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- 검색키워드
- 주제어 : Choledochoscopy (검색결과 13 건)
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Kristaps Atstupens,Haralds Plaudis,Vladimirs Fokins,Maksims Mukans,Guntars Pupelis 한국간담췌외과학회 2016 한국간담췌외과학회지 Vol.20 No.2
Backgrounds/Aims: Laparoscopic treatment of patients with choledocholithiasis and cholangitis is challenging due to mandatory recovery of the biliary drainage and clearance of the common bile duct (CBD). The aim of our study was to assess postoperative course of cholangitis and biliary sepsis after laparoscopic clearance of the CBD in emergently admitted patients with choledocholithiasis and cholangitis. Methods: Emergently admitted patients who underwent laparoscopic clearance of the CBD were included prospectively and stratified in 2 groups i.e., cholangitis positive (CH+) or negative (CH-) group. Patient demographics, comorbidities, preoperative imaging data, inflammatory response, surgical intervention, complication rate and outcomes were compared between groups. Results: Ninety-nine of a total 320 patients underwent laparoscopic clearance of the CBD, of which, 60 belonged to the acute cholangitis group (CH+) and 39 to the cholangitis negative group (CH-). Interventions were done on average 4 days after admission, operation duration was 95-105 min, and the conversion rate was 3-7% without differences in the groups. Preoperative inflammatory response was markedly higher in the CH+ group. Inflammation signs on intraoperative choledochoscopy were more evident in patients with cholangitis. Postoperative inflammatory response did not differ between the groups. The overall complication rate was 8.3% and 5.1%, respectively. Laparoscopic clearance of the CBD resulted in 1 lethal case (CH+ group), resulting in 1% mortality rate and a similar 12-month readmission rate. Conclusions: Single-stage laparoscopic intraoperative US and choledochoscopy-assisted clearance of the CBD is feasible in emergently admitted patients with choledocholithiasis and cholangitis.
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Kristaps Atstupens,Haralds Plaudis,Vladimirs Fokins,Maksims Mukans,Guntars Pupelis 한국간담췌외과학회 2016 Annals of hepato-biliary-pancreatic surgery Vol.20 No.2
Backgrounds/Aims: Laparoscopic treatment of patients with choledocholithiasis and cholangitis is challenging due to mandatory recovery of the biliary drainage and clearance of the common bile duct (CBD). The aim of our study was to assess postoperative course of cholangitis and biliary sepsis after laparoscopic clearance of the CBD in emergently admitted patients with choledocholithiasis and cholangitis. Methods: Emergently admitted patients who underwent laparoscopic clearance of the CBD were included prospectively and stratified in 2 groups i.e., cholangitis positive (CH+) or negative (CH-) group. Patient demographics, comorbidities, preoperative imaging data, inflammatory response, surgical intervention, complication rate and outcomes were compared between groups. Results: Ninety-nine of a total 320 patients underwent laparoscopic clearance of the CBD, of which, 60 belonged to the acute cholangitis group (CH+) and 39 to the cholangitis negative group (CH-). Interventions were done on average 4 days after admission, operation duration was 95-105 min, and the conversion rate was 3-7% without differences in the groups. Preoperative inflammatory response was markedly higher in the CH+ group. Inflammation signs on intraoperative choledochoscopy were more evident in patients with cholangitis. Postoperative inflammatory response did not differ between the groups. The overall complication rate was 8.3% and 5.1%, respectively. Laparoscopic clearance of the CBD resulted in 1 lethal case (CH+ group), resulting in 1% mortality rate and a similar 12-month readmission rate. Conclusions: Single-stage laparoscopic intraoperative US and choledochoscopy-assisted clearance of the CBD is feasible in emergently admitted patients with choledocholithiasis and cholangitis.
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서병선(Byoung Sun Suh),이승규(Sung Gyu Lee),민병철(Pyung Chul Min) 대한소화기학회 1994 대한소화기학회지 Vol.26 No.6
N/A Seventeen cases of microscopically proven peripheral cholangiocellular carcinoma(CCC) during 4 year period from June 1989 to June 1993 were reviewed. They comprised 9 men and 8 women with an average age of 50 years (range '. 37 to 62 years). The overall incidence of peripheral CCC in association with hepatolithiasis was 3.5% (9 in 258) and 9 out of 17 cases of peripheral CCC were combined with intrahepatic stones. The incidence of accurate preoperaive diagnosis was 41% due to low index of suspicion. Peripheral CCC developed in 2 patients with hepatolithiasis who underwent CBD exploration and left lateral segmentectomy 2 and 3 years later respectively. Their residual stones were completely removed by choledochoscopy after the operations. The resectability of 17 peripheral CCC was 47%(8 out of 17). The growth pattern of peripheral CCC was mass forming type in 6 cases and infiltra- tive type in 2 cases. Four patients with mass forming type died within 1 year because of tumor recurrence. One patient with infiltrative type survives 41 months after resection with- out any evidence of recurrence. (Korean J Gastroenterol 1994; 26: 987 994)
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임창섭(Chang-Sup Lim),장진영(Jin-Young Jang),이승은(Seung Eun Lee),강미주(Mee Joo Kang),김선회(Sun-Whe Kim) 한국간담췌외과학회 2010 한국간담췌외과학회지 Vol.14 No.1
Purpose: Treatment of hepatolithiasis is difficult because of the high recurrence rate, and the long-term outcome is not satisfactory. We reviewed clinical outcomes to determine the optimal treatment modalities for hepatolithiasis. Methods: Between 1981 and 2005, 648 patients with hepatolithiasis were treated at our institute. Changing patterns of treatment modalities and outcomes were analyzed for the periods: 1st (1981∼1985; n=159), 2nd (1986∼1990; n=100), 3rd (1991∼1995; n=111), 4th (1996∼2000; n=141), and 5th (2001∼2005; n=137). Clearance and recurrence rates according to the treatment modalities and associated malignancies were analyzed in patients for the most recent 10 years. Results: During the past 25 years, hepatectomy as a treatment for hepatholithiasis has increased in frequency and become the major treatment modality in the recent 10 years, while choledocholithotomy and drainage procedures have decreased in frequency. With improvement in operative clearance and post-operative lithotripsy, the final clearance rate improved from 79.0% to 91.3%. In the most recent 10 years, the final clearance rate of hepatectomy, choledocholithotomy, cholangioenterostomy, and PTCS was 97.1%, 82.0%, 78.8%, and 100%, respectively, and the recurrence rate was 34.7%, 15.4%, 17.0%, and 42.9%, respectively. Twenty-six patients (47.2%) had recurrences within 2 years, and 12 patients (21.8%) had recurrences after 5 years. Cholangiocarcinomas occurred in 10 patients (3.6%). The diagnosis of cholangiocarcinoma was established pre-operatively in 2 patients, post-operatively in 4 patients, and during the follow-up period in 4 patients. Conclusion: In the treatment of hepatolithiasis, hepatectomy has a high clearance rate and a low recurrence rate. To reduce the recurrence rate, complete stone clearance without residual stones seems to be of utmost importance. Suspicion of malignancy and long-term follow-up are needed in the management of patients with hepatolithiasis.
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임창섭(Chang-Sup Lim),장진영(Jin-Young Jang),김선회(Sun-Whe Kim) 한국간담췌외과학회 2008 한국간담췌외과학회지 Vol.12 No.1
Hepatolithiasis is characterized by its intractablity and frequent recurrence that requires multiple operative and non-operative interventions. To clarify the optimal treatment modalities and their effectiveness, a total of 648 patients with hepatolithiasis and who had treated at Seoul National University Hospital between January 1981 and December 2005 were analyzed according to the different time periods. Hepatectomy as a primary treatment of hepatolithiasis has gradually increased and become the major treatment modality in the recent 10 years, while choledocholithotomy and drainage procedures have decreased. New treatment modalities such as percutaneous choledochoscopic stone removal (PTCS) and laparoscopic liver resection were instituted during the past decades. Over the last 25 years, both advances in the operative stone clearance rate and the success rate of postoperative lithotripsy have resulted in an improved final stone clearance rate, and this has been progressive from 79.0% in the first period to 91.3% in the fifth period. In the last 10 years, the final clearance rate of hepatectomy, choledocholithotomy, drainage procedures and PTCS was 97.1%, 82.0%, 78.8% and 85.7%, respectively, and the rate of performing repeated hepatectomy, choledocholithotomy, drainage procedures and PTCS was 11.2%, 26.2%, 9.1% and 28.6% respectively. Hepatolithiasisassociated cholangiocarcinomas were found in 24 (4.7%) patients (1991-2005, n=512), and 5 of them were diagnosed after 5 years of follow-up. Histopathologic examinations of the resected livers showed various degrees of pathologies from proliferative cholangitis and hyperplasia through dysplasia and cholangiocarcinoma. Therefore, a suspicion of malignancy and long term follow-up are needed for managing the patients who suffer with hepatolithiasis.
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( Billy James Uy ),( Kristine Trocio ),( Catherine Teh ) 대한간학회 2012 춘·추계 학술대회 (KASL) Vol.2012 No.-
Introduction: The presence of intrahepatic lithiasis is an operative dilemma for surgeons. Not all cases are amenable to endoscopic retrograde cholangiography (ERCP) extraction, and intraoperative biliary extraction is fraught with difficulties. A usual option is to insert a t-tube to allow percutaneous choledoscope extraction post-operatively. Hepatic resection is also another option but has a higher morbidity. Recent studies have shown the applicability of laser lithotripsy in the removal of intrahepatic stones. Methods: We report a case of intrahepatic lithiasis not amenable to ERCP and intraoperative biliary extraction that was done in a center specialized in urologic cases. Summary: A 52 year old male presented colicky abdominal pain where ultrasound showed calculous cholecystitis. Patient was initially treated with antibiotics but developed jaundice with acolic stools after a week. Patient was admitted and repeat ultrasound revealed calculous cholecystitis with suspicious obstructing calculus in the proximal CBD, distal CBD stricture was noted. Ductal dilatation and stone extraction failed, hence a F10 stent was inserted and scheduled for surgery. Intraoperative ultrasound revealed multiple stones in the CBD and was extracted through a choledochotomy. A 0.5 cm stone was impacted in the secondary radicles of the right hepatic duct. A nephroscope was inserted and stone basket extraction done but failed. Laser lithotripsy was used to break the stone into smaller fragments, flushed out and extracted more proximally. A roux-en-y hepaticojejunostomy was done to bypass the distal CBD stricture. Patient recovered and was eventually discharged. Conclusion: In intrahepatic stones that have failed ERCP and biliary extraction, the combination of a surgical enterotomy, biliary endoscopy, and laser lithotripsy could provide a viable option for stone removal. However, for centers not specialized in hepatobiliary surgery with lack of equipment, this could pose a significant challenge on its applicability.
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