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각종 췌장질환에서 Somatostatin Analogue 사용 경험
김현영,김명환,박현주,이성구,서동완,민영일,신영록,이석수,전병민,표승일,유교상 대한소화기학회 2000 대한소화기학회지 Vol.35 No.6
Background/Aims: Octreotide, long-acting analogue of somatostatin, has been used for symptomatic carcinoid syndrome and vasoactive intestinal peptide-producing tumors. In pancreatic diseases, however, the effect of octreotide has not been settled yet. The aim of this study was to evaluate the effect of octreotide in various pancreatic diseases which did not respond to conventional medical treatment. Methods: We reviewed retrospectively the medical records of 28 patients who were admitted at the Asan Medical Center from January 1997 to June 1999. Their diseases were pancreatic fistula (n=9), pancreatic pseudocysts (n=17), and pancreatic ascites (n=2). Octreotide was administered subcutaneously at a dose of 0.1 mg every 12 hours. Results: In the cases of pancreatic fistulas, the mean output of baseline fistula was 289 cc/day. This was decreased to 178 cc/day on the first day of octreotide therapy and to 49 cc/day on the seventh day. Five (56%) patients eventually closed their fistulas. In the cases of pancreatic pseudocysts, 11 (65%) cases had showed complete resolution of pseudocysts. The remaining 6 cases which showed no improvement were treated operatively. In the cases of pancreatic ascites, the two patients (100%) were successfully treated with octreotide. Conclusions: Octreotide seems to be a safe and useful alternative therapy in patients with pancreatic fistulas, pseudocysts or ascites who do not respond to conventional medical management. Further detailed study may be necessary for the establishment of the role of octreotide in the treatment of various pancreatic diseases.
이승환,김현영,김명환,이성구,서동완,민영일,유교상,손정민,나비석,이석수,심선진,전병민 대한소화기내시경학회 2000 Clinical Endoscopy Vol.20 No.3
A Pancreaticobiliary fistula is a rare complication of acute necrotizing pancreatitis or pancreatic abscess. One case is herein reported of pancreaticobiliary fistula that was found following removal of pancreatic duct stones by extracorporeal shock-wave lithotripsy and endoscopic sphincterotomy. The patient was a 53-year old woman who was admitted with epigastric pain and fever. Endoscopic retrograde pancreatography revealed multiple stones in the main pancreatic duct. Pus from the pancreatic duct was drained through the major papilla during cannulation. On balloon cholangiogram obtained after removal of the stones, a direct fistulous connection between the main pancreatic duct and distal common bile duct was noted. It is speculated that pancreatic abscess or mechanical compression of pancreatic duct stones may contribute to the destruction of the intrapancreatic bile duct, which leads to the formation of a pancreaticobiliary fistula.