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식도정맥류의 내시경적 결찰술 전후의 하부 식도 내압 검사의 변화
유재규(Jae Kyu Ryu),김형언(Hyeong Eon Kim),류준형(June Hyung Lyou),최석채(Suck Chei Choi),김학철(Haak Cheoul Kim) 대한내과학회 1995 대한내과학회지 Vol.48 No.6
N/A Objectives: Endoscopic injection sclerotherapy is one of the effective therapeutic modalities for treating acutely bleeding esophageal varices. However, there are a number of complications and one of them is the changes in lower esophageal motility. A recently developed method that uses small rubber bands for treating bleeding varices, endoscopic variceal ligation (EVL), may change the lower esophageal motility. This study was designed for investigating the effects on lower esophageal motility in paients with esophageal varices before and after EUL. Methods: We prospectively performed lower esophageal manometry(using 8 lumen ESMR catheter, Arndorf, Medical Specialities Inc. in 20 patients with esophageal varices to investigate the length, pressure, relaxation percent, relaxation duration of lower esophageal sphincter(LES) and the speed of peristaltic wave, contraction amplitude, contraction duration in the lower esophagus before and after EVL therapy. EVL was performed with a Pentax EG2900 fiberoptic endoscope and Stiegmann-Goffligator kit. Results: There were noted mild epigastric discomfort, nausea, chest discomfort and sinus bradycardia during and after EVL that were improved spontaneously. The EVL caused considerable diminution in the size of esophageal varix by mean 8.7(range 3-21) ligations in mean 1.8(range 1-3) sessions. LES length after EVL was 3.7±0.8cm vs 3.7±0.7cm before treatment. LES pressure after EVL was 13.1±3.9mmHg vs 12.7±6.9mmHg before treatment. LES relaxation percent after EUL was 90.5±9.6 % vs 87.8±8.1% before treatment. LES relaxation duration after EVL was 9.1±1.8sec vs 9.5±2.1 before treatment. In the lower esophagus 3cm above LES, the speed of peristaltic waves after EVL was 3.46±0.8lcm/sec us 3.1±0.8cm/sec before treatment, contraction amplitude after EVL was 87.9±44.2 vs 73.0±39.8mmHg before treatment and contraction duration after EVL was 3.3±0.5 sec vs 2.7±0.5 sec before treatment. There were no significant changes in the length, pressure, relaxation percent and duration of the lower esophageal sphincter(LES) and in the speed of peristaltic wave in the lower esophagus after EVL. There were significant differences in the contraction amplitude and duration in the lower esophagus after EVL. Conclusion: Variceal ligation therapy may improve esophageal peristalsis due to increase in the contraction amplitude and duration in the lower esophagus and cause lesser motility dysfunction in the lower esophagus. In conclusion, EVL is a safe, easy and effective therapeutic modality in patients with esophageal varices.
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김학철,김제형,류준형 대한내과학회 1997 대한내과학회지 Vol.53 No.1
Benign tumors of the extrahepatic bile duct are rare. They occur mostly in the common bile duct. Among them, papillomas and adenomas are most common. We experienced a case of villous adenomas in the common bile duct and also in the cystic duct. The ultrasound and the CT scan of the abdomen revealed markedly dilated common bile duct, subtle filling defect, and irregular mass narrowing the lumen of the common bile duct. The cholangiogram demonstrated movable, feathery, and marginated papillary mass with tumors, a broad base, and biopsy of this mass was done through the PTBD. The biopsy specimen showed villous adenoma. Even though it was diagnosed as benign, cholecystectomy and excision with Roux-en-Y hepaticojejunostomy was performed because of the high incidence of recurrences and malignant potential.
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김제형,황호근,최두환,유광현,류준형,최석채,김학철 圓光大學校 醫科學硏究所 1995 圓光醫科學 Vol.11 No.1
Biloma has been defined as an extraductular collection of bile within a defined capsular space. Development of an intraabdominal bile collection usually occurs secondary to traumatic or iatrogenic injury including abdominal surgery, percutaneous catheter drainage and transhepatic cholangiogram. Spontaneous bile leakage associated with other primary causes, including sickle cell anemia, gall bladder cancer and hepatocellular carcinoma, has been reported rarely. We present a case of biloma secondary to traumatic injury with liver biopsy, who had right upper guadrant pain, jaundice and yellowish skin discoloration in a patient with cholangiocellular carcinoma. Huge biloma was confirmed by percutaneous transhepatic biliary drainage and drained with pig tail catheter successfully. A case of huge biloma secondary to liver biopsy is presented with brief review of the literatures.
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