담관 협착이 있는 간세포암에서 금속 스텐트에 의한 십이지장-담관 누공 1예
A Case of Duodenobiliary Fistula Caused by a Metal Stent in a Patient with Hepatocellular Carcinoma
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초록
악성 종양으로 인한 담관 폐쇄가 발생하였을 때 담관 배액술과 같은 보존적 치료를 시행하여 환자의 삶의 질을 높일 수 있다. 담관 금속 스텐트 삽입은 담즙의 생리적 배액이 가능하고 환자의 불편함이 적어 유용한 방법이다. 금속 스텐트 삽입 후 발생할 수 있는 합병증으로는 스텐트 내의 재협착, 간 천공, 장 천공, 누공 형성, 스텐트 탈락 등이 있다. 스텐트로 인한 천공이나 누공 형성이 발생하는 이유는 금속 스텐트 자체가 시간이 지나면서 펴지는 특성을 지니고 있고 이로 인해 지속적인 압력이 가해져서 발생하는 것으로 생각된다. 본 증례는 간세포암 환자에서 간동맥 화학 색전술 후 간내 담관 협착이 발생하여 금속 스텐트를 삽입하였고 이후 간내 담관과 십이지장 사이의 누공이 발생한 경우로 문헌 고찰과 함께 보고한다.
Abstract
Biliary drainage can improve the quality of life in a patient with obstructive jaundice caused by malignancy. Biliary metal stent insertion is a very useful method because it drains the bile physiologically and patients have little discomfort with the procedure. It has a few complications such as restenosis, liver perforation, bowel perforation, fistula formation and stent dislocation. Perforation and fistula formation are caused by pressure due to the self expanding characteristics of the metal stent. We report here on a case of duodenobiliary fistula that was caused by a biliary metal stent in a patient suffering with hepatocellula carcinoma, and we also include a review of the relevant literature.
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