풍선폐쇄법을 통한 간내담관의 선택적 삽관에 성공한 증례 1예
The Balloon Occluded Method for Selective Cannulation of the Intrahepatic Duct: A Case Report
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내시경 역행성 췌담관 조영술(ERCP)에서 간내담관으로의 선택적 삽관(selective cannulation)은 위장관 및 담관의 해부학적 구조, 담관 질환에 따라 상당히 어렵고 시간을 요할 수 있다. 다양한 유도철선과 카테터의 삽입 및 유두 괄약근 절개도(sphicterotome)를 통해 선택적인 삽관에 성공할 수 있다. 또한 우측의 간내담관에 풍선 확장을 시행하여 폐쇄하는 풍선 폐쇄법(balloon occluded method)을 이용하여 좌측의 간내담관에 유도철선의 유치를 성공한 예가 보고 되었다. 저자들은 담낭암 및 간전이 환자에서 양측 간내담관의 확장소견을 보여 좌측의 간내담관의 삽관 및 스텐트 삽입에 성공한 뒤, 우측 간내 담관에 기존의 방법으로 삽관을 시도하여 실패한 환자에서 좌측을 풍선확장으로 폐쇄하고 이후 우측 간내담관으로의 삽관에 성공하였기에 문헌고찰과 함께 증례를 보고한다.
Abstract
Selective cannulation into the intrahepatic duct during ERCP can occasionally be difficult and time-consuming depending on the GI tract anatomy and the presence of biliary tree anomalies or pathology. A variety of techniques or devices have been used to enhance the success rate of selective cannulation in these situations. The balloon occluded method for selective cannulation of the LHD (left hepatic duct) with using an inflated balloon catheter to occlude the RHD (right hepatic duct) has also been reported. We report here a case of successful selective cannulation of the RHD with using an inflated balloon catheter to occlude the LHD in a patient who had a GB cancer with liver metastasis. After this maneuver, a guidewire is advanced; it deflects off the inflated balloon and then proceeds to the RHD.
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