総胆管結石症に対する腹腔鏡下手術
要旨：総胆管結石症に対する腹腔鏡下手術について，内視鏡治療との比較をしながらメリットと現状を述べ，手技と成績を報告する．専門的施設から良好な成績が多数報告され，複数の比較試験でも内視鏡治療プラス腹腔鏡下胆嚢摘出術の2期的併用治療より優れていることが報告されている．また，十二指腸乳頭機能が温存されることから結石再発が少ないなど長期成績も良好と考えられる．しかし，総胆管治療の環境や手術難度から一般には定着しておらず，今後さらなる普及が期待される．筆者は，経胆嚢管法が205例，胆管切開法が300例（Cチューブ177例，Tチューブ75例，一期的縫合31例，ENBDまたはPTBD 16例，胆管十二指腸吻...
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| Published in | 胆道 Vol. 26; no. 1; pp. 40 - 45 |
|---|---|
| Main Authors | , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
日本胆道学会
2012
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| Subjects | |
| Online Access | Get full text |
| ISSN | 0914-0077 1883-6879 |
| DOI | 10.11210/tando.26.40 |
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| Abstract | 要旨：総胆管結石症に対する腹腔鏡下手術について，内視鏡治療との比較をしながらメリットと現状を述べ，手技と成績を報告する．専門的施設から良好な成績が多数報告され，複数の比較試験でも内視鏡治療プラス腹腔鏡下胆嚢摘出術の2期的併用治療より優れていることが報告されている．また，十二指腸乳頭機能が温存されることから結石再発が少ないなど長期成績も良好と考えられる．しかし，総胆管治療の環境や手術難度から一般には定着しておらず，今後さらなる普及が期待される．筆者は，経胆嚢管法が205例，胆管切開法が300例（Cチューブ177例，Tチューブ75例，一期的縫合31例，ENBDまたはPTBD 16例，胆管十二指腸吻合1例）を行った．開腹移行は1.9％で合併症，遺残結石や再発結石は少なく良好な成績を得た．修練として腹腔鏡下胆嚢摘出術50例経験，術中胆道造影と縫合結紮の習得によって約30例で手技が安定すると考えられる． |
|---|---|
| AbstractList | 要旨：総胆管結石症に対する腹腔鏡下手術について，内視鏡治療との比較をしながらメリットと現状を述べ，手技と成績を報告する．専門的施設から良好な成績が多数報告され，複数の比較試験でも内視鏡治療プラス腹腔鏡下胆嚢摘出術の2期的併用治療より優れていることが報告されている．また，十二指腸乳頭機能が温存されることから結石再発が少ないなど長期成績も良好と考えられる．しかし，総胆管治療の環境や手術難度から一般には定着しておらず，今後さらなる普及が期待される．筆者は，経胆嚢管法が205例，胆管切開法が300例（Cチューブ177例，Tチューブ75例，一期的縫合31例，ENBDまたはPTBD 16例，胆管十二指腸吻合1例）を行った．開腹移行は1.9％で合併症，遺残結石や再発結石は少なく良好な成績を得た．修練として腹腔鏡下胆嚢摘出術50例経験，術中胆道造影と縫合結紮の習得によって約30例で手技が安定すると考えられる． |
| Author | 松村, 直樹 徳村, 弘実 野村, 良平 |
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| References | 13) Glenn F, Dillon LD. Developing trends in acute cholecystitis and choledocholithiasis. Surg Gynecol Obstet 1980; 151: 528-532 5) Tinoco R, Tinoco A, El-Kadre L, et al. Laparoscopic common bile duct exploration. Ann Surg 2008; 247: 674-679 20) Martin DJ, Vernon DR, Toouli J. Surgical versus endoscopic treatment of bile duct stones. Cochrane Database Syst Rev 2006 Apr 19; (2): CD003327 7) Malet PF, Dabezies MA, Huang G, et al. Quantitative infrared spectroscopy of common bile duct gallstones. Gastroenterol 1988; 94: 1217-1221 2) Hunter JG. Laparoscopic transcystic common bile duct exploration. Am J Surg 1992; 163: 53-58 6) Tokumura H, Umezawa A, Hui Cao H, et al. Laparoscopic management of the common bile duct stones; Transcystic duct approach and cholecystectomy. J Hepatobiliary Pancreat Surg 2002; 9: 206-212 15) Rhodes M, Sussman L, Cohen L, et al. Randomised trial of laparoscopic exploration of common bile duct versus postoperative endoscopic retrograde cholangiography for common bile duct stones. Lancet 1998; 351: 159-161 25) Cetta F. Do surgical and endoscopic sphincterotomy prevent or facilitate recurrent common duct stone formation? Arch Surg 1993; 128: 329-336 16) Rogers SJ, Cello JP, Horn JK, et al. Prospective randomized trial of LC+LCBDE vs ERCP/S+LC for common bile duct stone disease. Arch Surg 2010; 145: 28-33 4) Berthou JC, Dron B, Charbonneau P, et al. Evaluation of laparoscopic treatment of common bile duct stones in a prospective series of 505 patients: indications and results. Surg Endosc 2007; 21: 1970-1974 14) Cuschieri A, Croce E, Faggioni A, et al. EAES ductal stone study. Preliminary findings of multi-center prospective randomized trial comparing two-stage vs single-stage management. Surg Endosc 1996; 10: 1130-1135 19) Tranter SE, Thompson MH. Comparison of endoscopic sphincterotomy and laparoscopic exploration of the common bile duct. Br J Surg 2002; 89: 1495-1504 17) Sgourakis G, Karaliotas K. Laparoscopic common bile duct exploration and cholecystectomy versus endoscopic stone extraction and laparoscopic cholecystectomy for choledocholithiasis. A prospective randomized study. Minerva Chir 2002; 57: 467-474 22) 徳村弘実, 鹿郷昌之, 柿田徹也, ほか. 腹腔鏡下胆管切石術. 臨外 2005; 60: 681-685 24) 徳村弘実, 梅澤昭子, 坂本宣英, ほか. ルーチン腹腔鏡下経胆嚢管的胆道造影1,179例の検討. 胆道 1999; 13: 301-307 3) Lyass S, Phillips EH. Laparoscopic transcystic duct common bile duct exploration. Surg Endosc 2006; 20: 441-445 8) 徳村弘実. 胆管原発結石の成因 乳頭機能と胆汁感染. 内科 2005; 95: 217-222 10) Ludwig K, Lorenz D, Koeckerling F. Surgical strategies in the laparoscopic therapy of cholecystolithiasis and common duct stones. ANZ J Surg 2002; 72: 547-552 23) Wenner DE, Whitwam P, Turner D, et al. Actual time required for dynamic fluoroscopic intraoperative cholangiography. SLS 2005; 9: 174-177 12) Boerma D, Rauws EA, Keulemans YCA, et al. Wait-and-see policy or laparoscopic cholecystectomy after endoscopic sphincterotomy for bile-duct stones; a randomized trial. Lancet 2002; 360: 761-765 11) 日本内視鏡外科学会. 内視鏡外科手術に関するアンケート調査 第9回集計結果報告. 日鏡外会誌 2008; 13: 499-611 18) Bansal VK, Misra MC, Garg P, et al. A prospective randomized trial comparing two-stage versus single-stage management of patients with gallstone disease and common bile duct stones. Surg Endosc 2010; 24: 1986-1989 1) Petelin JB. Laproscopic approach to common duct pathology. Surg Laparoscopic 1991; 1: 33-41 9) Stewart L, Smith AL, Pellegrini CA, et al. Pigment gallstones form as a composite of bacterial microcolonies and pigment solids. Am Surg 1987; 206: 242-250 21) 長谷川洋, 小木曽清二, 坂本英至, ほか. 経胆嚢管的載石―手技とその問題点―. 手術 2001; 15: 2017-2021 |
| References_xml | – reference: 11) 日本内視鏡外科学会. 内視鏡外科手術に関するアンケート調査 第9回集計結果報告. 日鏡外会誌 2008; 13: 499-611 – reference: 16) Rogers SJ, Cello JP, Horn JK, et al. Prospective randomized trial of LC+LCBDE vs ERCP/S+LC for common bile duct stone disease. Arch Surg 2010; 145: 28-33 – reference: 9) Stewart L, Smith AL, Pellegrini CA, et al. Pigment gallstones form as a composite of bacterial microcolonies and pigment solids. Am Surg 1987; 206: 242-250 – reference: 10) Ludwig K, Lorenz D, Koeckerling F. Surgical strategies in the laparoscopic therapy of cholecystolithiasis and common duct stones. ANZ J Surg 2002; 72: 547-552 – reference: 17) Sgourakis G, Karaliotas K. Laparoscopic common bile duct exploration and cholecystectomy versus endoscopic stone extraction and laparoscopic cholecystectomy for choledocholithiasis. A prospective randomized study. Minerva Chir 2002; 57: 467-474 – reference: 3) Lyass S, Phillips EH. Laparoscopic transcystic duct common bile duct exploration. Surg Endosc 2006; 20: 441-445 – reference: 7) Malet PF, Dabezies MA, Huang G, et al. Quantitative infrared spectroscopy of common bile duct gallstones. Gastroenterol 1988; 94: 1217-1221 – reference: 2) Hunter JG. Laparoscopic transcystic common bile duct exploration. Am J Surg 1992; 163: 53-58 – reference: 1) Petelin JB. Laproscopic approach to common duct pathology. Surg Laparoscopic 1991; 1: 33-41 – reference: 8) 徳村弘実. 胆管原発結石の成因 乳頭機能と胆汁感染. 内科 2005; 95: 217-222 – reference: 15) Rhodes M, Sussman L, Cohen L, et al. Randomised trial of laparoscopic exploration of common bile duct versus postoperative endoscopic retrograde cholangiography for common bile duct stones. Lancet 1998; 351: 159-161 – reference: 4) Berthou JC, Dron B, Charbonneau P, et al. Evaluation of laparoscopic treatment of common bile duct stones in a prospective series of 505 patients: indications and results. Surg Endosc 2007; 21: 1970-1974 – reference: 25) Cetta F. Do surgical and endoscopic sphincterotomy prevent or facilitate recurrent common duct stone formation? Arch Surg 1993; 128: 329-336 – reference: 13) Glenn F, Dillon LD. Developing trends in acute cholecystitis and choledocholithiasis. Surg Gynecol Obstet 1980; 151: 528-532 – reference: 23) Wenner DE, Whitwam P, Turner D, et al. Actual time required for dynamic fluoroscopic intraoperative cholangiography. SLS 2005; 9: 174-177 – reference: 12) Boerma D, Rauws EA, Keulemans YCA, et al. Wait-and-see policy or laparoscopic cholecystectomy after endoscopic sphincterotomy for bile-duct stones; a randomized trial. Lancet 2002; 360: 761-765 – reference: 19) Tranter SE, Thompson MH. Comparison of endoscopic sphincterotomy and laparoscopic exploration of the common bile duct. Br J Surg 2002; 89: 1495-1504 – reference: 22) 徳村弘実, 鹿郷昌之, 柿田徹也, ほか. 腹腔鏡下胆管切石術. 臨外 2005; 60: 681-685 – reference: 5) Tinoco R, Tinoco A, El-Kadre L, et al. Laparoscopic common bile duct exploration. Ann Surg 2008; 247: 674-679 – reference: 21) 長谷川洋, 小木曽清二, 坂本英至, ほか. 経胆嚢管的載石―手技とその問題点―. 手術 2001; 15: 2017-2021 – reference: 6) Tokumura H, Umezawa A, Hui Cao H, et al. Laparoscopic management of the common bile duct stones; Transcystic duct approach and cholecystectomy. J Hepatobiliary Pancreat Surg 2002; 9: 206-212 – reference: 14) Cuschieri A, Croce E, Faggioni A, et al. EAES ductal stone study. Preliminary findings of multi-center prospective randomized trial comparing two-stage vs single-stage management. Surg Endosc 1996; 10: 1130-1135 – reference: 24) 徳村弘実, 梅澤昭子, 坂本宣英, ほか. ルーチン腹腔鏡下経胆嚢管的胆道造影1,179例の検討. 胆道 1999; 13: 301-307 – reference: 18) Bansal VK, Misra MC, Garg P, et al. A prospective randomized trial comparing two-stage versus single-stage management of patients with gallstone disease and common bile duct stones. Surg Endosc 2010; 24: 1986-1989 – reference: 20) Martin DJ, Vernon DR, Toouli J. Surgical versus endoscopic treatment of bile duct stones. Cochrane Database Syst Rev 2006 Apr 19; (2): CD003327 |
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| SubjectTerms | Cチューブ 経胆嚢管法 総胆管結石症 胆管切開 腹腔鏡下手術 |
| Title | 総胆管結石症に対する腹腔鏡下手術 |
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