내시경 초음파 유도하 담관 조영술을 이용한 제방향 담즙 배액 1예 = A Case of Endoscopic Ultrasound Guided Cholangiography with Antegrade Drainage

다국어 초록 (Multilingual Abstract)

An 84-year-old woman presented with obstructive jaundice due to unresectable gallbladder cancer with a left renal cell carcinoma. Endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous transhepatic biliary drainage (PTBD) were unsuccessful because of tumor obstruction of the duodenal bulb, right hepatic duct and distal common bile duct. Endoscopic ultrasound (EUS)-guided biliary drainage with a transgastric approach was performed. A guide-wire was passed through the biliary obstruction and was successfully advanced into the duodenum via the ampulla. The procedure was completed in an antegrade fashion. The obstructed biliary system was successfully decompressed by the insertion of a biliary covered metal stent through the malignant stricture. There were no complications related to the use of this procedure.

국문 초록 (Abstract)

내시경 역행 췌담관 조영술은 총담관 결석뿐만 아니라 악성 췌담관 협착을 완화시켜주는 확립된 치료법이다. 하지만 유두 주위 게실, 수술력, 종양, 유두 협착, 혹은 담관을 막는 결석 등으로 실패할 수 있다. 내시경 역행 췌담관 조영술이 실패한 경우 경피 경간 담즙 배액술과 수술이 적용될 수 있으나 복막염, 패혈증, 담관염 등 합병증 발생률이 높고 이환율과 사망률 또한 높으며 환자의 삶의 질이 떨어진다. 최근에 해외에서 악성 담관 폐쇄, 수술력, 유두 협착 등으로 내시경 역행 췌담관 조영술이나 경피 경간 담즙 배액술을 시행할 수 없는 경우 내시경 초음파 유도하 담관 조영술을 이용한 담즙 배액술이 소개되고 있으나 아직까지 국내에서는 이에 대한 보고가 거의 없다. 저자들은 담낭암으로 우간내 담관 및 총담관의 협착과 폐쇄성 황달을 동반한 증례에서 고식적 치료로 내시경 초음파 유도하 담관 조영술을 이용한 제방향 담즙 배액술을 시술하여 문헌 고찰과 함께 보고한다.

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