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경십이지장 관약근 절개술 및 취관삽입술 Transduodenal Sphincterotomy and Human Pancreatic Cannulation

대한외과학회지 1972년 14권 5호 p.15 ~ 23
黃毅浩, 許景渤, 金春奎,
소속 상세정보
黃毅浩 (  ) 
연세대학교 의과대학 외과학교실

許景渤 (  ) 
고려병원 안과
金春奎 (  ) 
연세대학교 의과대학 외과학교실

Abstract


Residual stones which develop after biliary tract surgery have been a very troublesome postoperative
complication even though operative cholangiography and careful surgical exploration of common bile duct
were employed at the time of the primary surgery.
Transduodenal sphincterotomy was first performed in 1891 by Charles Mcburney who removed a
common duct stone which was impacted in the ampullary region. This technic has had the reputation of
being effective in the treatment of bile stasis and a post-cholecystectomy syndrome due to residual stones.
It is well known that gall stones are found more frequently in the extracholecystin biliary tract in
Koreans than in Americans or Europeans. This fact might contribute to the oncreased frequency of
Transduodenal sphincterotomy in our series.
From 1958 through 1967, 314 surgical procedures on the biliary tract were performed for benign
conditions. Among the 314 patients, in 75 Transduodenal sphincterotomy was performed. Among the
75, in 26 the pancreatic duct was cannulated to prevent post-operative acute pancreatitis. Indications
for Transduodenal sphincterotomy were:
1. Impacted stones at the Ampulla Vater or in the distal common bile duct.
2. Muddy or sandy stones in the common or hepatic ducts.
3. Multiple gallbladder or common bile duct stones.
4. Stenosis or spasm of the Ampulla Vater.
5. The post-cholecystectomy syndrome.
6. Retrograde exploration for the common bile duct via the Ampulla Vater.
7. Non-calculous cholecystitis with dilatation of the common bile duct.
The over-all complication rate after Transduodenal sphincterotomy (75 cases) was 33.3%, and among
these 3 cases residual stones and 9 cases of post-operative acute pancreatitis were found. The mortality
rate was 2.7% (2/75).
The fact that residual stones developed after transduodenal sphincterotomy suggests that transduodenal
sphincterotomy is not the best nor the only method for the treatment of residual gall stones. This
fact also emphasizes the need for some kind of bypass procedure such as a Roux-en-Y choledochojeju
nostomy.
Post-operative acute pancreatitis is a dreadful complication of transduodenal sphincterotomy. Authors
cannulated the pancreatic duct whenever excessive manipulation was exerted on the priampullary region
during the Transduodenal sphincterotomy. Although the incidence of this complication was 9 cases among
75 patients (12.0%), only one serious case of the 9 occurred in the group in which the pancreatic
duct was cannulated.

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