진행성 총담관암에서 고식적 치료법으로써 내시경적 고주파열제거술 후 인공담관 삽입술과 담낭 내 에탄올 치료

• Published in: The Korean journal of gastroenterology Vol. 75; no. 1; pp. 50 - 55
• Main Authors: 이용우, Yong-woo Lee, 김현정, Hyun Jeong Kim, 이상엽, Sang Yub Lee, 허준, Jun Heo, 정민규, Min Kyu Jung
• Format: Journal Article
• Language: Korean
• Published: 대한소화기학회 31.01.2020
• Subjects: Cholangiocarcinoma; Cholangiopancreatography; endoscopic retrograde; Gallbladder; Radiofrequency ablation
• ISSN: 1598-9992

Endobiliary radiofrequency ablation (RFA) is a procedure performed widely to induce locoregional tumor control by the transfer of thermal energy to the lesion and subsequent tumor necrosis. A 72-year-old male with a prior history of acute calculous cholangitis and perforated cholecystitis was admitted to the Kyungpook National University Hospital complaining of fever and nausea. He had an indwelling percutaneous transhepatic gallbladder drainage (PTGBD) catheter from the previous episode of perforated cholecystitis. An abdominal CT scan showed marked dilation of both the intrahepatic and extrahepatic bile ducts. Common bile duct cancer was confirmed histologically after an endobiliary biopsy. A surgical resection was considered to be the initial treatment option. During open surgery, multiple metastatic nodules were present in the small bowel mesentery and anterior abdomi­nal wall. Resection of the tumor was not feasible, so endobiliary RFA was performed prior to biliary stenting. Cholecystectomy was required for the removal of the PTGBD catheter, but the surgical procedure could not be performed due to a cystic ductal invasion of the tumor. Instead, chemical ablation of the gallbladder (GB) with pure ethanol was performed to breakdown the GB mucosa. Palliative treatment for a biliary obstruction was achieved successfully using these procedures. In addition, a PTGBD catheter was removed successfully without significant side effects. As a result, an improvement in the patient’s quality of life was accomplished.