先天性胆道拡張症の術後経過と問題点  [in Japanese] Postoperative Results and Problems of Congenital Bile Duct Dilatation  [in Japanese]

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Abstract

広島大学第一外科において経験した小児期に初回手術を受けた先天性胆道拡張症(CBD)24例を一期的分流手術後3年以上経過例14例,初回内瘻術後再手術例4例,初回外瘻術(うち3例は胆道穿孔合併)後分流手術例6例に分け術後経過,合併症を術式別に検討した.一期的分流手術例では術後短期間膵炎や胆管炎症状を認めるものや,術後数年間肝内胆管拡張を認めるものも有るが徐々に軽減しており概ね問題は無い.胆道穿孔合併例や,初回胆管炎や膵炎が内科的にコントロールできないものには,初回胆汁外瘻造詮術を行い合併症予防のために有用であった.二期的分流手術後の術後経過も一期的分流手術例に比し差を認めず良好であった,これに対し初回内瘻造般例は,その後全例重篤な胆管炎を起こし,2年から15年後に分流手術を要しており,たとえ無症状でも早期に分流手術を行うべきである. CBD の分流手術にあたっては胆汁の充分なドレナージは当然必要であるが,膵管内 protein plug や結石を認め更に膵液流出障害が考えられる場合は膵液ドレナージ術の付加も考慮すべきである.

We analyzed 24 cases with congenital bile duct dilatation operated in childhood and followed up over 3 years after surgery. Among these cases, we performed primary diversion in 14 patients, secondary diversion after initial external drainage for bile duct perforation in 3 and for severe pancreatitis or chorangitis in 3. In 4 patients internal drainage procedure without diversion was performed from 1964 to 1971 at our and at other hospitals. Patients who had primary diversion were sometimes suffered form cholangitis or pancreatitis, but most of them became free of symptoms and well so far. All of patients who had temporary external drainage have been well too. Whereas all patients who underwent internal drainage were suffered from severe cholangitis and required reoperation within 2 to 19 years after the surgery. We recommend cyst excision for who had internal drainage procedure even when asymptomatic. In cases with stasis of pancreatic juice, additional drainage procedure may be indicated.

Journal

  • Journal of the Japanese Society of Pediatric Surgeons

    Journal of the Japanese Society of Pediatric Surgeons 31(5), 732-738, 1995

    The Japanese Society of Pediatric Surgeons

References:  16

Cited by:  2

Codes

  • NII Article ID (NAID)
    110002107245
  • NII NACSIS-CAT ID (NCID)
    AN00192281
  • Text Lang
    JPN
  • Article Type
    Journal Article
  • ISSN
    0288-609X
  • Data Source
    CJP  CJPref  NII-ELS  J-STAGE 
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