Yamakawa T, Honda H
Department of Surgery, Teikyo University Hospital, Mizonokuchi.
Nihon Rinsho. 1993 Jul;51(7):1802-7.
With an advent of cholangiofiberscope in 1975, tremendous changes have been made in thinking way on the treatment of biliary tract stones. The technique of percutaneous transhepatic cholangioscopy (PTCS) was detailed and its clinical significance was discussed in this paper. PTCS is the technique which is conducted by insertion of cholangiofiberscope into the biliary tract through the dilated fistula produced by percutaneous transhepatic biliary drainage (PTBD). Advantages of this techniques are; (1) it is applicable to the cases who had had bilio-enteric anastomosis or gastro-jejunostomy before, (2) it can be repeatedly carried out if the fistula is maintained open, (3) stones visible are readily removable with the instruments guided by cholangiofiberscope and finally, (4) the informations necessary to select an adequate surgical procedure can be obtained by PTCS, because biliary architecture is clearly delineated. For the period of 18 years started from 1975, 126 cases with intrahepatic stones have been encountered in our Hospital, endoscopic stones extraction technique was successful in 106 out of 121 cases excluding 5 cases converted for hepatic lobectomy. And the prognosis of the cases in which stones were successfully extracted were, in general, good. Therefore, the authors believe that the therapeutic results would be significantly improved with the routine use of PTCS.
随着1975年纤维胆道镜的问世，胆道结石治疗的思维方式发生了巨大变化。本文详细介绍了经皮经肝胆道镜检查（PTCS）技术，并讨论了其临床意义。PTCS是一种通过经皮经肝胆道引流（PTBD）产生的扩张瘘管将纤维胆道镜插入胆道进行操作的技术。该技术的优点包括：（1）适用于既往有胆肠吻合术或胃空肠吻合术的病例；（2）如果瘘管保持开放，可以重复进行；（3）在纤维胆道镜引导下，可见的结石很容易用器械取出；最后，（4）由于胆道结构清晰，PTCS可以获得选择适当手术方法所需的信息。从1975年开始的18年期间，我院共收治126例肝内结石患者，除5例改行肝叶切除术外，121例中有106例内镜取石技术成功。成功取出结石的病例总体预后良好。因此，作者认为常规使用PTCS将显著改善治疗效果。
