膵胆道系疾患の内視鏡治療の評価

EVALUATION OF ENDOSCOPIC TREATMENT OF THE PANCREATOBILIARY SYSTEM DISORDERS.

• І Shkvarkovskyj
• О Moskaliuk
• I Bryndak
• V Grebeniuk
• I Kozlovska

抄録

胆管・膵臓疾患の治療において、内視鏡的逆行性胆管膵臓造影検査（ERCP）が普及してきている。ERCPの治療能力と診断能力、およびこの方法に伴う合併症を研究することにより、この方法の適応と禁忌を再考することが可能となった。本論文の目的は、膵胆道病理の内視鏡治療法の有効性と安全性を検討することである。本研究論文では、内視鏡手術センターで治療中の膵胆道系疾患患者412例を対象に、内視鏡治療を行った結果を報告する。一次外科的介入は319例（77.43％）で行われた。ガイドワイヤーを用いた目的の膵管のカニュレーションは284例（68.93％）で達成された。内視鏡的介入の最も一般的な適応は、総胆管内のコンクリションによる機械的黄疸であり、結石性胆嚢炎を併発している患者209人(50,72%)、再発性の胆汁性胆汁症が26人(6,31%)、肝膵十二指腸帯の新生物が130人(31,55%)に認められた。肝外胆管からのコンクリメントの摘出は235例（57,03％）に実施された。膵臓腫瘍と肝外胆道が原因で内胆道ステント留置術は158例(38,34%)で122例(29,61%)に実施された。術後合併症の発生頻度は7,8%を超えていない。このように、ERCPは全身麻酔を必要とせず、外科的外傷も少なく、開腹手術を回避し、治療の即効性と長期的な治療成績を向上させることができる非常に有効な診断・治療法である。

Endoscopic retrograde cholangiopancreatography (ERCP) is becoming more widespread in the treatment of diseases of the bile ducts and pancreas. Studying the therapeutic and diagnostic capabilities of the ERCP and the complications accompanying this method made it possible to reconsider the indications and contraindications for its use, the main of which is the removal of concretions from the bile ducts and the stenting in the case of duct obturation with neoplasms. The purpose of the paper is to study the effectiveness and safety of endoscopic methods of treating pancreatobiliary pathology. The results of the endoscopic treatment of 412 patients with diseases of the pancreatobiliary system who were on the treatment at the center of endoscopic surgery are presented in this research paper. Primary surgical interventions were performed in 319 patients (77.43%). The cannulation of the desired duct with guidewire was achieved in 284 patients (68.93%). The most common indication for endoscopic interventions was mechanical jaundice caused by concretions in the common bile duct in combination with calculous cholecystitis 209 patients (50,72%), recurrent choledocholithiasis was observed in 26 patients (6,31%), neoplasms in the hepatopancreatoduodenal zone were found in 130 patients (31,55%). Extraction of concrements from extrahepatic bile ducts was carried out in 235 patients (57,03%). Endobiliary stenting was performed in 158 (38,34%) patients in 122 (29,61%) of them due to pancreatic tumors and extrahepatic biliary tract. The frequency of occurrence of postoperative complications does not exceed 7,8%. Thus, ERCP is highly effective diagnostic and treatment method that do not require general anesthesia, do not cause significant surgical trauma, avoiding open surgery and improving the immediate and long-term outcomes of treatment.