Clinical Endoscopy

  • 제41권3호
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  • Pages.140-146
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  • 2010
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  • 2234-2400(pISSN)
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  • 2234-2443(eISSN)
대한소화기내시경학회 (The Korean Society of Gastrointestinal Endoscopy)
권호 표지

단일기관에서의 소아 ERCP 10예에 대한 임상적 고찰

A Single Institution's Experience of Ten Pediatric Patients with Endoscopic Retrograde Cholangiopancreatography

  • 박진우 (순천향대학교 의과대학 천안병원 소화기내과학교실) ;
  • 박상흠 (순천향대학교 의과대학 천안병원 소화기내과학교실) ;
  • 이태훈 (순천향대학교 의과대학 천안병원 소화기내과학교실) ;
  • 심윤숙 (순천향대학교 의과대학 천안병원 소화기내과학교실) ;
  • 황순오 (순천향대학교 의과대학 천안병원 소화기내과학교실) ;
  • 김상필 (순천향대학교 의과대학 천안병원 소화기내과학교실) ;
  • 이준영 (순천향대학교 의과대학 천안병원 소화기내과학교실) ;
  • 이세환 (순천향대학교 의과대학 천안병원 소화기내과학교실) ;
  • 이창균 (순천향대학교 의과대학 천안병원 소화기내과학교실) ;
  • 박도현 (울산대학교 의과대학 서울아산병원 소화기내과학교실) ;
  • 이석호 (순천향대학교 의과대학 천안병원 소화기내과학교실) ;
  • 정일권 (순천향대학교 의과대학 천안병원 소화기내과학교실) ;
  • 김홍수 (순천향대학교 의과대학 천안병원 소화기내과학교실) ;
  • 김선주 (순천향대학교 의과대학 천안병원 소화기내과학교실)
  • Park, Jin-Woo (Division of Gastroenterology, Department of Internal Medicine, Soonchunhyang University Cheonan Hospital,Soonchunhyang University College of Medicine) ;
  • Park, Sang-Heum (Division of Gastroenterology, Department of Internal Medicine, Soonchunhyang University Cheonan Hospital,Soonchunhyang University College of Medicine) ;
  • Lee, Tae-Hoon (Division of Gastroenterology, Department of Internal Medicine, Soonchunhyang University Cheonan Hospital,Soonchunhyang University College of Medicine) ;
  • Shim, Yun-Suk (Division of Gastroenterology, Department of Internal Medicine, Soonchunhyang University Cheonan Hospital,Soonchunhyang University College of Medicine) ;
  • Hwang, Soon-Oh (Division of Gastroenterology, Department of Internal Medicine, Soonchunhyang University Cheonan Hospital,Soonchunhyang University College of Medicine) ;
  • Kim, Sang-Pil (Division of Gastroenterology, Department of Internal Medicine, Soonchunhyang University Cheonan Hospital,Soonchunhyang University College of Medicine) ;
  • Lee, Jun-Young (Division of Gastroenterology, Department of Internal Medicine, Soonchunhyang University Cheonan Hospital,Soonchunhyang University College of Medicine) ;
  • Lee, Seo-Whan (Division of Gastroenterology, Department of Internal Medicine, Soonchunhyang University Cheonan Hospital,Soonchunhyang University College of Medicine) ;
  • Lee, Chang-Kwun (Division of Gastroenterology, Department of Internal Medicine, Soonchunhyang University Cheonan Hospital,Soonchunhyang University College of Medicine) ;
  • Park, Do-Hyun (Asan Medical Center, University of Ulsan College of Medicine) ;
  • Lee, Suck-Ho (Division of Gastroenterology, Department of Internal Medicine, Soonchunhyang University Cheonan Hospital,Soonchunhyang University College of Medicine) ;
  • Chung, Il-Kwun (Division of Gastroenterology, Department of Internal Medicine, Soonchunhyang University Cheonan Hospital,Soonchunhyang University College of Medicine) ;
  • Kim, Hong-Soo (Division of Gastroenterology, Department of Internal Medicine, Soonchunhyang University Cheonan Hospital,Soonchunhyang University College of Medicine) ;
  • Kim, Sun-Joo (Division of Gastroenterology, Department of Internal Medicine, Soonchunhyang University Cheonan Hospital,Soonchunhyang University College of Medicine)
  • 투고 : 2010.03.26
  • 심사 : 2010.08.03
  • 발행 : 2010.09.30
⟨ 이전 논문 다음 논문 ⟩

초록

목적: 최근 소아에서의 담췌관 질환의 진단 및 치료를 위해 ERCP의 역할이 꾸준히 증가하고 있다. 저자들은 단일병원에서 10명의 소아환자에서 시행한 ERCP를 검토해 임상적 적응증, 진단 및 치료효과, 합병증과 마취 및 그 선택에 있어서 성인과의 차이점에 대하여 알아보고자 하였다. 대상 및 방법: 2005년 8월부터 2008년 6월까지 본원에 입원한 15세 이하의 소아 환자 중 담췌관 질환으로 치료적 ERCP를 시행한 10명의 환아를 대상으로 하였다. 결과: 총 10명(남：여=3：7, 평균나이 5.7세[23개월~14세])에서 13회의 치료적 ERCP를 시행하였고, 적응증은 담도성 췌장염(n=6), 담도 결석(n=3) 및 담도성 동통(n=1)이었다. 마취방법은 midazolam, propofol, ketamine의 단독 또는 혼합 정맥마취를 사용하였다. 수면마취의 만족도는 만족 10, 불만족 3이었고, 수면 마취에 불만족인 3예는 midazolam과 propofol을 복합투여하였던 8세 이하의 환아들이었다. 담도삽관 성공율은 92.3%(12/13)이었으며, 담도삽관에 성공한 예에서 시행된 치료적 시술은 내시경 유두괄약근절개술 4회, 내시경 유두 풍선확장술 3회, 두 시술 동시 시행 5회였다. 시술 관련 합병증은 7.7%(1/13, 십이지장 천공 1예)에서 발생하였으며, 췌장염이나 출혈은 없었다. 십이지장 천공환자는 수술적 치료 후 호전되었다. 결론: 소아에서의 ERCP는 성인에서와 마찬가지로 임상적으로 매우 유용한 시술이다. 그러나 정맥마취의 적용 및 그 효과, 합병증 발생시 대처방법, 소아 위장관의 해부학적 특성이 성인과 차이가 있어 주의를 요한다.

Background/Aims: ERCP is being used increasingly as a diagnostic and therapeutic tool for children with pancreaticobiliary disorders. Differences between thirteen pediatric ERCPs and adult ERCPs were reviewed with respect to their indications, method of anesthesia, choice of endoscope and complications. Methods: The medical records of 13 ERCPs for 10 children (age: 23 months to 14 years) done between 2005 and 2008 were reviewed retrospectively. Results: ERCP was indicated for gallstone pancreatitis (6), choledocholithiasis (3), and unexplained pain (1). The method of anesthesia was intravenous sedation with a single agent or a combination of midazolam, propofol or ketamine. The quality of sedation was satisfactory in 10 cases and unsatisfactory in three cases. These 3 cases were less than 8 years old and sedated with a combination of midazolam and propofol. Selective biliary cannulation was successful in 92.3% (12/13) of attempts. Therapeutic ERCP included sphincterotomy (4), endoscopic papillary balloon dilatation (3), and both (5). Complications occurred in 7.7% of attempts (1/13; 1 duodenal perforation) which was successfully managed by surgery. Conclusions: Pediatric ERCP is a feasible and useful technique. Special caution is needed, however, because of differences with adult ERCP in terms of the effectiveness of intravenous sedation, complications, and size of the gastrointestinal tract.

키워드

참고문헌

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