Clinical Endoscopy

The Korean Society of Gastrointestinal Endoscopy (대한소화기내시경학회)
권호 표지

Percutaneous Transhepatic Therapy Using Cholangioscopy in Patients with Benign Bilio-Enteric Anastomotic Strictures

담도-장 문합 부위 협착에서 담도경을 이용한 경피 경간 치료의 유용성

Kim, Jung-Ho;Lee, Sung-Koo;Park, Do-Hyun;Kim, Hyun-Kuk;Kim, Sun-Young;Lee, Sang-Soo;Seo, Dong-Wan;Kim, Myung-Hwan;Min, Young-Il
김정호;이성구;박도현;김현국;김선영;이상수;서동완;김명환;민영일

  • Published : 20030000
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Abstract

Background/Aims: Percutaneous transhepatic therapy (PTT) is a non-operative procedure for anastomotic strictures after bilio-enteric anastomosis which cannot be reached via transpapillary route. The aim of this study was to evaluate immediate and long-term results of the PTT using cholangioscopy in patients with benign bilio-enteric anastomotic strictures. Methods: We conducted a etrospective analysis on 22 patients who had undergone PTT for bilio-enteric anastomotic strictures between October 1994 and March 2001. The follow-up duration was 12 to 79 months after PTT (mean 33.0 months). Results: The initial technical success rate was 100%, and the short-term morbidity and mortality rates were 13.5% and 0%, respectively. However, 9 patients developed recurrent strictures (40.9%) with a mean duration of 16.8 months (range: 2 to 38). The success rate without recurrence was 59.1% and the overall success rate was 77.3% when the procedures were repeated. The long term morbidity rate was 36%, but most morbidities resolved with medical treatments. In 18 patients (81.8%), bile duct stones were combined and successfully treated by percutaneous transhepatic cholangioscopy (overall clearance rate: 94.4%, recurrence rate: 39.8%). Conclusions: The PTT using cholangioscopy in patients with benign bilio-enteric anastomotic strictures is a safe and effective method, and it appears a minimally invasive alternative to surgery.

목적: 경피 경간 치료법(percutaneous transhepatic therapy)은 경유두적으로 도달하기 어려운 담도-장 문합술의 문합 부위 협착에 있어 비수술적인 치료 방법의 하나이다. 저자들은 담도-장 문합 부위에 양성 협착이 발생한 환자들에서 담도경(percutaneous transhepatic cholangioscopy, PTCS)을 이용한 경피 경간 치료에 있어 단기간 및 장기간의 안정성과 유용성을 알아보고자 하였다. 대상 및 방법: 단일 병원에서 1994년 10월부터 2001년 3월 사이에 담도-장 문합 부위에 발생한 양성 협착으로 PTCS를 이용한 풍선 확장술 및 PTCS 카테터 (또는 nelatone 카테터)를 삽입받은 22명의 환자들을 후향적인 방법으로 분석하였고, 평균 33.0개월(범위: 12$\sim$79개월) 동안 추적 관찰하였다. 결과: 경피 경간 치료로 협착 부위의 확장은 22명 모두에서 성공(초기 시술 성공률: 100%)하였고 단기 이환율과 사망률은 각각 13.5%, 0%였다. 추적 기간 동안 총 9명에서 재협착 (재협착률: 40.9%)이 발생하였고 재협착까지의 기간은 평균 16.8개월(범위: 2$\sim$38개월)이었다. 확장 시술에 성공한 22명 가운데 추적 기간 동안 재발 없이 성공한 경우는 13명(59.1%)이었고 반복된 시술에 의한 성공을 합하면 총 치료 성공률은 77.3%였다. 경피 경간 치료의 장기 이환율은 36% (22명 중 9명)로 내과적 치료만으로 모두 호전되었다. 담석이 동반된 경우는 18명으로 수 차례 PTCS를 이용한 담석 제거로 94.4%의 제거율과 추적 기간 동안 38.9%의 재발률을 보였다. 결론: PTCS를 이용한 경피 경간 치료는 담도-장 문합 부위의 양성 협착에 있어서 수술에 비해 덜 침습적이고 비교적 안전하면서 단기적으로 효과적인 방법으로 우선적인 치료로 고려할 수 있을 것이다. 그러나 장기적으로 경과 관찰 시 재협착률이 높아 이에 대한 대책과 연구가 필요하다.

Keywords

References

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