Clinical Endoscopy

The Korean Society of Gastrointestinal Endoscopy (대한소화기내시경학회)
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Bilateral Biliary Approach in Patients with Hepatolithiasis

간내담석 환자에서 양측성 담도 접근

  • Kim, Dong-Uk (Department of Internal Medicine, Pusan National University School of Medicine) ;
  • Song, Geun-Am (Department of Internal Medicine, Pusan National University School of Medicine) ;
  • Kim, Kwang-Ha (Department of Internal Medicine, Pusan National University School of Medicine) ;
  • Kim, Suk (Department of Radiology, Pusan National University School of Medicine) ;
  • Kim, Hyung-Wook (Department of Internal Medicine, Pusan National University School of Medicine) ;
  • Kang, Dae-Hwan (Department of Internal Medicine, Pusan National University School of Medicine)
  • 김동욱 (부산대학교 의학전문대학원 내과학교실) ;
  • 송근암 (부산대학교 의학전문대학원 내과학교실) ;
  • 김광하 (부산대학교 의학전문대학원 내과학교실) ;
  • 김석 (부산대학교 의학전문대학원 영상의학교실) ;
  • 김형욱 (부산대학교 의학전문대학원 내과학교실) ;
  • 강대환 (부산대학교 의학전문대학원 내과학교실)
  • Received : 2010.06.21
  • Accepted : 2010.10.06
  • Published : 2010.11.30
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Abstract

Background/Aims: Percutaneous procedures for treating patients with hepatolithiasis associated with intrahepatic biliary stricture (IHBS) have been shown to have a relatively lower rate of successful stone removal than without IHBS. The reason is tight stenosis or acute angulation of intrahepatic bile ducts (IHDs). We suggest that a bilateral approach to IHDs would improve the success rate of stone removal in patients with complicated IHBS. Methods: Conventional cholangioscopic electrohydrolithotripsy (EHL) was performed in 82 patients without IHBS. Percutaneous transhepatic stricture dilation and cholangioscopic EHL through unilateral access was performed to treat 41 patients with hepatolithiasis with IHBS. In 21 patients with complicated stricture and multiple stones, removal of hepatolithiasis was achieved by a bilateral approach. The rate of complete stone clearance and complication was reviewed retrospectively. Results: Complete stone clearance was achieved in 92.7% (76/82) of patients using a unilateral approach without IHBS, in 61.0% (25/41) of cases using a unilateral approach with IHBS, and in 85.7% (18/21) of cases using a bilateral approach with IHBS (p<0.05). The number of sessions of PTCS was $2.7{\pm}0.3$, $3.9{\pm}0.3$, and $2.7{\pm}0.5$ respectively. The overall complication rate was 14.6% (21/144), and didn't differ between groups. Conclusions: A bilateral approach to IHDs may be a useful alternative treatment in unresectable patients with multiple hepatolithiasis associated with complicated IHBS.

목적: 복합담도협착을 동반한 간내담석 환자에서 경피적 담도경을 통한 담석제거율은 협착을 동반하지 않은 경우와 비교하여 상대적으로 낮게 보고되고 있다. 그 원인으로 심한 협착과 간내담도의 예각 등이 기술적인 문제로 거론되고 있다. 이에 저자들은 복합담도협착을 동반한 환자에서 양측성 담도접근로를 확보하여 담석제거율이 증가하는지를 평가하고자 하였다. 대상 및 방법: 담도협착이 없는 82명의 환자에서는 일측성으로 접근하여 일반적인 담도내시경을 이용하여 담석을 제거하였다. 담도협착이 있는 경우 경피적 풍선 담도확장술과 담도경하 전기수압쇄석술을 시행하였으며, 41명의 환자는 일측성으로 접근하였고, 21명의 환자는 양측성으로 접근하였다. 각 군간에 완전담석제거율과 합병증을 후향적으로 분석하였다. 결과: 담석의 완전제거는 협착이 없는 일측성 접근군은 90.2%(74/82), 협착이 있는 일측성 접근군은 61.0%(25/41), 협착이 있는 양측성 접근군은 85.7%(18/21)로 협착이 있는 일측성 접근군이 의미있게 낮았다(p<0.05). 경피적 담도경시술의 횟수는 각각 $2.7{\pm}0.3$, $3.9{\pm}0.3$ 및 $2.7{\pm}0.5$이며(p=0.058), 전반적인 합병증의 발생률은 각각 13.4%(11/82), 17.1%(7/41) 및 14.3%(3/21)으로(p=0.889) 세 군간에 차이가 없었다. 결론: 담도협착을 동반한 간내담석 환자에서 양측성 담도접근방법은 수술적 제거를 시행하기 힘든 경우에서 간내담석의 완전제거를 위한 대안적 방법으로 유용할 것으로 생각한다.

Keywords

Acknowledgement

Supported by : 부산대학교병원

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