Clinical Endoscopy

The Korean Society of Gastrointestinal Endoscopy (대한소화기내시경학회)
권호 표지

Endoscopic Treatment of Gallstone Diseases

담석의 내시경 치료

  • Yoo, Byeong-Moo (Department of Internal Medicine, Ajou Univeristy School of Medicine)
  • 유병무 (아주대학교 의과대학 소화기내과학교실)
  • Received : 2010.10.17
  • Accepted : 2010.11.25
  • Published : 2010.11.30
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Abstract

Gallstone diseases include gallbladder stones, extrahepatic bile duct stones and intrahepatic duct stones. In the past, the main treatment modality was a surgical operation. With the development of endoscopic treatment, the main treatment modality is shifting towards endoscopic treatment. After the development of endoscopic sphincterotomy, endoscopic stone removal using a basket or balloon has been the major treatment modality for extrahepatic bile duct stones. For huge extrahepatic bile duct stones, mechanical or laser lithotripsy are used as ancillary equipment. Direct peroral cholangioscopic methods using a slim endoscopy or a Spyglass system now being rapidly developed instead of the "mother and baby" scope. If extrahapatic bile duct stones fail to be removed with peroral endoscopic treatment, then the stones can be treated via a percutaneous route (a percutaneous transhepatic route or a percutaneous transabdominal route). For intrahepatic duct stones, the location of stones, the site and degree of bile duct stricture and the existence of parenchymal atrophy are important factors to decide the treatment modality. The treatment modality is usually decided on according to the Tsunoda classification. Gallbladder stones usually need cholecystectomy because of recurrence. Endoscopic treatment is an indication for treating inoperable calculous cholecystitis patients. Endoscopic treatment for gallstone disesae will continue to rapidly develop in the future to the benefit of both the patients and endoscopists.

담석은 그 위치에 따라 담낭 담석, 간외 담석, 간내 담석으로 분류할 수 있으며, 위치에 따라 치료 방침이 달라진다. 담석은 과거에는 수술이 주치료 방법이었으나 내시경 및 술기의 발달로 인하여 근래에는 많은 경우에 내시경 치료가 일차적인 치료방법으로 선호되고 있다. 담석의 내시경 치료는 내시경유두괄약근절개술 및 담석 제거를 위한 여러가지 부속기구가 개발되면서 급격히 발전하기 시작하였다. 간외 담석의 내시경 치료는 유두괄약근절개술 시행 후 바스켓이나 풍선도관을 이용하는 것이 일반적인 치료 방침이나 거대 담석의 제거에 기계식쇄석술이나 레이저쇄석술이 사용되기도 한다. 이러한 시술로도 제거가 어려운 경우에는 세경내시경을 이용하여 담도를 직접 관찰하고 담석을 제거하는 시술이 시행되기도 한다. 간외담석의 치료는 경구경유두 시술이 가장 간단한 치료 방법이나 경구경유두 접근에 실패하거나 담석제거에 실패한 경우에는 경피적 경로를 통하여 제거할 수 있다. 간내 담석이나 담낭 담석의 내시경적 치료는 주로 경피적 경로(경피경간 또는 경피경복적 경로)를 통하여 시행하게 된다. 간내 담석은 담석의 위치, 간내담도의 협착위치 및 정도, 간실질의 위축 여부에 따라 치료방법이 결정되며 주로 Tsunoda 분류 방법이 치료 방침을 결정하는데 사용되고 있다. 담낭 담석은 수술적 치료가 원칙이지만 수술이 불가능한 환자에서는 담낭염이 있는 경우 경피적 경로를 통하여 내시경 치료를 시행할 수 있다. 담석의 내시경 치료는 지금까지 발전이 있어왔지만 향후에도 환자와 내시경 시술의 모두에게 도움이 되는 방향으로 발전해 갈 것으로 생각한다.

Keywords

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