急性胆嚢炎に対する内視鏡的胆嚢ステント留置術
急性胆嚢炎は，胆嚢に生じた炎症性疾患である．炎症は胆嚢局所に留まることが多いが，炎症の悪化に伴い致死的な経過を取る場合もある．中等症以上の急性胆嚢炎に対しては，腹腔鏡下胆嚢摘出術が推奨されるが，高齢あるいは全身状態不良のため手術困難な症例も多い．そのような症例に対して，経皮経肝胆嚢ドレナージ（percutaneous transhepatic gallbladder drainage: PTGBD）が一般的に行われるが，出血などの重篤な合併症をきたす可能性や，特に高齢者では自己抜去の危険性もある．これまでに肝移植前の急性胆嚢炎に対する内視鏡的胆嚢ステント留置術（EGBS: endoscopic...
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| Published in | JOURNAL OF UOEH Vol. 36; no. 4; pp. 265 - 272 |
|---|---|
| Main Authors | , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
学校法人 産業医科大学
01.12.2014
産業医科大学 |
| Subjects | |
| Online Access | Get full text |
| ISSN | 0387-821X 2187-2864 |
| DOI | 10.7888/juoeh.36.265 |
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| Abstract | 急性胆嚢炎は，胆嚢に生じた炎症性疾患である．炎症は胆嚢局所に留まることが多いが，炎症の悪化に伴い致死的な経過を取る場合もある．中等症以上の急性胆嚢炎に対しては，腹腔鏡下胆嚢摘出術が推奨されるが，高齢あるいは全身状態不良のため手術困難な症例も多い．そのような症例に対して，経皮経肝胆嚢ドレナージ（percutaneous transhepatic gallbladder drainage: PTGBD）が一般的に行われるが，出血などの重篤な合併症をきたす可能性や，特に高齢者では自己抜去の危険性もある．これまでに肝移植前の急性胆嚢炎に対する内視鏡的胆嚢ステント留置術（EGBS: endoscopic gallbladder stenting）の有用性の報告があり，最近では手術困難症例に対する恒久的留置としての役割が期待されている．本稿では急性胆嚢炎に対する内視鏡的胆嚢ステント留置術について解説する． |
|---|---|
| AbstractList | 「要旨」急性胆嚢炎は, 胆嚢に生じた炎症性疾患である. 炎症は胆嚢局所に留まることが多いが, 炎症の悪化に伴い致死的な経過を取る場合もある. 中等症以上の急性胆嚢炎に対しては, 腹腔鏡下胆嚢摘出術が推奨されるが, 高齢あるいは全身状態不良のため手術困難な症例も多い. そのような症例に対して, 経皮経肝胆嚢ドレナージ(percutaneous transhepatic gallbladder drainage:PTGBD)が一般的に行われるが, 出血などの重篤な合併症をきたす可能性や, 特に高齢者では自己抜去の危険性もある. これまでに肝移植前の急性胆嚢炎に対する内視鏡的胆嚢ステント留置術(EGBS:endoscopic gallbladder stenting)の有用性の報告があり, 最近では手術困難症例に対する恒久的留置としての役割が期待されている. 本稿では急性胆嚢炎に対する内視鏡的胆嚢ステント留置術について解説する. 急性胆嚢炎は，胆嚢に生じた炎症性疾患である．炎症は胆嚢局所に留まることが多いが，炎症の悪化に伴い致死的な経過を取る場合もある．中等症以上の急性胆嚢炎に対しては，腹腔鏡下胆嚢摘出術が推奨されるが，高齢あるいは全身状態不良のため手術困難な症例も多い．そのような症例に対して，経皮経肝胆嚢ドレナージ（percutaneous transhepatic gallbladder drainage: PTGBD）が一般的に行われるが，出血などの重篤な合併症をきたす可能性や，特に高齢者では自己抜去の危険性もある．これまでに肝移植前の急性胆嚢炎に対する内視鏡的胆嚢ステント留置術（EGBS: endoscopic gallbladder stenting）の有用性の報告があり，最近では手術困難症例に対する恒久的留置としての役割が期待されている．本稿では急性胆嚢炎に対する内視鏡的胆嚢ステント留置術について解説する． |
| Author | 村瀬, 貴之 麻植ホルム, 正之 野村, 亮介 前川, 智 安, 泰善 原田, 大 |
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| DOI | 10.7888/juoeh.36.265 |
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| References | 12. Feretis C, Apostolidis N, Mallas E, Manouras A & Papadimitriou J (1993): Endoscopic drainage of acute obstructive cholecystitis in patients with increased operative risk. Endoscopy 25: 392-395 18. Pannala R, Petersen BT, Gostout CJ, Topazian MD, Levy MJ & Baron TH (2008): Endoscopic transpapillary gallbladder drainage: 10-year single center experience. Minerva Gastroenterol Dietol 54: 107-113 24. 松原三郎，徳山信行，内田麻美，梅舟仰胤，田村直樹，小椋啓司，伊佐山浩通（2013）：急性胆嚢炎に対する経乳頭的ドレナージ．胆と膵 34：917-923 11. Itoi T, Sofuni A, Itokawa F, Kurihara T, Tsuchiya T, Moriyasu F, Yamagishi T & Serizawa H (2006): Preoperative diagnosis and management of thick-walled gallbladder based on bile cytology obtained by endoscopic transpapillary gallbladder drainage tube. Gastrointest Endosc 64: 512-519 25. Sugiyama M, Tokuhara M & Atomi Y (1998): Is percutaneous cholecystostomy the optimal treatment for acute cholecystitis in the very elderly? World J Surg 22: 459-463 4. Conway JD, Russo MW & Shrestha R (2005): Endoscopic stent insertion into the gallbladder for symptomatic gallbladder disease in patients with end-stage liver disease. Gastrointest Endosc 61: 32-36 14. Kjaer DW, Kruse A & Funch-Jensen P (2007): Endoscopic gallbladder drainage of patients with acute cholecystitis. Endoscopy 39: 304-308 19. Ogawa O, Yoshikumi H, Maruoka N et al (2008): Predicting the success of endoscopic transpapillary gallbladder drainage for patients with acute cholecystitis during pretreatment evaluation. Can J Gastroenterol 22: 681-685 17. Toyota N, Takada T, Amano H, Yoshida M, Miura F & Wada K (2006): Endoscopic naso-gallbladder drainage in the treatment of acute cholecystitis: alleviates inflammation and fixes operatorʼs aim during early laparoscopic cholecystectomy. J Hepatobiliary Pancreat Surg 13: 80-85 6. Shrestha R, Trouillot TE & Everson GT (1999): Endoscopic stenting of the gallbladder for symptomatic gallbladder disease in patients with end-stage liver disease awating orthotopic liver transplantation. Liver Transplant Surg 5: 275-281 16. Mutignani M, Iacopini F, Perri V, Familiari P, Tringali A, Spada C, Ingrosso M & Costamagna G (2009): Endoscopic gallbladder drainage for acute cholecystitis: technical and clinical results. Endoscopy 41: 539-546 2. Maekawa S, Nomura R, Murase T, Ann Y, Oeholm M & Harada M (2013): Endoscopic gallbladder stenting for acute cholecystitis: a retrospective study of 46 elderly patients aged 65 years or older. BMC Gastroenterol 13: 65 10. Matsubara S, Arizumi T, Togawa O et al (2007): Endoscopic transpapillary approach to the gallbladder for diagnosing gallbladder cancer. Can J Gastroenterol 21: 809-813 9. Kozarek RA (1984): Selective cannulation of the cystic duct at time of ERCP. J Clin Gastroenterol 6: 37-40 7. Shrestha R, Bilir BM, Everson GT & Steinberg SE (1996): Endoscopic stenting of gallbladder for symptomatic cholelithiasis in patients with end-stage liver disease awaiting orthotopic liver transplantation. Am J Gastroenterol 91: 595-598 23. Feretis CB, Manouras AJ, Apostolidis NS & Golematis BC (1990): Endoscopic transpapillary drainage of gallbladder empyema. Gastrointest Endosc 36: 523-525 5. Schlenker C, Trotter JF, Shah RJ, Everson G, Chen YK, Antillon D & Antillon MR (2006): Endoscopic gallbladder stent placement for treatment of symptomatic cholelithiasis in patients with end-stage liver disease. Am J Gastroenterol 101: 278-283 13. 糸井隆夫，祖父尼淳，糸川文英，栗原俊夫，土屋貴愛，新戸禎哲（2010）：経乳頭的胆嚢ドレナージ． Gastroenterol Endosc 52: 3337-3346 8. Gaglio PJ, Buniak B & Leevy CB (1996): Primary endoscopic retrograde cholecystoendoprosthesis: a nonsurgical modality for symptomatic cholelithiasis in cirrhotic patients. Gastrointest Endosc 44: 339-342 3. Lee TH, Park DH, Lee SS, Seo DW, Park SH, Lee SK, Kim MH & Kim SJ (2011): Outcomes of endoscopic transpapillary gallbladder stenting for symptomatic gallbladder diseases: a multicenter prospective follow-up study. Endoscopy 43: 702-708 15. Tamada K, Seki H, Sato K et al (1991): Efficacy of endoscopic retrograde cholecystoendoprosthesis (ERCCE) for cholecystitis. Endoscopy 23: 2-3 1 . 高田忠敬，真弓俊彦，吉田雅博，他（2013）：急性胆管炎・胆嚢炎診療ガイドライン2013．第2版，急性胆管炎・胆嚢炎診療ガイドライン改訂出版委員会，日本腹部救急医学会，日本肝胆膵外科学会，日本胆道学会，日本外科感染症学会，日本医学放射線学会 編，医学図書出版株式会社，東京 195pp 20. Itoi T, Sofuni A, Itokawa F et al (2008): Endoscopic transpapillary gallbladder drainage in patients with acute cholecystitis in whom percutaneous transhepatic approach is contraindicated or anatomically impossible (with video). Gastrointest Endosc 68: 455-460 21. Itoi T, Coelho-Prabhu N & Barton TH (2010): Endoscopic gallbladder drainage for management of acute cholecystitis. Gastrointest Endosc 71: 1038-1045 22. Nakatsu T, Okada H, Saito K, Uchida N, Minami A, Ezaki T, Morshed SA & Nishioka M (1997): Endoscopic transpapillary gallbladder drainage (ETGBD) for the treatment of acute cholecystitis. J Hepatobiliary Pancreat Surg 4: 31-35 |
| References_xml | – reference: 8. Gaglio PJ, Buniak B & Leevy CB (1996): Primary endoscopic retrograde cholecystoendoprosthesis: a nonsurgical modality for symptomatic cholelithiasis in cirrhotic patients. Gastrointest Endosc 44: 339-342 – reference: 21. Itoi T, Coelho-Prabhu N & Barton TH (2010): Endoscopic gallbladder drainage for management of acute cholecystitis. Gastrointest Endosc 71: 1038-1045 – reference: 7. Shrestha R, Bilir BM, Everson GT & Steinberg SE (1996): Endoscopic stenting of gallbladder for symptomatic cholelithiasis in patients with end-stage liver disease awaiting orthotopic liver transplantation. Am J Gastroenterol 91: 595-598 – reference: 15. Tamada K, Seki H, Sato K et al (1991): Efficacy of endoscopic retrograde cholecystoendoprosthesis (ERCCE) for cholecystitis. Endoscopy 23: 2-3 – reference: 6. Shrestha R, Trouillot TE & Everson GT (1999): Endoscopic stenting of the gallbladder for symptomatic gallbladder disease in patients with end-stage liver disease awating orthotopic liver transplantation. Liver Transplant Surg 5: 275-281 – reference: 2. Maekawa S, Nomura R, Murase T, Ann Y, Oeholm M & Harada M (2013): Endoscopic gallbladder stenting for acute cholecystitis: a retrospective study of 46 elderly patients aged 65 years or older. BMC Gastroenterol 13: 65 – reference: 18. Pannala R, Petersen BT, Gostout CJ, Topazian MD, Levy MJ & Baron TH (2008): Endoscopic transpapillary gallbladder drainage: 10-year single center experience. Minerva Gastroenterol Dietol 54: 107-113 – reference: 4. Conway JD, Russo MW & Shrestha R (2005): Endoscopic stent insertion into the gallbladder for symptomatic gallbladder disease in patients with end-stage liver disease. Gastrointest Endosc 61: 32-36 – reference: 12. Feretis C, Apostolidis N, Mallas E, Manouras A & Papadimitriou J (1993): Endoscopic drainage of acute obstructive cholecystitis in patients with increased operative risk. Endoscopy 25: 392-395 – reference: 11. Itoi T, Sofuni A, Itokawa F, Kurihara T, Tsuchiya T, Moriyasu F, Yamagishi T & Serizawa H (2006): Preoperative diagnosis and management of thick-walled gallbladder based on bile cytology obtained by endoscopic transpapillary gallbladder drainage tube. Gastrointest Endosc 64: 512-519 – reference: 24. 松原三郎，徳山信行，内田麻美，梅舟仰胤，田村直樹，小椋啓司，伊佐山浩通（2013）：急性胆嚢炎に対する経乳頭的ドレナージ．胆と膵 34：917-923 – reference: 25. Sugiyama M, Tokuhara M & Atomi Y (1998): Is percutaneous cholecystostomy the optimal treatment for acute cholecystitis in the very elderly? World J Surg 22: 459-463 – reference: 5. Schlenker C, Trotter JF, Shah RJ, Everson G, Chen YK, Antillon D & Antillon MR (2006): Endoscopic gallbladder stent placement for treatment of symptomatic cholelithiasis in patients with end-stage liver disease. Am J Gastroenterol 101: 278-283 – reference: 14. Kjaer DW, Kruse A & Funch-Jensen P (2007): Endoscopic gallbladder drainage of patients with acute cholecystitis. Endoscopy 39: 304-308 – reference: 17. Toyota N, Takada T, Amano H, Yoshida M, Miura F & Wada K (2006): Endoscopic naso-gallbladder drainage in the treatment of acute cholecystitis: alleviates inflammation and fixes operatorʼs aim during early laparoscopic cholecystectomy. J Hepatobiliary Pancreat Surg 13: 80-85 – reference: 9. Kozarek RA (1984): Selective cannulation of the cystic duct at time of ERCP. J Clin Gastroenterol 6: 37-40 – reference: 23. Feretis CB, Manouras AJ, Apostolidis NS & Golematis BC (1990): Endoscopic transpapillary drainage of gallbladder empyema. Gastrointest Endosc 36: 523-525 – reference: 22. Nakatsu T, Okada H, Saito K, Uchida N, Minami A, Ezaki T, Morshed SA & Nishioka M (1997): Endoscopic transpapillary gallbladder drainage (ETGBD) for the treatment of acute cholecystitis. J Hepatobiliary Pancreat Surg 4: 31-35 – reference: 19. Ogawa O, Yoshikumi H, Maruoka N et al (2008): Predicting the success of endoscopic transpapillary gallbladder drainage for patients with acute cholecystitis during pretreatment evaluation. Can J Gastroenterol 22: 681-685 – reference: 13. 糸井隆夫，祖父尼淳，糸川文英，栗原俊夫，土屋貴愛，新戸禎哲（2010）：経乳頭的胆嚢ドレナージ． Gastroenterol Endosc 52: 3337-3346 – reference: 10. Matsubara S, Arizumi T, Togawa O et al (2007): Endoscopic transpapillary approach to the gallbladder for diagnosing gallbladder cancer. Can J Gastroenterol 21: 809-813 – reference: 3. Lee TH, Park DH, Lee SS, Seo DW, Park SH, Lee SK, Kim MH & Kim SJ (2011): Outcomes of endoscopic transpapillary gallbladder stenting for symptomatic gallbladder diseases: a multicenter prospective follow-up study. Endoscopy 43: 702-708 – reference: 1 . 高田忠敬，真弓俊彦，吉田雅博，他（2013）：急性胆管炎・胆嚢炎診療ガイドライン2013．第2版，急性胆管炎・胆嚢炎診療ガイドライン改訂出版委員会，日本腹部救急医学会，日本肝胆膵外科学会，日本胆道学会，日本外科感染症学会，日本医学放射線学会 編，医学図書出版株式会社，東京 195pp – reference: 20. Itoi T, Sofuni A, Itokawa F et al (2008): Endoscopic transpapillary gallbladder drainage in patients with acute cholecystitis in whom percutaneous transhepatic approach is contraindicated or anatomically impossible (with video). Gastrointest Endosc 68: 455-460 – reference: 16. Mutignani M, Iacopini F, Perri V, Familiari P, Tringali A, Spada C, Ingrosso M & Costamagna G (2009): Endoscopic gallbladder drainage for acute cholecystitis: technical and clinical results. Endoscopy 41: 539-546 |
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| Snippet | 急性胆嚢炎は，胆嚢に生じた炎症性疾患である．炎症は胆嚢局所に留まることが多いが，炎症の悪化に伴い致死的な経過を取る場合もある．中等症以上の急性胆嚢炎に... 「要旨」急性胆嚢炎は, 胆嚢に生じた炎症性疾患である. 炎症は胆嚢局所に留まることが多いが, 炎症の悪化に伴い致死的な経過を取る場合もある. 中等症以上の急性胆嚢炎に... |
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| SubjectTerms | 内視鏡的胆嚢ステント留置術 急性胆嚢炎 恒久的留置 経皮経肝胆嚢ドレナージ 高齢者 |
| Title | 急性胆嚢炎に対する内視鏡的胆嚢ステント留置術 |
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