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박은택 대한내과학회 2016 대한내과학회지 Vol.90 No.1
Thickening of the gallbladder wall is a relatively frequent finding on diagnostic imaging. Such thickening is also a common but nonspecific finding in many patients with intrinsic gallbladder disease and extracholecystic conditions. Wall thickening may be diagnostically problematic, occurring (as it does) in both symptomatic and asymptomatic patients and in those with and without indications for cholecystectomy. An important first step is to distinguish between the diffuse and focal forms of thickening. Subsequently, identification of ancillary imaging findings and the directed use of additional imaging modalities allow accurate diagnosis. This is of clinical importance. Misinterpretation of the cause of thickening can trigger unnecessary cholecystectomies in patients without intrinsic gallbladder disease. Also, misdiagnosis of patients who do in fact require cholecystectomy may delay treatment, thus increasing morbidity. Although a definitive imaging diagnosis may not be possible, the cause of gallbladder wall thickening can be determined in most instances by correlating the clinical presentation with associated imaging findings. 담낭벽 종대는 흔하게 발견되는 담낭질환이며 대부분의-박은택. 담낭벽 종대 발견시 적절한 대처 - - 19 - 경우 양성의 경과를 밟고 임상증상을 잘 파악하면 대부분에서 진단 및 치료가 용이하다. 하지만 일부에서는 악성의 주요 증상으로 나타나므로 발견 즉시 그 원인을 확실하게 파악하고, 만일 초음파상에서 불명확한 경우 내시경초음파나CT를 이용하여 보다 정밀한 검사를 권유하는 것이 좋다. 또한 진단이 불분명하나 악성의 위험을 가지는 국소성 담낭벽 종대인 경우 가능한 짧은 주기로 추적관찰하거나 수술적 처치를 고려하고 특히 바로 수술하지 않는 경우 향후 악성의 가능성에 대해 환자에게 반드시 교육시키는 것을 권유한다.
담관 낭종 및 담낭 선근종증이 동반된 췌담관 합류이상 1예
박은택,정명교,강석우,이재호,문치숙,정정명,최창수,최봉기,장윤식,이연재,이상혁,설상영,최영길,윤혜경 대한소화기내시경학회 2002 Clinical Endoscopy Vol.24 No.5
Anomalous union of pancraeticobiliary drain (AUPBD) is uncommon anomaly of the pancreaticobiliary ductal union system. Usually, this anomaly is confirmed by long common channel (>15 mm) at ERCP and is divided into according to relationship between pancreatic duct and common bile duct. Recently several reports showed that AUPBD may be associated with congenital choledochal cyst and gallbladder carcinoma. A 33-year old man was admitted with RUQ pain and jaundice. Ultrasonography, Abdominal CT, ERCP, and PTBD cholangiography showed type I choledochal cyst, AUPBD and focal adenomyomatosis on the gallbladder. Whipple's operation with excision of the choledochal cyst and chloecystectomy were performed for treatment. This clinical experience suggests that high incidence of choledochal cyst in patients with AUPBD and gallbladder adenomyomatosis are may be closely related to the carcinogenesis of gallbladder cancer in patients with AUPBD. (Korean J Gastrointest Endosc 2002;24:312-316) 췌담관 합류 이상은 비교적 드문 췌담도계의 기형으로 일반적으로 췌담도 조영술에서 공통관의 길이가 15 mm 이상일 때로 정의한다. 최근 췌담관 합류부 이상이 선천성 담관 낭종이나 담낭암 발생과 연관성이 있다고 알려져 있다. 저자 등은 전형적인 급성 담관염 증상을 가진 33세 남자에서 복부 초음파, 복부 전산화단층촬영, 내시경적 역행성 췌담관조영술, 그리고 경피 경간 담도 조영술로 Todani I형 담관 낭종, 국소형 담낭선근종증을 동반한 Kimura B형의 췌담관 합류 이상을 진단하고, 낭종 절제술, 담낭 절제술 그리고 Whipple씨 수술로 치료한 1예를 경험하였기에 보고하는 바이다.
Endoscopic Retrograde Cholangiopancreatography in Bilioenteric Anastomosis
박은택 대한소화기내시경학회 2016 Clinical Endoscopy Vol.49 No.6
For diagnosis and treatment of pancreatobiliary diseases, endoscopic retrograde cholangiopancreatography (ERCP) is usefulmethod nowadays and its technically success rate is usually in about 90%-95% of patients with normal gastric and pancreaticobiliaryanatomy. Recently ERCP is significantly challenging after intestinal reconstruction, particularly in patients who have undergonepancreaticoduodenectomy (PD, classic Whipple’s operation) or pylorus-preserving pancreatoduodenectomy (PPPD) withreconstruction. PD and PPPD relate to numerous techniques have been presented for reconstruction of the digestive tract andpancreaticobiliary tree during the resection bilioenteric stricture commonly occurs later in the postoperative course and developedin 5-year cumulative probability of biliary stricture rate of 8.2% and pancreaticoenteric stricture of 4.6%. This complication was nodifference in incidence between patients with benign or malignant disease. In PD or PPPD with reconstruction, short pancreatobiliarylimb with biliojejunal anastomosis site is made usually, modestly success rate of intubation to blind loop and cannulation withconventional endoscope. However, in combined Reux-en-Y anastomosis, longer pancreatobiliary limb and additional Reux limb areobstacle to success intubation and cannulation by using conventional endoscope. In this situation, new designed enetroscope withdedicated accessories is effcient.