経皮経肝胆嚢ドレナージ後のMTBE直接胆石溶解療法が奏功した高齢急性胆嚢炎合併多発大胆嚢結石の1例  [in Japanese] Successful direct dissolution therapy with MTBE following percutaneous gallbladder drainage in an elderly gallstone patient with large multiple cholesterol gallstones complicated with acute cholecystitis  [in Japanese]

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Author(s)

    • 安部井 誠人 ABEI Masato
    • 筑波大学臨床医学系消化器内科 Division of Gastroenterology, Institute of Clinical Medcine, University of Tsukuba
    • 池田 和穂 IKEDA Kazuho
    • 筑波大学臨床医学系消化器内科 Division of Gastroenterology, Institute of Clinical Medcine, University of Tsukuba
    • 小田 竜也 ODA Tatsuya
    • 筑波大学臨床医学系消化器外科 Division of Surgery, Institute of Clinical Medcine, University of Tsukuba
    • 轟 健 TODOROKI Takeshi
    • 筑波大学臨床医学系消化器外科 Division of Surgery, Institute of Clinical Medcine, University of Tsukuba
    • 正田 純一 SHODA Junichi
    • 筑波大学臨床医学系消化器内科 Division of Gastroenterology, Institute of Clinical Medcine, University of Tsukuba
    • 田中 直見 TANAKA Naomi
    • 筑波大学臨床医学系消化器内科 Division of Gastroenterology, Institute of Clinical Medcine, University of Tsukuba

Abstract

症例は85歳, 女性. 発熱と右悸肋部痛のため, 本院に緊急入院となった. 腹部超音波およびCT検査にて,胆嚢は15mmを越える大胆石6個以上の充満と胆嚢管への嵌頓が認められ,急性胆嚢炎と診断された.洞不全症候群,糖尿病,糖尿病性腎症,慢性気管支炎等,複数の重度合併症を持つ高齢者であり,手術には危険が予想されたこと,石灰化のないコレステロール石であること,PTGBDチューブが挿入され胆嚢炎が軽快したこと等の理由より,胆嚢結石の治療としてMTBEによる直接溶解療法を試みた.その結果,計28時間の治療により完全溶解が得られた.MTBE直接溶解療法は,手術リスクの高い急性胆嚢炎合併コレステロール石例に対して,PTGBDによる炎症改善後に考慮すべき治療法と考えられた.

A 85-year old woman was admitted to our hospital because of high fever and right hypochondralgia. On ultrasound and CT examination, her gallbladder was filled with multiple, large noncalcified stones and seriously inflamed. The cholecystitis was successfully treated with percutaneous gallbladder drainage. Then, direct dissolution therapy with methyl-tert-buthyl-ether was chosen to treat her gallstones, despite their size and numbers, since she had multiple risk factors for surgery. It was considered that direct dissolution therapy is a treatment of choice in cholesterol gallstones patients with acute cholecystitis and high operative risks following successful treatment with percutaneous gallbladder drainage.

Journal

  • Tando

    Tando 16(1), 73-78, 2002-03-25

    Japan Biliary Association

References:  20

Cited by:  1

Codes

  • NII Article ID (NAID)
    10008363463
  • NII NACSIS-CAT ID (NCID)
    AN10062001
  • Text Lang
    JPN
  • Article Type
    Journal Article
  • ISSN
    09140077
  • Data Source
    CJP  CJPref  J-STAGE 
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