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Percutaneous Transhepatic Biliary Biopsy with a Newly Designed Stent Biopsy Kit
Park, Auh Whan 인제대학교 백병원 2002 仁濟醫學 Vol.23 No.4
목적: 담도 폐색환자에 있어 새로이 고안된 스텐트 조직생검기구를 이용한 조직생검의 효과를 평가하기 위함. 재료 및 방법: 2002년 7월부터 2003년 1월까지 폐색성 황달을 보이는 총 15명의 환자(남자 10명, 여자5명: 평균나이, 65세)를 대상으로 경피경간담즙배액술 도중 혹은 후에 담도내 스텐트 조직생검을 실시하였다. 조직을 얻은 위치는 간내외담도(12명), 간외담도장문합부(1명), 파터팽대부(2명)였으며 최종진단은 수술 혹은 내시경적 조직생검으로 확진 하였다. 결과 : 14명(93%)에서 악성진단을 받았고 1명에서 양성진단이 나왔다. 조직생검과 관련된 임상적으로 특이할만한 합병증은 없었고 전체적인 민감도, 특이도, 정확도 각각 85.7%, 100%, 86.7% 였다. 결론 : 새로이 고안된 경피경간 스텐트 조직생검기구를 이용한 조직생검은 비교적 높은 민감도를 보였으며 안전하고도 쉽게 시행이 가능하며 특히 총담관 파터팽대부 병변의 생검시 용이한 잇점이 있다고 하겠다.
Park, Auh Whan,Juhn, Jae Ryang 인제대학교 백병원 2002 仁濟醫學 Vol.23 No.4
간세포암 파열로 인한 복강내 전이는 드문 합병증중의 하나로 저자들은 간세포암 파열후 복강내전이 및 복강내전이암의 자발성파열로 인한 복강내 출혈을 1례 경험하였던 바 방사선학적 소견 및 역할 그리고 임상적 치료에 대해 문헌고찰과 함께 보고하는 바이다.
Park, Auh Whan 인제대학교 백병원 2002 仁濟醫學 Vol.23 No.4
성인에서 부신 출혈은 드문 질환이다. 저자는 부신의 자발성 출혈로 인한 후복막강 대량 출혈환자에서 미세코일을 이용한 색전술 치료를 경험하여 혈관촬영을 통한 진단 및 동맥색전술의 치료 가치에 대해 문헌 고찰과 함께 보고하는 바이다.
Sunghun Park,Auh Whan Park 소화기인터벤션의학회 2018 Gastrointestinal Intervention Vol.7 No.1
A 75-year-old male with recurrent pancreatic adenocarcinoma after a previous Whipple’s procedure presented with jaundice. The local advancement of the tumor caused obstructions of the common bile duct, intrahepatic bile duct hilum, and small bowel. Endoscopic stent insertion was precluded by the Roux-en-Y reconstruction. A successful transhepatic percutaneous single-access stenting of the whole biliary tree and intestine was achieved by H-configured triple stenting by combining T-configured dual stent placement in the biliary system with a duodenal stent insertion across the bottom of the anastomosis after looping a wire in the afferent limb. The ‘H-configured’ stents remained patent for 10 months without major or minor complications. This technique adds a new minimal-invasive and effective palliative option for patients with obstruction of a bilio-enteric anastomosis inaccessible to endoscopy.
Sunghun Park,Auh Whan Park 소화기인터벤션의학회 2018 International journal of gastrointestinal interven Vol.7 No.1
A 75-year-old male with recurrent pancreatic adenocarcinoma after a previous Whipple’s procedure presented with jaundice. The local advancement of the tumor caused obstructions of the common bile duct, intrahepatic bile duct hilum, and small bowel. Endoscopic stent insertion was precluded by the Roux-en-Y reconstruction. A successful transhepatic percutaneous single-access stenting of the whole biliary tree and intestine was achieved by H-configured triple stenting by combining T-configured dual stent placement in the biliary system with a duodenal stent insertion across the bottom of the anastomosis after looping a wire in the afferent limb. The ‘H-configured’ stents remained patent for 10 months without major or minor complications. This technique adds a new minimal-invasive and effective palliative option for patients with obstruction of a bilio-enteric anastomosis inaccessible to endoscopy.
Abhimanyu Aggarwal,Auh Whan Park,Jonathan West 소화기인터벤션의학회 2017 Gastrointestinal Intervention Vol.6 No.3
Biliary stricture formation is a known complication of hepatic surgery in cases of adult living donor liver transplant. In our case, successful percutaneous placement of a hepatico-gastric stent was performed for the drainage of an isolated bile duct after right liver transplant with Roux-en-Y biliary anastomosis in a 42-year-old male. The patient initially presented with cholangitis and a percutaneous transhepatic cholangiogram revealed an isolated stricture of the posterior bile duct. Multiple attempts at regaining continuity of the isolated bile duct with the jejunum were unsuccessful. Thus a tract was created via a percutaneous transhepatic and transluminal approach between the isolated duct and the stomach using a covered stent. The patient had no complications at 18-month follow-up.
Abhimanyu Aggarwal,Auh Whan Park,Jonathan West 소화기인터벤션의학회 2017 International journal of gastrointestinal interven Vol.6 No.3
Biliary stricture formation is a known complication of hepatic surgery in cases of adult living donor liver transplant. In our case, successful percutaneous placement of a hepatico-gastric stent was performed for the drainage of an isolated bile duct after right liver transplant with Roux-en-Y biliary anastomosis in a 42-year-old male. The patient initially presented with cholangitis and a percutaneous transhepatic cholangiogram revealed an isolated stricture of the posterior bile duct. Multiple attempts at regaining continuity of the isolated bile duct with the jejunum were unsuccessful. Thus a tract was created via a percutaneous transhepatic and transluminal approach between the isolated duct and the stomach using a covered stent. The patient had no complications at 18-month follow-up.
Review : Updates on Percutaneous Radiologic Gastrostomy/Gastrojejunostomy and Jejunostomy
( Ji Hoon Shin ),( Auh Whan Park ) The Editorial Office of Gut and Liver 2010 Gut and Liver Vol.4 No.s1
Gastrostomy placement for nutritional support for patients with inadequate oral intake has been attempted using surgical, endoscopic, and, more recently, percutaneous radiologically guided methods. Surgical gastrostomy has been superseded by both endoscopic and radiologic gastrostomy. We describe herein the indications, contraindications, patient preparations, techniques, complications, and aftercare with regard to radiologic gastrostomy. In addition, we discuss the available tube types and their perceived advantages. There remain some controversies regarding gastropexy performance and primary percutaneous gastrojejunostomy. Percutaneous jejunostomy is indicated for patients whose stomach is inaccessible for gastrostomy placement or for those who have had a previous gastrectomy. (Gut Liver 2010;4(Suppl. 1): S25-31)