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完整後設資料紀錄
DC 欄位 | 值 | 語言 |
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dc.contributor.advisor | 吳明賢(Ming-Shiang Wu) | |
dc.contributor.author | Kuang-Chun Hu | en |
dc.contributor.author | 胡光濬 | zh_TW |
dc.date.accessioned | 2021-06-16T13:40:45Z | - |
dc.date.available | 2015-09-24 | |
dc.date.copyright | 2013-09-24 | |
dc.date.issued | 2013 | |
dc.date.submitted | 2013-07-13 | |
dc.identifier.citation | 參考文獻:
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Chang CW, Chang WH, Lin CC, Chu CH, Wang TE, Shih SC. Acute transient hepatocellular injury in cholelithiasis and cholecystitis without evidence of choledocholithiasis. World J Gastroenterol. 2009; 15: 3788–3792. Chen CH, Huang MH, Yang JC, Nien CK, Etheredge GD, Yang CC, Yeh YH, Wu HS, Chou DA, Yueh SK. Prevalence and risk factors of gallstone disease in an adult population of Taiwan: an epidemiological survey. J Gastroenterol Hepatol. 2006;21:1737–1743. Chen CJ, Wang LY, Yu MW. Epidemiology of hepatitis B virus infection in the Asia-Pacific region. J Gastroenterol Hepatol. 2000; 15:E3-E6. Collins C, Maguire D, Ireland A, et al. A prospective study of common bile duct calculi in patients undergoing laparoscopic cholecystectomy: natural history of choledocholithiasis revisited. Ann Surg 2004;239: 28–33. Freeman M L, Nelson D B, Sherman S, et al. Complications of endoscopic biliary sphincterotomy. N Engl J Med 1996; 335.13: 909-919. Freitas ML, Bell RL & Duffy AJ. Choledocholithiasis: evolving standards for diagnosis and management. World Journal of Gastroenterology 2006, 12: 3162–3167. Frossard JL, Hadengue A, Amouyal G, et al. Choledocholithiasis: a prospective study of spontaneous common bile duct stone migration. Gastrointest Endosc 2000;51:175– 179. Geenen, D J, et al. The role of surveillance endoscopic retrograde cholangio- pancreatography in preventing episodic cholangitis in patients with recurrent common bile duct stones. Endoscopy, 1998, 30.01: 18-20 Hacker KA,Schultz CC, Helling TS. Choledochotomy for calculous disease in the elderly. Am J Surg. 1990; 160:610-612. Jarnagin WR, Belghiti J, Buchler MW, et al. In: Saldinger PF, Cocieru A, eds. Natural history of gallstones and asymptomatic gallstones. Philadelphia: Elsevier Saunders, 2012:483-486. Jarnagin WR, Belghiti J, Buchler MW, et al. Blumgart’s Surgery of the Liver, Biliary Tract, and Pancreas. In: Kelly K, Weber S, eds. Cholecystitis. Philadelphia: Elsevier Saunders, 2012:487-493. Jeon WJ, Han JH, Seo JC, et al. Clinical features of patients with choledocholithiasis showing high levels of aminotransferases [in Korean]. Korean J Gastroenterol 2006;47: 213–217. Jovanovic P, Salkic NN, Zerem E, Ljuca F. Biochemical and ultrasound parameters may help predict the need for therapeutic endoscopic retrograde cholangiopancreatography (ERCP) in patients with a firm clinical and biochemical suspicion for choledocholithiasis. European Journal of Internal Medicine 2011;22: e110–e114 Kialian GP, Aznaurian AV. The aged related characteristics of the muscular layer of the common bile duct in man [in Russian]. Morfologiia 1995; 108: 10–12. Lai, K H, et al. Prediction of recurrent choledocholithiasis by quantitative cholescintigraphy in patients after endoscopic sphincterotomy. Gut, 1997, 41.3: 399-403. Lai MY. Combined interferon and ribavirin therapy for chronic hepatitis C in Taiwan. Intervirology 2006;49: 91-95. Liu CM, Tung TH, Chou P, Chen VTK, Hsu CT, Chien WS, Lin YT, Lu HF, Shih HC, Liu JH. Clinical correlation of gallstone disease in a Chinese population in Taiwan: Experience at Cheng Hsin General Hospital. World J Gastroenterol 2006; 12: 1281-1286. Liu CJ, Liou JM, Chen DS, et al. Natural course and treatment of dual hepatitis B virus and hepatitis C virus infections. J Formos Med Assoc. 2005;104: 783–791. Onken JE, Brazer SR, Eisen GM, et al. Predicting the presence of choledocholithiasis in patients with symptomatic cholelithiasis. Am J Gastroenterol 1996;91:762–767. Prat F, Meduri B, Ducot B, et al. Prediction of common bile duct stones by noninvasive tests. Ann Surg. 1999;229: 362–368. Sharara AI, Mansour NM, El-Hakam M, et al. Duration of pain is correlated with elevation in liver function tests in patients with symptomatic choledocholithiasis. Clin Gastroenterol Hepatol. 2010;8:1077–1082. Sugiyama M, Atomi Y. Endoscopic ultrasonography for diagnosing choledocholithiasis: a prospective comparative study with ultrasonography and computed tomography. Gastrointest Endosc 1997;45: 143 -146. Tham TC, Collins JS, Watson RG, Ellis PK, McIlrath EM. Diagnosis of common bile duct stones by intravenous cholangiography: prediction by ultrasound and liver function tests compared with endoscopic retrograde cholangiography. Gastrointest Endosc 1996;44: 158-163. Toyota N, Miyai K, Hardison WG. Effect of biliary pressure versus high bile acid flux on the permeability of hepatocellular tight junction. Lab Invest 1984;50: 536–542. Valdiieso V, Palma R, Wunkhaus R, et al. Effect of aging on biliary lipid composition and bile acid metabolism in normal Chilean women. Gastroenterology 1978; 74: 871-874. Watanabe N, Kojima S, Takashimizu S, et al. Initial site of bile regurgitation following extrahepatic biliary obstruction in living rats. J Gastroenterol Hepatol 2007;22: 1983–1992. Williams EJ, Green J, Beckingham I, et al. Guidelines on the management of common bile duct stones. Gut 5 Mar 2008;57: 1004–1021. Yang HI, Lu SN, Liaw YF, et al. Hepatitis B e-Antigen and the risk of hepatocellular carcinoma. N Engl J Med 2002; 347:168-174. Yang MH, Chen TH, Wang SE, Tsai YF, Su CH, Wu CW, Lui YW, Shyr YM. Biochemical Predictors for the Absence of Common Bile Duct Stone in Patients Undergoing Laparoscopic Cholecystectomy. Surg Endosc 2008;22:1620-1624. | |
dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/62318 | - |
dc.description.abstract | 研究背景:
在成年人口中,膽結石的盛行率約有5-10%。70歲以上的老年病患發現膽結石的比例甚至高達25-30%。根據過去的文獻報告,有10-20%的膽結石患者會併患為膽道結石。臨床上在病患接受膽囊切除術時,膽道結石的有無,將會影響後續治療的方法及步驟。而膽道結石的確診,是依據侵入性的逆行性內視鏡膽道鏡檢查(Endoscopic retrograde cholangiopancreatography, ERCP)結果為主。然而ERCP不僅昂貴,風險也高,而膽道疾病又是以中老年患者居多。所以,在進行ERCP之前,先以非侵入性的檢查,來選擇適當的病患再進行逆行性內視鏡膽道鏡檢查,在臨床上就是一重要的課題。在術前的非侵入性檢查評估中,主要依據病患本身的症狀、肝功能的檢查及腹部超音波的檢查,來推測有無膽道結石的存在。因為膽道結石疾病的患者,是以中老年人為主,而針對不同年齡層的膽道結石病患,其術前的臨床表現是否有所不同,值得進一步探討。 研究目的: 探討不同年齡層的膽道結石病患,其臨床症狀、肝功能的檢查及腹部超音波的檢查結果,是否有所不同。 研究方法: 本研究為回溯性研究,研究資料收集從2007年7月至2008年6月間,年齡在18至64歲之間,以及2004年7月至2008年6月間,年齡在65至85歲之間,因胰臟與膽道系統疾病於馬偕紀念醫院接受一般生化檢查,腹部超音波檢查及逆行性內視鏡膽胰管攝影術檢查及治療的病患。將這群病患分成18-64歲(成年組)、65-74歲(少老年組)、75-84歲(中老年組)、大於85歲(老老年組)等四個年齡層,分析不同年齡層病患,術前的臨床表徵,資料內容包含肝功能(包括aspartate amino- transferase(AST), alanine amino-transferase (ALT), alkaline phosphatase (ALK-P), total and direct bilirubin) 等檢驗,腹部超音波檢查結果。並以逆行性內視鏡膽道鏡檢查,作為膽道結石確診的依據。同時排除:病毒性肝炎、酒精性肝炎、藥物性肝炎、自體免疫性肝炎、代謝性肝臟疾病患者,及曾經接受內視鏡括約肌切開術的患者。在各年齡的分組中,以STATA ( for student)進行統計分析,以student’s t test檢測各個變項中,有無膽道結石者,有無明顯差異。 研究結果: 研究期間內總共收錄了443位病患進行分析,其中成年組:143人,少老年組:168人,中老年組:97人,老老年組:35人。在臨床表徵方面,於成年組及少老組中確診為膽道結石的患者,有膽絞痛(Biliary colic)表現者比例明顯偏高(成年組:89%,少老年:78%),有黃疸表現者,於成年組中確診為膽道結石的患者,比例也較高(67% vs 39%, p<0.05)。而老老年患者,在臨床表徵上,則無明顯差異。在急性膽道炎的表現方面,少老年組中有膽道結石的患者,合併急性膽道炎者與無膽道結石者相比,比例較高(47% vs 22%, p<0.05),但是在其他三組病患,則無此發現。於肝功能檢查方面,於成年組中確診為膽道結石的患者,包括AST, ALT, total and direct bilirubin檢查的平均值,均明顯高於無膽道結石的患者。對於成年組、少老年組、中老年組,AST及ALT檢查結果異常的比例皆明顯大於無膽道結石的患者。對老老年患者,肝功能的表現,在膽道結石的有無之間,無明顯差異。在腹部超音波檢查部分,於超音波診斷膽道結石的敏感度(sensitivity)及準確度(accuracy),隨著年齡層的增加而上升。敏感度:成年組:0.15,少老年組:0.45,中老年組:0.57,老老年組:0.48。準確度:成年組:0.48,少老年組:0.63,中老年組:0.7,老老年組:0.71。 結論: 對於不同年齡的膽道疾病患者,臨床表現會有所不同。經逆行性內視鏡膽道鏡檢查確診為膽道結石的病患,於年齡較輕者,臨床表徵及肝功能異常的比例較高;而年紀較長者,以超音波診斷膽道結石的敏感度及準確度較高。若我們能經由非侵入的檢查結果來評估膽道疾病的情形,在臨床上能幫助我們決定處置病患的方向及方法。 | zh_TW |
dc.description.abstract | BACKGROUND:
The prevalence of gallstone disease in the general population was 5.3-10% in Taiwan. Common bile duct (CBD) stones would develop in about 10%-20% of patients with gallstones. The role of clinical symptoms, trans-abdominal ultrasound scan (USS) and liver function tests (LFTs) in evaluating common bile duct(CBD) stones in patients with suspected pancreatobiliary disease has been studied widely. However, it is not clear whether these predictive models are useful in different aging cohort population. OBJECTIVES: To investigate the clinical symptoms and signs, trans-abdominal ultrasonographic findings, LFTs and endoscopic retrograde cholangiopancreatography(ERCP) findings in different aging cohort patients with and without CBD stones. METHODS: The medical records of patients aged from 18 year-old or older who underwent USS and ERCP from July 2004 to June 2008 were collected. Four hundred thirty-three patients with pancreatobiliary diseases divided into cohorts according to decades as young(Y, n= 143), young-old (YO, 65–74, n=153), old-old (OO, 75–84, n=88), and very-old (VO, ≥85, n=32). Clinical symptoms, biochemical liver tests, trans- abdominal ultrasonographic findings and ERCP results in these 4 groups were demonstrated and compared. The categorical variables of the groups were compared by Chi-square analysis. The significance of the mean differences between patients with and without stones was evaluated by Student's t test. RESULTS: Four hundred thirty-three patients who received USS and ERCP procedures were included this study. Young and YO group patients were more likely to develop symptoms such as biliary colic when they had CBD stones. Mean serum AST level (205.32±213.60 vs 79.47±126.53, p<0.05) and ALT level (305.14±218.60 vs 100.65±128.72, p<0.05 ) were significant higher in Young groups patient with CBD stones than those without CBD stones. The proportion of abnormal serum AST and ALT were significant greater in Young, YO and OO groups patient with CBD stones than without CBD stones. Mean value and abnormal proportion of alkaline phosphatase (ALK-P) was higher in YO patients with CBD stone than without CBD stone (YO: 75.8%; OO: 50%; p=0.005). Sensitivity of USS for CBD stones in Young: 0.15; YO: 0.45; OO: 0.57; VO: 0.68. Accuracy of USS for detected CBD stone in Young: 48%; YO: 62.5%; OO: 70.1%; VO: 71.4%. Higher biliary pancreas malignancy rate might see in patients without CBD stone (Young: 18.6%; YO: 25%; OO: 21% VO: 23%). CONCLUSION: Combined evaluation of biochemical and USS findings may help predict the presence of CBD stones. In Young, Young-old and Old-old patients with CBD stones, the incidences of abnormal LFTs were higher. USS sensitivity and accuracy for CBD stone presentation was increased by aging. | en |
dc.description.provenance | Made available in DSpace on 2021-06-16T13:40:45Z (GMT). No. of bitstreams: 1 ntu-102-P00421001-1.pdf: 617857 bytes, checksum: 923448e11b5b5006d168aa6ac7097515 (MD5) Previous issue date: 2013 | en |
dc.description.tableofcontents | 目 錄
口試委員會審定書……………………………………………………………… i 誌謝………………………………………………………………………………. ii 中文摘要………………………………………………………………………… iv 英文摘要…………………………………………………………………………. vii 碩士論文內容 第一章 研究背景及目的………………………………………………………….. 1 第二章 研究方法與進行步驟…………………………………………………….. 6 第三章 研究結果 …………………………………………………………….. 9 第四章 討論 …………………………………………………………….. 13 第五章 結論與展望 …………………………………………………………….. 19 參考文獻 ……………………………………………………………………….. 21 表1 ……………………………………………………………………………. 27 表2 ……………………………………………………………………………. 28 表3 ……………………………………………………………………………. 29 表4 ……………………………………………………………………………. 30 表5 ……………………………………………………………………………. 31 圖1 ……………………………………………………………………………. 32 縮寫對照表 ……………………………………………………………………. 33 附錄 ……………………………………………………………………. 34 | |
dc.language.iso | zh-TW | |
dc.title | 不同年齡層膽道結石疾病患者的臨床表現 | zh_TW |
dc.title | Clinical Presentations of Different Aging Cohort with Biliary Tract Stone diseases | en |
dc.type | Thesis | |
dc.date.schoolyear | 101-2 | |
dc.description.degree | 碩士 | |
dc.contributor.coadvisor | 劉俊人(Chun-Jen Liu) | |
dc.contributor.oralexamcommittee | 施壽全(Shou-Chuan Shih) | |
dc.subject.keyword | 年齡,膽道結石,臨床症狀,肝功能檢查,腹部超音波,逆行性內視鏡膽道鏡, | zh_TW |
dc.subject.keyword | Aging,common bile duct stone,Liver function test,trans-abdominal ultrasound scan,Endoscopic retrograde cholangiopancreatography, | en |
dc.relation.page | 34 | |
dc.rights.note | 有償授權 | |
dc.date.accepted | 2013-07-15 | |
dc.contributor.author-college | 醫學院 | zh_TW |
dc.contributor.author-dept | 臨床醫學研究所 | zh_TW |
顯示於系所單位: | 臨床醫學研究所 |
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