Journal of the Korean Society of Radiology (대한영상의학회지)

The Korean Society of Radiology (대한영상의학회)
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Usefulness of a Biliary Manipulation Catheter in Percutaneous Transhepatic Biliary Drainage

피부경유담즙배액술에서 담관조작용카테터의 유용성

  • Park, Auh-Whan (Department of Radiology, Virginia University Health Center) ;
  • Won, Je-Hwan (Department of Radiology, Ajou University School of Medicine) ;
  • Lee, Jei-Hee (Department of Radiology, Ajou University School of Medicine) ;
  • Sun, Joo-Sung (Department of Radiology, Ajou University School of Medicine) ;
  • Kwak, Kyu-Sung (Department of Radiology, Ajou University School of Medicine) ;
  • Bae, Jae-Ik (Department of Radiology, Ajou University School of Medicine)
  • 박오환 ;
  • 원제환 (아주대학교 의과대학 영상의학과) ;
  • 이제희 (아주대학교 의과대학 영상의학과) ;
  • 선주성 (아주대학교 의과대학 영상의학과) ;
  • 곽규성 (아주대학교 의과대학 영상의학과) ;
  • 배재익 (아주대학교 의과대학 영상의학과)
  • Published : 2011.04.01
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Abstract

Purpose: To evaluate usefulness of a manipulation catheter in percutaneous transhepatic biliary drainage (PTBD). Materials and Methods: A biliary manipulation catheter was used for the aspiration of retained bile and lesion crossing during an initial PTBD in 91 consecutive patients over a 6 month period. This catheter allowed for a 0.035 inch guide wire made of 5F short steel braided polyurethane. The terminal 1 cm segment was tapered and $45^{\circ}$ angulated. Two side holes were made in the terminal segment to facilitate the aspiration of bile. The safety of this procedure was evaluated based on whether the catheters caused complications during insertion and manipulation, and whether cholangitis was aggravated after the procedure. Effectiveness of the procedure was evaluated based on the ability to aspirate retained bile and to cross the lesion. Results: Both the insertion of a 0.035 inch hydrophilic guide wire and aspiration of sufficient retained bile were successful with the catheter. Crossing the common bile duct (CBD) lesion had a 98.1% success rate during the initial PTBD. Crossing the hilar obstruction lesion was had a 94.7% success rate to the CBD and 92.1% to the contralateral lobe. Cholangitis improved in 97% of cases, and aggravated transiently in only 3% of cases after PTBD. Conclusion: A biliary manipulation catheter should be considered as a useful tool for a safe and effective PTBD, attributed to the facilitation of bile aspiration and lesion crossing.

목적: 피부경유담즙배액술(percutaneous transhepatic biliary drainage, 이하 PTBD) 시행 시 담관조작용카테터(biliary manipulation catheter)사용의 유용성을 알아보고자 하였다. 대상과 방법: 6개월간 91명의 연속적인 PTBD 시행환자에서 배액관 삽입 전 고인 담즙을 흡인해내고 폐쇄병변을 평가하는 목적으로 담관조작용카테터를 사용하였다. 이는 5F 굵기 40 cm 길이의 짧고 빳빳한 카테터로서 끝 1 cm 부분은 45도 각으로 휘어져 있고 2개의 측공이 있어, 담관 내에서 길을 찾거나 고여 있는 담즙을 흡인하는데 유리할 수 있는 디자인을 하고 있다. 카테터 사용에 따른 안전성은 삽입과 조작에 따른 문제발생 여부 및, 담관염의 악화여부로 평가하였고, 효용성은 고인 담즙의 흡인능력과 병변을 찾고 통과하는 능력을 기준으로 평가하였다. 결과: 유도철사를 통한 카테터의 삽입과 이를 이용한 고인 담즙의 흡인은 전 예에서 성공적이었다. 이 카테터를 이용하여 PTBD시에 바로 폐쇄 병변을 찾고 이를 통과하는 데에는 95%에서 성공하였다; 총담관폐쇄의 경우 98.1%, 간문부폐쇄의 경우 총담관으로는 94.7%, 반대쪽 엽으로는 92.1%, 배액관 삽입 전 카테터 조작과 병변부 평가를 시행하였음에도 불구하고 PTBD직후 담관염은 97%에서 호전되었고, 3%에서만 일시적으로 악화되었으나 패혈성 쇼크는 없었으며 모두 7일 이내에 정상으로 회복되었다. 결론: 담관조작용카테터는 담관염의 악화 없이도 PTBD시행 시 바로 폐쇄병변부의 평가나 이의 통과를 가능하게 하여 효과적인 담즙배액을 유도하는데 유용하다.

Keywords

References

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