Billroth II 위절제술을 시행한 환자에서 누두절개술 후 풍선확장 병합술의 유용성
A Role of Endoscopic Balloon Dilatation after Partial Infundibulotomy in Billroth II Patients
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서론: 최근 내시경 시술의 경험 축적으로 ERCP의 성공률과 합병증의 발생이 감소하였으나 Billroth II 문합술 등의 상부 위장관 수술을 받은 환자에서는 ERCP의 성공률이 낮으며 시술 후 합병증의 발생률이 높은 것으로 알려져 있다. 본 연구는 Billroth II 수술을 시행 받은 환자에서 절개도를 이용하여 누두절개 후 누공을 통한 풍선확장술을 이용한 ERCP방법의 유용성과 안전성에 대하여 후향적으로 분석하였다. 대상 및 방법: 2004년 1월부터 2005년 12월까지 한양대학병원 소화기내과에 입원하여 ERCP를 시행 받은 환자 중 Billroth II 술식으로 위절제술을 시행 받은 환자 10명을 대상으로 하였다. 누두절개방법은 침형절개도를 이용하여 팽대부의 개구부는 절개하지 않고 구측 융기부만을 11～12시 방향으로 절개하였다. 누두절개 후 형성된 담도․십이지장 누공을 통하여 유도선을 총담관 내에 삽입한 다음, 유도선을 따라 풍선확장기를 이용하여 유두부 성형술을 시도하였다. 결과: 담도삽관은 총 10명 중 8명(80.0%)에서 성공을 하였다. 선택적 담도삽관이 불가능하였던 2예는 모두 Braun 문합술을 시행받은 경우로 afferent loop가 길어 유두에 도달이 불가능하였던 경우였으며 유두 도달이 가능하였던 8예 모두에서는 누두절개술 후 선택적인 담관조영을 할 수 있었다. 총담관 결석은 모두 성공적으로 제거되었고 기계적 쇄석술을 이용한 경우는 없었다. ERCP 시행 후 고아밀라아제 혈증을 보였던 경우는 3예에서 관찰되었고 모두 정상 상한치의 2.5배 이내로 상승되었으며 임상적으로 췌장염이 발생하였던 경우는 없었다. 결론: Billroth II 수술을 받은 환자에서 침형 절개도를 이용한 누두절개 후 풍선확장술을 이용하는 병합술이 비교적 안전하게 사용될 수 있다고 생각한다.
Abstract
Background/Aims: Endoscopic retrograde cholangiopancreatography (ERCP) is difficult to perform in patients with a Billroth II anastomosis due to the anatomical alterations. This study evaluated retrospectively the efficacy and safety of endoscopic balloon dilatation after a partial infundibulotomy with a needle knife in patients who had undergone a Billroth II operation. Methods: Between January 1, 2004 and December 31, 2005, 11 patients, who had undergone a prior Billroth II gastrectomy, underwent ERCP because of a suspicion of pancreatobiliary diseases. Infundibulotomy was performed using a needle knife sphincterotome. After a partial infundibulotomy, a dilation balloon was passed over a prepositioned guidewire and placed in the biliary orifice. Under endoscopic and fluoroscopic control, the balloon was then inflated with diluted contrast over a period of 1 to 2 minutes. Results: A total of 10 patients (7 male and 3 female) were enrolled in this study. Eight had common bile duct stones, 1 bile duct cancer, and 1 pancreatic cancer. The common bile duct was dilated by a balloon. The calculi were removed in 6 patients, and a common bile duct stent was implanted in two cases via endoscopy. No complications such as acute pancreatitis or apparent infections of the biliary tracts were encountered in these cases except for mild fever, temporary high serum levels of aminotransferase and amylase after ERCP in 3 cases. No severe bleeding or perforation occurred in patients undergoing balloon dilatation. Conclusions: An infundibulotomy with balloon dilatation is a valuable alternative to endoscopic sphinterotomy in the treatment of patients with bile duct diseases, who have undergone prior Billroth II gastrectomies. (Korean J Gastrointest Endosc 2007;35:74-79)
참고문헌 (18)
- "Needle-knife sphincterotomy guided by a biliary endoprosthesis in Billroth II gastrectomy patients", 27, pp.229~232 (1995)
- "A randomized trial of endoscopic balloon dilation and endoscopic sphincterotomy for removal of bile duct stones in patients with a prior Billroth II gastrectomy", 53, pp.19~26 (2001)
- "Major early complications from diagnostic and therapeutic ERCP: a prospective multicenter study", 48, pp.1~10 (1998)
- in patients with Billroth II gastrectomy, , 1999, 546~549
- "Complications of endoscopic biliary sphincterotomy", 335, pp.909~918 (1996)
- "Intestinal perforation after ERCP in Billroth II partial gastrectomy", pp.389~390
- "ERCP and sphincterotomy after Billroth II gastrectomy", pp.971~974
- "Endoscopic papillary balloon dilation to remove common bile duct stones: clinical analysis of 106 cases (translated from Korean)", 61, pp.S85A~ (2001)
- "Pancreatitis induced by endoscopic balloon sphincter dilation and changes in serum amylase levels after the procedure", 49, pp.472~476 (1999)
- "Endoscopic papillary balloon dilation for the management of common bile duct stones: experience of 226 cases", 30, pp.12~17 (1998)
- for bile duct stones: efficacy, safety, and follow-up in 100 patients, , 1995, 468~474
- "Endoscopic balloon dilation compared with sphincterotomy for extraction of bile duct stones", 127, pp.1291~1299 (2004)
- "Endoscopic balloon dilatation versus endoscopic sphincterotomy for the removal of bile duct stones: a prospective randomised trial", 52, pp.1165~1169 (2003)
- "Endoscopic sphincteroclasy: a useful therapeutic tool for biliary endoscopy in Billroth II gastrectomy patients", 29, pp.79~81 (1997)
- "The usefullness of endoscopic papillary balloon dilation in patients with bite duct stones who have underwent Billroth II gastrectomy (translated from Korean)", 23, pp.425A~ (2001)
- "The needle knife: a valuable tool in diagnostic and therapeutic ERCP", pp.499~503
- "Needle-knife sphincterotomy in a tertiary referral center: efficacy and complications", 44, pp.48~53 (1996)
- "an alternative method for endoscopic retrograde cholangiopancreatography", pp.13~15