をときどき経験した.その症例においてEPBDを行ったところノッチ(乳頭括約筋が影響している部分)が形成され,それを解除することにより容易に採石が可能であった.そこで,EST後のノッチがどの位の割合で,どのような症例に存在するのかをプロスペクティブに検討した.その結果,EST後にもかかわらず25%(13/52)にノッチ形成を認めた.ノッチの形成はnarrow distal segmentの長い症例において有意に高率であった.ESTを施行しても25%でノッチが残存し,そのような症例では採石が困難となる可能性があることが示唆された.<br>

At the treatment of bile duct stones using EST, we sometimes experienced the difficult cases, even if the stones were small. For these cases, we tried endoscopic papillary balloon dilatation, and as a result knoches were made. And after the disappearance of the knoch, we could easily remove the stone. So we prospectively examined how often and at what cases, the knoches were made immediately after EST. As a result, knoches were present for 25% (13/52) of patients even after EST. Narrow distal segments of knoch-present patients were longer than that of knoch-absent patients, significantly. As a result, some function of sphincter was shown to be remained for a quarter of patients even after EST, and for these cases, the treatment of the stones may be difficult.<br>


  • Nippon Shokakibyo Gakkai Zasshi  

    Nippon Shokakibyo Gakkai Zasshi 104(11), 1607-1613, 2007-11-05 

    The Japanese Society of Gastroenterology

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