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간장 ( 肝臟 ) , 담도 ( 膽道 ) 및 췌장 ( 膵臟 ) : 만성췌장염의 임상적 고찰
강진경(Jin Kyung Kang),최흥재(Heung Jai Choi),박인서(In Suh Park),정재복(Jae Bock Chung),김원호(Won Ho Kim),송시영(Si Young Song),최광준(Kwang Jun Choe) 대한소화기학회 1991 대한소화기학회지 Vol.23 No.3
N/A Chronic pancreatitis is characterized by both persistent and irreversible progression of pancreatic lesions with various clinical manifestations and complications. In the Western country, alcohol abuse predominates as the most common cause of chronic pancreatitis. However, the causes and clinical features of chronic pancreatitis in Korea are still unknown. Here, we analyzed 83 cases of chronic pancreatitis diagnosed by clinical symptoms, imaging studies, operative or histological findings at the Department of Internal Medicine, Yonsei University College of Medicine, form January 1981 to December 1989. The results were as follows; 1) Mean age of 83 patients with chronic pancreatitis was 52.1 years (14-81), and the majority was in 4th, 5th and 6th decades. The male to female ratio was 3 : l 2) Alcohol was considered as the cause of chronic pancreatitis in 34(40.9%) of 83 cases, but in remainder the cause was not evident. 3) Abdominal pain was the most common symptoms (83.1%), followed by weight loss (16.9%), jaundice (12.0%) and steatorrhea (12.0%). 4) Hyperglycemia (43.3%) was the most common laboratory finding followed by anemia (33.7%), elevated transaminase (26.5%) and jaundice (14.5%). The serum amylase was elevated in 11 cases (13.3%). 5) Plain abdominal X-ray showed calcified density in pancreatic area in 29 (48.3%) arnong 60 cases. Ultrasonography showed the characteristic findings of chronic pancreatitis in 40 (58.8%) of 68 cases tested, the computed tomography 29 (70.7%) of 41 cases and the retrograde cholangiopancreatography 60 (100%) of 60 cases. 6) The most common complication was main pancreatic duct stone (18.1%) followed by pancreatic pseudocyst (9.6%), obstructive jaundice (9.6%), pleural effusion (7.2%) and pancreatic abscess (1.2%). 7) Conservative treatment was given in 64 cases (77.1%) and operation was performed in 19 cases (22.9%). Operative procedures included partial pancreatectomy with drainage procedure in 14 cases, transduodenal pancreaticolithotomy in 1 case and pancreaticoduodenectomy in 4 cases.
내시경적 역행성 담췌관 조영술로 진단된 담췌관 합류이상의 임상적 의의
강진경,최광준,박인서,문영명,정재복,유효민,정준표,송시영 대한소화기내시경학회 1994 Clinical Endoscopy Vol.14 No.1
To evaluate the clinical significance of anomalous pancreaticobiliary ductal union(PBDU), we analysed 11 cases(0.19%) of anomalous PBDU among 5675 cases performed ERCP from Jan. 1973 to Aug. 1992. According to the classification of Kimura et al., 4 cases were type 1(P-C union) and 7 cases type 2(C-P union). The length of common channel ranged from 1.5 cm to 3.1 cm(mean 1.9 cm). The common associated disease were choledochal cyst(7 cases), carcinoma of the gallbladder(5 cases) and biliary stone(3 cases). Four cases of carcinoma of the gallbladder were type 1. The incidence of anomalous PBDU was significantly higher in cases with carcinoma of the gallbladder(5 cases among 49 cases) than in case without carcinoma of the gallbladder(6 cases among 5626 cases). And the incidence of gallbladder carcinoma(45%) among the 11 cases of anomalous PBDU was significantly higher than that(0.78%) among those who did not have anomalous PBDU. In conclusion, the common associated diseases with the anomalous PBDU were choledochal cyst, carcinoma of the gallbladder and stone, and the anomalous PBDU may be risk factor in the development of carcinoma of the gllbladder.
담낭 회충미입증 1예 : 증례 보고 A case report
김원호,최광준,강진경,박인서,김명욱,최흥재,장길진 대한소화기내시경학회 1993 Clinical Endoscopy Vol.13 No.1
Migration of roundworms, Ascaris lumbricoies, into the biliary tract is a relatively common cause of biliary symptoms in endemic areas, but the number of reported gallbladder ascariasis was scanty even in these areas. Some diagnostic methods might provide suggestive informations, but there are no pathognomonic clinical features for biliary ascariasis, so it is discovered usually after surgical exploration, which is especially the case of gallbladder ascariasis. A young female patient with 4 months' history of right upper quadrant pain which did not respond to medical control and was aggravated recently, presented normal level of peripheral blood leukocyte count with no eosinophilia, normal liver function test, normal serum amylase level and subjectively no febrile sense. Abdominal ultrasonogram disclosed a long, thick, linear, non-motile echogenic structure, not accompanied by acoustic shadowing, within the gallbladder. The intra-and extra-hepatic bile ducts were not dilated and the pancreas was revealed as normal echogenecity and contoru. Endoscopic retrograde cholangiopancreatography was performed immediately thereafter, and it showed a thin linear filling defect in the gallbladder. Cholecystectomy was performed under the impression of gallbladder ascariasis. A mummified Ascaris lumbricoides was found in the lumen of the gallbladder. There was no stones and the histologic examination of the gallbladder revealed chronic cholecystitis.