내시경으로 진단 및 치료한 총담관 내 관상 선종 1예
Tubular Adenoma of the Common Bile Duct: Endoscopic Diagnosis and Treatment
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초록
간외 담도 종양 중 양성 종양은 6% 정도로 악성 종양에 비해 드물게 발견된다. 양성 종양은 십이지장 유두부에 가장 호발하며, 다음으로 총담관에서 발견된다. 총담관 양성 종양은 증상 및 검사 소견이 담석 및 악성 종양과 유사하여 수술 전 진단하기 어렵기 때문에 총담관의 양성 종양은 주로 수술 후 병리학적으로 진단되나 수술 고위험군 환자를 내시경으로 치료한 예도 보고된 바 있다. 국내에서도 총담관 양성 종양 중 융모성 선종 등은 여러 차례 보고되었으나 아직까지 관상 선종을 경피경간 담도내시경 직시하에 치료한 보고는 없었다. 저자 등은 복부초음파와 자기 공명 담췌도 영상에서 총담관 담석과 감별이 어려웠으나, 유두괄약근 절개 후 바스켓으로 적출된 조직에서 관상 선종을 확인하고, 경피경간 담도 내시경 직시 하에 담도 종양을 내시경으로 부분 제거하였던 총담관 관상 선종 1예를 경험하였기에 문헌고찰과 함께 보고하는 바이다.
Abstract
Biliary adenoma of the common bile duct is a rare disease found in biliary tract encounterd in biliary mass lesion, and it is difficult to differentiate from their malignant counterparts. Symptoms and signs of these tumors can mimic choleliathiasis and malignant tumors. Therefore, this tumor is rarely diagnosed preoperatively. In addition, there has been no reported case of a tubular adenoma of the common bile duct in Korea, until recently. We experienced a case of tubular adenoma of the common bile duct, which was diagnosed and partially resected by percutaneous transhepatic cholangioscopy. The patient was a 84-year-old male who showed abnormal liver function test. Abdominal ultrasonography showed a dilated common bile duct, and a soft tissue was observed on endoscopic retrograde cholangiography. This was initially thought as a stone, but it became partially detachable from the common bile duct during an endoscopic retrograde cholangioscopic basket removal. The mass lesion was partially resected by a percutaneous transhepatic cholangioscopic snare. This resected tissue was confirmed as a tubular adenoma.
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