Korean Journal of Gastrointestinal Endoscopy 2010;41(5): 273-279.
간내담석 환자에서 양측성 담도 접근
김동욱ㆍ송근암ㆍ김광하ㆍ김 석*ㆍ김형욱ㆍ강대환
부산대학교 의학전문대학원 내과학교실, *영상의학교실
Bilateral Biliary Approach in Patients with Hepatolithiasis
Dong Uk Kim, M.D., Geun Am Song, M.D., Kwang Ha Kim, M.D., Suk Kim, M.D.*, Hyung Wook Kim, M.D. and Dae Hwan Kang, M.D.
Departments of Internal Medicine and *Radiology, Pusan National University School of Medicine, Busan, Korea
Abstract
Background/Aims: Percutaneous procedures for treating patients with hepatolithiasis associated with intrahepatic biliary stricture (IHBS) have been shown to have a relatively lower rate of successful stone removal than without IHBS. The reason is tight stenosis or acute angulation of intrahepatic bile ducts (IHDs). We suggest that a bilateral approach to IHDs would improve the success rate of stone removal in patients with complicated IHBS.
Methods: Conventional cholangioscopic electrohydrolithotripsy (EHL) was performed in 82 patients without IHBS. Percutaneous transhepatic stricture dilation and cholangioscopic EHL through unilateral access was performed to treat 41 patients with hepatolithiasis with IHBS. In 21 patients with complicated stricture and multiple stones, removal of hepatolithiasis was achieved by a bilateral approach. The rate of complete stone clearance and complication was reviewed retrospectively.
Results: Complete stone clearance was achieved in 92.7% (76/82) of patients using a unilateral approach without IHBS, in 61.0% (25/41) of cases using a unilateral approach with IHBS, and in 85.7% (18/21) of cases using a bilateral approach with IHBS (p＜0.05). The number of sessions of PTCS was 2.7±0.3, 3.9±0.3, and 2.7±0.5 respectively. The overall complication rate was 14.6% (21/144), and didn't differ between groups.
Conclusions: A bilateral approach to IHDs may be a useful alternative treatment in unresectable patients with multiple hepatolithiasis associated with complicated IHBS. (Korean J Gastrointest Endosc 2010;41:273-279)
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