담석 췌장염의 임상적 고찰

민영일(Young Il Min),이성구(Sung Koo Lee),김병식(Byung Sik Kim),한동수(dong Soo Han),김명환(Myung Hwan Kim),이승규(Sung Gyu Lee),이선영(Sun Young Yi),이미화(Mi Hwa Lee) 대한소화기학회 1993 대한소화기학회지 Vol.25 No.4

N/A Etiologic diagnosis is important in the management of a patient with acute pancreatitis. Early differentiation of gallstone pancreatitis from nongallstvne pancreatitis by imaging methods is often difficult. The objectives of this study are to assess valucs of clinical and laboratory data in establishing gallstone as an etiology of pancreatitis and to analyze endoscopie retrograde clholangiopancreato- grophy (ERCP) findings of gallstome panrreatitis. Age, sex, serum alkaline phosphatase, aminotransferase (SGPT), amylase, lipase, and total bilirubin levels were significantly clifferent (p < 0.05, chi square) between gallstone and nongallstone groups. The item which favor gallstone pancreatitis are age.50 years, female sex, amylase>1000 IU/ml, lipase 3000 IU/ml, SGPT-100 IU,/L, alkaline phosphatase2400 IU/L, and total bilirubin 2.5 mg, dl. It was found that, those who had more than 4 of above factors (21 cases) were more likely to have gallstone pancreatitis (15 cases, 71.4%). ERCP findings of 22 patients with gallstone pancreatitis were analysed. l5 cases (68.2%) had common bile duct stones, of which 9 had undertaken endoscopic sphincterotomy and removal of stones. In conclusion, clinical and biochemical predictive systems for presence of gallstones in acute pancreatitis may have useful roles in evaluation of etiology in acute pancreatitis and in planing early interventional treatment. ERCP and endoscopic sphinctivotomy in gallstone pancreatitis are safe and effective diagnostic and therapeatic measures.

급성 췌장염 진료 권고안: 급성 췌장염의 진단

고동희,김종혁,이진,최호순 대한췌담도학회 2013 대한췌담도학회지 Vol.18 No.2

급성 췌장염의 진단에 대해서는 최근 생화학 검사의 발 달과 영상의학의 발달로 조금씩 변화하고 있다. 일반적으 로 인정받는 기준은 1)상복부의 급성 복통과 압통, 2)혈액 췌장 효소 수치의 상승(아밀라아제 그리고/또는 리파아제 ≥ 정상상한치의 3배), 3)복부 초음파나 복부 CT, 복부 MRI에서 급성 췌장염의 소견 위의 세가지 중에 2가지 이 상이면서 다른 췌장 질환이나 급성 복통을 질환을 감별된 다면 급성 췌장염으로 진단 할 수 있다. 급성 췌장염을 진 단하는데 있어 현재 많이 사용되고 있는 생화학적 검사는 혈청 아밀라아제이지만, 혈청 리파아제검사가 혈청 아밀라 아제검사보다 특이도와 민감도가 높아 더 급성췌장염의 진 단에 유용하다. 복부 CT는 급성 췌장염을 확진 하는데 있 어 가장 좋은 검사로 다른 복부 질환들을 감별할 수 있고, 췌장염의 중증도를 결정하고, 합병증을 확인 할 수 있는 영상 검사이다. 급성 췌장염으로 진단되면 앞으로 치료 계 획의 수립과 재발 방지를 위해 가능한 빨리 원인에 대한 평가를 시작하여야 한다. 일차적으로 환자의 과거력과 가 족력을 확인하고 간기능검사, 칼슘, 중성지방 등의 혈액검 사와 복부 초음파검사를 시행하여야 한다. 담석성 췌장염 이 강력히 의심되는 환자에서 담도염이 있거나, 담도폐쇄 가 지속되는 경우 조기에 ERCP를 시행한다. 경증의 담석 성 췌장염환자에서 증상이 호전되기 시작하면 같은 입원기 간 내에 복강경 담낭절제술을 시행하고, 중증의 췌장염의 경우에는 염증반응이 충분히 해소되고 임상적으로 호전된 후 시행하는 것을 권장한다. There is general acceptance that a diagnosis of acute pancreatitis requires two of the following three features: 1) abdominal pain characteristic of acute pancreatitis, 2) serum amylase and/or lipase ≥3 times the upper limit of normal, and 3) characteristic findings of acute pancreatitis on ultrasonography, CT or MRI. Other pancreatic diseases and acute abdomen have been ruled out are diagnosed. In pancreatic enzymes, serum lipase may be preferable because it is thought to be more sensitive and specific than serum amylase in the diagnosis of acute pancreatitis. Contrast-enhanced CT scan is the best imaging technique to exclude conditions that masquerade as acute pancreatitis, to diagnose the severity of acute pancreatitis, and to identify complications of pancreatitis. After the diagnosis of acute pancreatitis has been made, its etiology should be made clear to decide treatment policy of acute pancreatitis or to prevent the recurrence of pancreatitis. The etiology of acute pancreatitis in an emergency situation should be assessed by clinical history, laboratory tests such as serum liver function tests, measurement of serum calcium and serum triglycerides and ultrasonography. A differentiation of gallstone-induced acute pancreatitis should be given top priority in its etiologic diagnosis because it is related to the decision of treatment policy. Early ERCP should be performed in patients with gallstone pancreatitis if a complication of cholangitis and a prolonged passage disorder of the biliary tract are suspected. Cholecystectomy should be considered after recovery from an attack of gallstone pancreatitis during the same hospital stay. In severe gallstone-induced acute pancreatitis, cholecystectomy should be delayed until there is sufficient resolution of the inflammatory response and clinical recovery.

급성 췌장염의 예 후에 대한 원인 적 요소의 영향

김광희,김창덕,이홍식,이성준,박흥진,진윤태,전훈재,송치욱,이상우 大韓消化器病學會 1998 大韓消化器病學會誌 Vol.31 No.4

경미한 담석췌장염 환자에서 복상경 담낭 절제술 시행전 역행성 담췌관 조영술은 필요한가?

이규택 ( Kyu Taek Lee ),이종균 ( Jong Kyun Lee ),박형석 ( Hyung Suk Park ),박상종 ( Sang Jong Park ),김지은 ( Jee Eun Kim ),김창섭 ( Chang Seop Kim ),성인경 ( In Kyung Sung ),심상군 ( Sang Ken Sim ),최윤호 ( Uoon Ho Choi ),백승운 대한췌담도학회 1999 대한췌담도학회지 Vol.4 No.1

The large majority of patients with gallstone pancreatitis have a mild course that is not altered by ERCP and endoscopic sphincterotomy, a more selective use of ERCP might be advisable. This study is designed to evaluate the efficacy of preoperative endoscopic retrograde cholangiopancreatography (ERCP) in patients with mild gallstone pancreatitis and to determine criteria predictive of common bile duct stones (CBDS). Methods: We analyzed the value of serum biochemical tests and findings of ERCP in patients with mild gallstone pancreatitis. Preoperatively, ERCP revealed CBDS in 6 of 47 (12.8%) patients with mild gallstone pancreatitis. Laboratory values on admission did not predict CBDS. Persistent hyperamylasemia and increased serum ALT were associated with CBDS. It is unnecessary to perform preoperative ERCP in patients with mild gallstone pancreatitis who have a normalization of serum amylase and liver function tests.

담석성 췌장염 치료에서 내시경적 유두부 괄약근절개술의 임상적 유용성

박상흠(Sang Heum Park),권광안(Kwang An Kwon),김인호(In Ho Kim),김은주(Eun Joo Kim),정일권(Il Kwun Chung),김홍수(Hong Soo Kim),이문호(Moon Ho Lee),김선주(Sun Joo Kim) 대한소화기학회 2000 대한소화기학회지 Vol.36 No.3

Background/Aims : Gallstone pancreatitis has been classically treated by cholecystectomy to prevent recurrence of pancreatitis. However, for patients whose condition is not suitable to operation, endoscopic sphincterotomy (EST) without cholecystectomy was recently performed. Thus, we analyzed the result of EST without cholecystectomy in patients with gallstone pancreatitis and evaluated its clinical usefulness. Methods: Seventeen patients who were diagnosed as gallstone pancreatitis from January 1997 to January 2000 and treated by EST without cholecystectomy because of difficulties in operation were enrolled in this study. The patients were followed up by visiting outpatient department or interview by telephone. Results: The mean age was 64.4 years and the mean duration of follow-up was 15.5 months. According to modified Glasgow criteria, the disease status of 14 patients were mild and the other 3 patients were severe. The site of gallstones were gallbladder in 6 patients, common bile duct (CBD) in 2, and both in 6. Success rate of stone removal in CBD was 100%(11/11) and EST-related complication rate was 6%(1/11). During the follow-up period, there were no pancreatobiliary diseases. Conclusions: EST without cholecystectomy is a safe and useful therapeutic modality in patients with gallstone pancreatitis who had diffculties in operation. (Kor J Gastroenterol 2000;36:383 - 389)

응급 내시경적 역행성 담췌관 조영술(Endoscopic Retrograde CholangioPancreatography)은 모든 담석 췌장염 환자에서 필요한가?

염혜정,이선영 이화여자대학교 의과학연구소 2007 EMJ (Ewha medical journal) Vol.30 No.2

목적:내시경적 역행성 담췌관 조영술(Endoscopic Retrograde Cholangiopancreatography, 이하 ERCP)과 내시경적 유두 괄약근 절개술(Endoscopic Sphincterotomy,이하 ES)은 급성 담석 췌장염 환자의 진단과 치료에 유용하다. 이 연구에서는 담석 췌장염 환자에서 응급ERCP의 유용성에 관하여 알아보고자 하였다. 방법:1994년 7월부터 2002년 12월까지 본원에서 급성 담석 췌장염을 진단받고 ERCP를 시행 받은 환자 66명을 대상으로 후향적인 연구를 하였다. 담석으로 인한 폐쇄성 황달은 응급 ERCP의 명백한 적응증이 되므로 이 연구에서 제외하였다. 대상 환자를 A군(응급 ERCP군 ; 내원 72시 간 내에 ERCP를 시행 받은 군)과 B군(정규 ERCP군 ;내원 72시간 후에 ERCP를 시행 받은 군)으로 나누고 두 군 사이의 임상양상과 부작용 발생 빈도를 비교하였다. 결 과:두 군에서 생화학적 검사 결과, 췌장염의 정도, 췌장염의 부작용, 췌장 유두부의 특성. 입원 기간 사이에는 유의한 차이가 없었다. A군이(40.9%) B군에(24.2%) 비해 ERCP에서 육안적으로 담석이 확인된 경우가 많았다. 결 론:ERCP가 급성 담석 췌장염의 진단과 치료에서 매우 유용하지만. 명백한 폐쇄성 황달이 없을 경우에는 응급 ERCP가 반드시 필요하지는 않다. Objectives : Endoscopic Retrograde Cholangiopancreatogrphy (ERCP) and endoscopic sphincterotomy are useful for both diagnosis and treatment of patients with acute gallstone pancreatitis. In this study, we assessed the feasibility of emergency ERCP in patients with all gallstone pancreatitis. Methods : We retrospectively reviewed the medical records of 66 patients, who underwent ERCP with a diagnosis of acute gallstone pancreatitis between July 1994 and December 2002. Obstructive jaundice from gallstones is excluded, because it is a distinct indication of emergency ERCP. Patients were divided into the group A (emergency ERCP group : ERCP was performed within 72 hours after hospitalization, mean 37.0±16.4 hours, range 6-70 hours) and group B (elective ERCP group ; ERCP, over 72 hours after hospitalization, mean 124.0±49.3 hours, range 76-288 hours). Comparisons of the clinical characteristics and incidence of complications were made between these two groups. Results : There was no significant difference for biochemical measurements, severity of pancreatitis, complications of pancreatitis, characteristics of ampulla, and length of hospital stay between the two groups, Group A had more cases (40.9%) with macroscopic stones on ERCP than group B (24.2%). Conclusion : Although ERCP was a very useful modality for the diagnosis and treatment of patients having acute gallstone pancreatitis, an emergency ERCP would not be necessary unless there is definite obstructive jaundice.

비만과 췌장담도 질환

이훈구,고동희 대한소화기학회 2020 대한소화기학회지 Vol.75 No.5

Obesity has become a major medical and public health problem worldwide. Recent studies have shown that obesity is a chronic disease that is associated with many diseases, such as gallstone disease, acute pancreatitis, fatty liver, and digestive cancer. Obesity is also a risk factor for the formation of cholesterol gallstones. Clinical and epidemiological studies have suggested that obesity is positively associated with the risk of gallbladder cancer. Obesity may modulate the lipid and endogenous hormones metabolism, affect gallbladder motility, increase the risk of gallstones, and increased the risk of gallbladder cancer. In addition, obesity has been considered a risk factor for pancreatic diseases, including pancreatitis and pancreatic cancer. Obese patients develop systemic and local complications of acute pancreatitis more frequently. Several epidemiologic studies have suggested an association of pancreatic cancer with high body mass and lack of physical activity. This study reviewed the literature on obesity and pancreatobiliary disease in terms of epidemiology and mechanism.

Gallstone Pancreatitis의 임상적 고찰

김남규(Nam Kyu Kim),지훈상(Hoon Sang Chi),김병로(Byong Ro Kim),민진식(Jin Sik Min) 대한외과학회 1994 Annals of Surgical Treatment and Research(ASRT) Vol.47 No.5

Gallstone Pancreatitis의 임상적 고찰

이기식(Ki Sik Lee),박진현(Jin Hyun Park),이병철(Byung Cheol Lee) 대한외과학회 1995 Annals of Surgical Treatment and Research Vol.48 No.2

급성 담석 췌장염의 합병증으로 발생한 십이지장 벽내 혈종 1예

권혁희,최효인,전민지,송호준,이상수,정훈용,김진호 대한내과학회 2013 대한내과학회지 Vol.84 No.4

췌장 기원의 십이지장 벽내 혈종은 드문 질환으로서 저자들은 담석에 의한 급성 췌장염 환자에서 십이지장 벽내 혈종이 발생한 1예를 경험하였다. 급성 췌장염에서 복통과 장관 폐쇄의 악화, 위장관 출혈이 병발한 경우에는 합병증으로서 십이지장 벽내 혈종을 의심할 수 있다. 본 증례에서는 췌장과 십이지장 절제 없이 내과적인 방법으로 췌장염과 십이지장 벽내 혈종을 치료하였다. Intramural duodenal hematoma (IDH) is a rare complication of pancreatitis. We report a unique case of IDH caused by acute gallstone pancreatitis in a 37-year-old man. The patient presented with hematemesis and sudden exacerbation of upper abdominal pancreatic pain. An abdominal computed tomography scan showed an intramural hyperdense hematoma and symmetric thickening of the duodenal wall along with peripancreatic inflammation and gallbladder stones. A duodenoscopy also revealed a bloody edematous duodenal wall with a narrow lumen due to IDH. The patient recovered fully from the acute pancreatitis and IDH without pancreaticoduodenectomy using conservative management and a subsequent cholecystectomy.