담관의 확장 - gie.or.kr

1 2008;36(Suppl. 1):269-273269 .. , . , . , .. 2 3 1 mm 2 mm 4 mm .. Parulekar mm 4% 7 mm 7 mm . 230 mm , 95% mm 7 mm.

2 , 8 10 mm . , 90% 7 mm .. 10 mm , 10 mm . , (Magnetic Resonance Cholangiopan-creatography, MRCP) (Endoscopic Retrograde Cholangiopancreatography, ERCP) (Percutaneous transhepatic cholangiography, PTC) . MRCP.

3 MRCP . 10 15 cmH2O 30 cmH2O .. , . , , .. 270 2008;36(Suppl. 1):269-273 Table 1. The number of the Ppatients and Diagnosis who Revealed Biliary Dilatation on Ultrasonography (J Clin Gastro-enterol, 2001)Diagnosis EUSERCP/SECholedocholithiasis Tumor Benign biliarystricture Choledochal cystOva of Ascaris Dilated CBD only 40 13 8 2 124 3912 9 2 1 9**ERCP was not performed in 13 patients.

4 SE indicates surgical exploration. , . , , , .. , , , . , Klatskin , , .. , .. ?.

5 , . ( , , ), , (Table 1).. , 7 mm 77 ERCP CT . ERCP 49 20 ( ) , 11 ( ), 10 ( ), 2 ( ), 2 ( ), (anomalous union of the pancreaticobiliary duct, AUPBD) 2 ( ), AUPBD 2 ( ) (Table 2).

6 , . CT 47 271 Table 3. Patient Characteristics and Final Diagnoses of Patients with Biliary Dilatation according to Status of Liver Enzyme (Dig Dis Sci, 2007)FindingsNormal liver enzymes (n=32)Elevated liver enzymes (n=15)p valueMean age (yr)Male/FemaleMean CBD diameter (mm) Abdominal pain Prior cholecystectomyDiagnoses % (n)Findings to explain CBD dilatationNormal CBD stone Ampullary tumor Periampullary diverticulum Chronic pancreatitis 103/29 (22/32)40% (13/32) 6% (2) 84% (27) 3% (1) 0% (0) 3% (1) 9% (3) 67% (10/15)47% (7/15)53% (8) 47% (7) 20% (3) 7% (1) 27% (4) 0% (0) 2.

7 Endoscopic Retrograde Cholangiography (ERCP) Findings in Patients who Showed Biliary Dilation on Ultrasono-graphy Without Biliary Pain and Jaundice (Endoscopy, 2001)Findingn (%)No lesionJDD without CBD indentation JDD with CBD indentation Benign strictureDistal CBD massCholedochal cystAUPBDC holedochal cyst with AUPBD20 ( ) 9 ( ) 2 ( )10 ( ) 2 ( ) 2 ( ) 2 ( ) 2 ( )JDD, juxtapapillary duodenal diverticulum; CBD, common bile duct; AUPBD, anomalous union of the pancreaticobiliary duct. (Endoscopic Ultrasonography, EUS) . , 32 2 (6%) , 1.

8 15 8 (53%) , (3 ), (4 ), (1 ) . (Table 3). ERCP . 21 13 62% , 17 1 (6%) (Table 4). , (MRCP, EUS, ERCP).

9 , . ? CT ERCP, MRCP, EUS . 272 2008;36(Suppl. 1):269-273 Table 4. Clinical Analysis of ERCP Findings in Pre-laparoscopic Cholecystectomy (LC) Patients (Korean J Gastrointest Endosc, 1997)Pre-LC conditionAbnormal LFT* and ductNo. of patientsCBD stones(%)Dilatation in ultrasonographyAbnormal LFTDuct dilatation in ultrasonographyNormal2144173513 ( ) 6 ( )1 ( )1 ( )*Elevated total bilirubin, alkaline phophatase, or alanine amino-transferase.

10 ERCP . , ERCP , . , , . ERCP MRCP EUS . MRCP . , ERCP . ERCP . ERCP , MRCP.