The Korean Journal of Medicine

The Korean Association of Internal Medicine (대한내과학회)
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PTPBD for Managing Extrahepatic Bile Duct Stones in Patients with Failed or Contraindicated ERCP

간외 담관 결석 환자에서 경피 경간 치료술의 유용성 및 안전성에 대한 연구

  • Seon, Han-Gyung (Digestive Disease Center, CHA Bundang Medical Center, CHA University) ;
  • Kwon, Chang-Il (Digestive Disease Center, CHA Bundang Medical Center, CHA University) ;
  • Yoon, Sang-Pil (Digestive Disease Center, CHA Bundang Medical Center, CHA University) ;
  • Yoo, Kwang-Ho (Digestive Disease Center, CHA Bundang Medical Center, CHA University) ;
  • Ok, Chang-Su (Digestive Disease Center, CHA Bundang Medical Center, CHA University) ;
  • Kim, Won-Hee (Digestive Disease Center, CHA Bundang Medical Center, CHA University) ;
  • Ko, Kwang-Hyun (Digestive Disease Center, CHA Bundang Medical Center, CHA University) ;
  • Hong, Sung-Pyo (Digestive Disease Center, CHA Bundang Medical Center, CHA University) ;
  • Park, Pil-Won (Digestive Disease Center, CHA Bundang Medical Center, CHA University)
  • 선한경 (CHA 의과학대학교 분당차병원 소화기센터) ;
  • 권창일 (CHA 의과학대학교 분당차병원 소화기센터) ;
  • 윤상필 (CHA 의과학대학교 분당차병원 소화기센터) ;
  • 유광호 (CHA 의과학대학교 분당차병원 소화기센터) ;
  • 옥창수 (CHA 의과학대학교 분당차병원 소화기센터) ;
  • 김원희 (CHA 의과학대학교 분당차병원 소화기센터) ;
  • 고광현 (CHA 의과학대학교 분당차병원 소화기센터) ;
  • 홍성표 (CHA 의과학대학교 분당차병원 소화기센터) ;
  • 박필원 (CHA 의과학대학교 분당차병원 소화기센터)
  • Published : 2012.07.01
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Abstract

Background/Aims: Endoscopic retrograde cholangiopancreatography (ERCP) occasionally fails due to surgically altered anatomy, difficult cannulation, or poor general condition. This study evaluated the safety and effectiveness of percutaneous transhepatic papillary balloon dilatation (PTPBD) for managing extrahepatic bile duct stones. Methods: Between 2001 and 2010, 17 out of 509 patients with extrahepatic bile duct stones and acute cholangitis were enrolled retrospectively. After PTPBD of the sphincter, the stones were extracted using an occlusion balloon to push the stone over a guidewire into the duodenum. The procedure success was evaluated based on residual stones. In addition, the size and number of stones and complications were analyzed. Results: Of the 17 patients, nine had a previous gastrectomy, four had poor general condition, and four had unsuccessful cannulation. The stone diameter ranged from 8 to 25 mm. Seven, five, and five patients had one, two, or three or more stones, respectively. The results were successful in 16 out of 17 patients, with no residual stones. Treatment failed in one patient, who was then treated with the rendezvous technique with endoscopy. No procedure-related major complication occurred. Three patients had mild transient elevations of the serum amylase levels. Conclusions: PTPBD was safe and effective for managing extrahepatic bile duct stones in patients with unsuccessful or contraindicated ERCP.

목적: ERCP를 이용한 유두 괄약근 절개술은 간외 담관 결석 환자에게서 가장 널리 이용되는 치료방법이지만, ERCP가 실패하거나, 위절제술을 받은 경우, 담췌관으로의 접근이 어려운 경우, 환자의 전신상태가 불량한 경우 등에서는 시술하기가 어렵다. 본 연구의 목적은 ERCP를 시행하기 어려운 간외 담관 결석을 가진 환자들에게서 PTPBD (percutaenous transhepatic papillary balloon dilatation) 및 폐쇄 풍선 카테터를 이용한 간외 담관 결석 제거술의 안전성 및 유용 유용성을 알아보고자 하였다. 방법: 2001년부터 2010년까지 10년간 간외 담도 결석으로 내원한 509명의 환자 중 PTPBD를 이용하여 간외 담도 결석 제거술을 시행한 17명의 환자를 후향적으로 자료 분석하였다. 모든 환자는 결석을 제거하기 3-4일 전에 PTBD를 시행 하였다. 십이지장 유두부를 풍선 확장술로 확장시킨 후, 폐쇄 풍선 카테터(풍선 지름 11.5 mm)를 이용하여 결석을 확장된 유두부를 통해 십이지장 안으로 밀어내어 제거하였다. 크기가 15 mm를 넘는 큰 결석 일부는 부분 쇄석술을 먼저 시행한 후 시술을 시행하였다. 시술결과는 잔류 결석의 유무로 평가하였고, 합병증 및 결석의 크기와 수에 따라서 세부적으로 분석하였다. 결과: 시술을 시행한 17명의 환자들 중 이전에 위절제술을 시행한 환자는 9명, 전신상태가 불량한 환자가 4명, ERCP에 실패한 환자가 4명이었다. 결석의 크기는 직경이 평균 13.6 mm (8-25 mm)이었고, 7명은 결석이 1개(41.2%), 5명은 2개 (29.4%), 그리고 남은 5명은 결석이 3개 이상(29.4%)이었다. 17명의 환자 중에 16명(94%)이 잔류 결석 없이 시술에 성공 하였다. 이 중 2명의 환자(11.7%)는 시술을 2번 시행하여 성공하였다. 치료에 실패한 1명(6%)의 환자는 랑데뷰 방법을 이용하여 직시 위내시경을 통해 치료에 성공하였다. 시술과 연관된 사망 및 합병증의 발생은 없었다. 췌장염의 발생은 없었고, 3명의 환자에게서 경도의 일시적인 아밀라아제 상승소견이 보였다. 결론: 경피 경간 유두부 풍선 확장술 및 폐쇄 풍선 카테터를 이용한 간외 담관 결석 제거술은 ERCP에 부적절하거나 실패한 환자군에서 안전하고 효과적인 대체 방법으로 이용될 수 있다.

Keywords

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