한국간담췌외과학회지 (Annals of Hepato-Biliary-Pancreatic Surgery)

  • 제13권3호
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  • Pages.164-170
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  • 2009
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  • 2508-5778(pISSN)
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  • 2508-5859(eISSN)
한국간담췌외과학회 (The Korean Association of Hepato-Biliary-Pancreatic Surgery)
권호 표지

내시경적 치료에 실패한 총담관석 환자에서의 복강경 총담관 탐색술

Laparoscopic Common Bile Duct Exploration in Patients with Failed Endoscopic Stone Extraction

  • 신형섭 (충남대학교 의학전문대학원 외과학교실) ;
  • 전광식 (충남대학교 의학전문대학원 외과학교실) ;
  • 송인상 (충남대학교 의학전문대학원 외과학교실)
  • Shin, Hyoung-Seob (Department of Surgery, Chungnam National University School of Medicine) ;
  • Chun, Kwang-Sik (Department of Surgery, Chungnam National University School of Medicine) ;
  • Song, In-Sang (Department of Surgery, Chungnam National University School of Medicine)
  • 발행 : 2009.09.30

⟨ 이전 논문 다음 논문 ⟩

초록

Purpose : Laparoscopic common bile duct exploration (LCBDE) has more advantages than conventional common bile duct surgery, but the use of this route for stone removal and biliary drainage remains controversial. The goal of this study was to investigate the usefulness of LCBDE in patients who had been failed in the endoscopic stone extraction. Methods : From November 2005 to August 2008, 52 patients underwent LCBDE due to failure of endoscopic stone extraction in Chungnam National University Hospital. Clinical data were collected and analyzed retrospectively. Results : Duodenal diverticulum (23 cases, 44.2%) was the most common cause in failure of endoscopic stone extraction and large common bile duct stone 12 cases (23.1%), previous upper gastrointestinal operation 10 cases (19.2%) were followed. Twenty four patients did not have preoperative biliary drainage, such as PTBD, ENBD, PTGBD. Forty-five patients (86.5%) of the 52 participating patients underwent LCBDE successfully, but 7 cases resulted in open surgery for the following reasons: 3 cases of severe intraabdominal adhesions, 3 cases of stone impaction in ampulla portion on , and 1 case of a remnant stone. External biliary drainage was performed in 41 cases with T-tube (31 cases, 68.9%), PTBD (7 (cases, 15.6%), ENBD (3 cases, 6.7%). The stone clearance of LCBDE was 95.6%. Remnant stone were detected in 2 cases (4.4%) and removed with choledochoscope via external biliary drain. Postoperative complications happened in 5 cases (9.5%). Procedure related complications happened in 2 cases (3.8%). Conclusion : LCBDE is useful technique in patients with failed endoscopic stone extraction, and biliary drainage may be necessary for detection and removal of latent remnant CBD stones.

키워드

참고문헌

  1. Vecchio R, MacFadyen BV. Laparoscopic common bile duct exploration. Langenbeck's Arch Surg. 2002;387:45-54. https://doi.org/10.1007/s00423-002-0289-7
  2. Fitzgibbons RJ Jr, Gardner GC. Laparoscopic surgery and the common bile duct. World J Surg. 2001;25:1317-1324. https://doi.org/10.1007/s00268-001-0117-1
  3. Lilly MC, Arregui ME. A balanced approach to choledocholithiasis. Surg Endosc. 2001;15:467-472. https://doi.org/10.1007/s004640080020
  4. Cho BH. Choledocholithiasis and cholangitis. In: Park YH, KIM SW, Lee KU, editors. HBP Surgery. 1st ed. Seoul: Medrang Publishing; 2000. p.541-548.
  5. Ahrendt SA, Pitt HA. Biliary tract. In: Townsend CM Jr. editors. Textbook of surgery: The biological basis of modern surgical practice. 16st ed. Philadelphia: W. H. Saunders;2001. p. 1076-111.
  6. Petelin JB. Laparoscopic approach to common duct pathology. Am J Surg 1993;165:487. https://doi.org/10.1016/S0002-9610(05)80947-X
  7. Fiore NF, Ledniczky G, Wiebke EA, et al. An analysis of perioperative cholangiography in one thousand laparoscopic cholecystectomies. Surgery 1997;122:817-823. https://doi.org/10.1016/S0039-6060(97)90092-1
  8. Freeman ML. Long-term sequelae of endoscopic papillotomy. Endoscopy. 1998;30:A221-227.
  9. Karaliotas C, Sgourakis G, Goumas C, Papaioannou N, Lilis C, Leandros E. Laparoscopic common bile duct exploration after failed endoscopic stone extraction. Surg Endosc. 2008;22:1826-1831. https://doi.org/10.1007/s00464-007-9708-8
  10. Taichi K, Kazuya S, Yoichiro N, Masahiro Y, Nozomi U, Yoshifumi T. Laparoscopic choledochotomy in management of choledocholithiasis. Surg Laparosc Endosc Percutan Tech 2007;17:262-266. https://doi.org/10.1097/SLE.0b013e31806c7d5f
  11. Cotton PB, Lehman G. Vennes J, et al. Endoscopic sphincterotomy complications and their management: an attempt at consens us. Gastrointest Endosc 1991;37:383-393. https://doi.org/10.1016/S0016-5107(91)70740-2
  12. Neoptolemos JP, Carr-Locke DL, London NJ, Bailey lA, James D, Fossard DP, Controlled trial of urgent endoscopic retrograde cholangiopancreatography and endoscopic sphincterotomy versus conservative treatment for acute pancreatitis due to gallstones. Lancet 1998;2:979-983.
  13. Fan ST, Lai EC, Mok FP, Lo CM, Zheng SS, Wong J. Early treatment of acute biliary pancreatitis by endoscopic papillotomy. N Engl J Med 1993;328:228-232. https://doi.org/10.1056/NEJM199301283280402
  14. Cuschieri A, Lezoche E, Morino M, et al. E. A. E. S multicenter prospective randomized trial comparing two-stage vs single-stage management ofpatients with gallstone disease and ductal calculi. Surg Endosc 1999;13:952-957. https://doi.org/10.1007/s004649901145
  15. Holdsworth RJ, Sadek SA, Ambikar S, Cuschieri A. Dynamics of bile flow through the human choledochal sphincter following exploration of the commonbile duct. World J Surg 1989;13:300-306 https://doi.org/10.1007/BF01659038
  16. Wu JS, Soper NJ. Comparison of laparoscopic choledochotomy closure techniques. Surg Endosc 2002;16:1309-1313. https://doi.org/10.1007/s004640080016
  17. Decker G, Borie F, Millat B, et al. One hundred laparoscopic choledochotomies with primary closure of common bile duct. Surg Endosc 2003;17:12-18. https://doi.org/10.1007/s00464-002-9012-6
  18. Park JH, Choi IS, Choi WJ, Go DG, Yoon OS. Laparoscopic CBD Exploration without T-tube. J Korean Soc Endosc Laparosc Surg 2004;7:48-55.
  19. Lauter OM, Froines EJ. Laparoscopic common duct exploration in the management of choledocholithiasis. Am J Surg 2000;179:372-374. https://doi.org/10.1016/S0002-9610(00)00368-8
  20. Nathanson LK, O' Rourke NA, Martin IJ et al. Postoperative ERCP versus laparoscopic choledochotomyfor clearance of selected bile duct calculi. A randomized trial. Ann Surg 2005;242:188-192. https://doi.org/10.1097/01.sla.0000171035.57236.d7
  21. Rhodes M, Sussman L, Cohen L, Lewis MP. Randomised trial of laparoscopic exploration of common bile duct versus postoperative endoscopic retrograde cholangiography for common bile duct stones. Lancet 1998;351:159-161. https://doi.org/10.1016/S0140-6736(97)09175-7
  22. Vecchio R, MacFadyen BV Jr, Ricardo AE. Bile duct injury : management options during and after gallbladder surgery. Semin Laparosc Surg 1998;5:135-144.
  23. Yi NJ, Kim YW, Han HS, Min SK, Choi YM. Comparative study of laparoscopic common bile duct exploration vs open method for the treatment of CBD stone. J Korean Surg Soc 2002;63:416-422.
  24. Schippers E, Tittel A, Ottinger A, Schumpelick V. Laparoscopy versus laparotomy: comparision of adhesion-formation after bowel resection in canine model. Dig Surg 1998;15:145-147. https://doi.org/10.1159/000018608
  25. Polymeneas G, Theodosopoulos T, Stamatiadis A, Kourias E. A comparative study of postoperative adhesion formation after laparoscopic vs open cholecystectomy. Surg Endosc 2001;15:41-43. https://doi.org/10.1007/s004640000269
  26. Koivulsalo A, Esklinen M, Wolff H, et al. Development of T-tube tracts in piglets: effect of insertion method and material of T-tubes. Res Exp Med 1997;197:53-61. https://doi.org/10.1007/s004330050055