臨床外科60巻1号

2005年01月発行

特集 手術のグッドタイミング 〔根治術のタイミング〕

胆石性膵炎における胆石に対する治療

著者： 杉山政則¹ 阿部展次¹ 柳田修¹ 正木忠彦¹ 森俊幸¹ 跡見裕¹

所属機関： ¹杏林大学医学部外科

ページ範囲：P.39 - P.44

要旨：胆石性膵炎では，軽症例は胆石が乳頭から十二指腸へ自然排出することが多いが，重症膵炎では胆石の乳頭部嵌頓が持続したり胆石が総胆管内に長くとどまることが多い．したがって，重症膵炎や黄疸・急性胆管炎合併例では48～72時間以内のERCPや，内視鏡的乳頭切開による総胆管切石が必要である．胆囊結石に対しては膵炎が完全に改善したのちに胆囊摘出術を行う（通常は発症後3週目以降）．軽症膵炎では胆石に対する早期の治療は不要であり，膵炎消退後すみやかに膵炎予防のために胆囊摘出術を行う（通常は発症後5～10日目以降）．多くの症例では腹腔鏡下手術が可能である．

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