Korean Journal of Gastrointestinal Endoscopy 2002;25(6): 443-448.
경구경유두적 경로로 제거가 불가능한 총수담관결석의 경피경간적 경로를 통한 치료의 유용성
서정인·이동기·최윤종·정필호·김문영·박동훈·김현수·백순구·권상옥
연세대학교 원주의과대학 내과학교실
Efficacy of Percutaneous Treatment of CBD Stones Which Could
Jung In Seo, M.D., Dong Ki Lee, M.D., Yeun Jong Choi, M.D., Phil Ho Jeong, M.D.,Moon Young Kim, M.D., Dong Hoon Park, M.D., Hyun Soo Kim, M.D.,Soon Koo Baik, M.D. and Sang Ok Kwon, M.D.
Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
Abstract
Background/Aims: Common bile duct (CBD) stones can be removed by endoscopic retrograde cholangiopancreatography (ERCP) with endoscopic sphincterotomy (EST) in most cases. In addition, surgery or stenting as well as percutaneous transhepatic cholangioscopy (PTCS) with lithotripsy can be used to remove CBD stones also. In this study we evaluated the efficacy of percutaneous removal of CBD stones which could not be removed by per-oral endoscopic method. Methods: From Jan. 1998 to Sep. 2001, ERCP were tried to remove CBD stones in 395 patients. We reviewed causes of treatment failure through the peroral method and PTCS-results by the medical records and cholangiograms in 15 patients. Results: We successfully removed stones with PTCS in all 15 patients. The reasons for percutaneous approach were previous operation history in 8 (53.3%) and old age in 10 (66.7%). Mean number and size of stone were 4.4 and 17.4⁓13.1 mm, respectively. Complete fragmentation and removal of stones were achieved in a single session in 40%. Mean time to complete removal was 19 days. In 1 patient, bile peritonitis was developed but cured by conservative management alone. Conclusions: PTCS with or without lithoptripsy is an effective and safe method for the treatment of CBD stones which can not be removed by peroral endoscopic approach. (Korean J Gastrointest Endosc 2002;25:443448)
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