급성 담낭염의 비수술적 담낭배액술 - 내시경적 경비 담낭배액술 및 경피경간 담낭배액술을 중심으로

Background/Aims: Acute cholecystitis is the most common biliary emergency and until now, the choice of the treatment of this disease is surgical operation. But, the. Mortality and morbidity associated with surgical cholecystostomy in those patients are relatively high. Recently, PTCCD and ENGBD were developed as a useful method of nonsurgical cholecystic drainage in high surgical risk group of acute cholecystitis. The purpose of this study was tn assess the usefulness of nonsurgical cholecystic drainage such as PTCCD and ENCrBD in the patients with acute cholecystitis. Methods: Of 59 patients with acute cholecystitis treated with nonsurgical cholecystic drainage, 47 were calculous cholecystitis and 12 were acalculous cholecystitis. Nonsurgical chole- cystic drainages were successful in all 59 cases: PTCCD in 45 patients, ENGBD in rernaining 14 patients. 39 patients were treated with nonsurgical cholecystic drainages due to high surgical risk. In remaining 20 patients there were cholangiocarcinoma in 5 patients, netastatic heptna in 2, gallstone pancreatitis in 1, advanced gastric cancer in 2, refusal of surgery in 10. Results: The prompt clinical recovery were achieved in 42 patients(93.3%) with PTCCD and cornpletely in all 2 cases with ENGBD. In the group with 35 calculous cholecystitis performed PTCCD, 28 under- went PTCCS-L, 4 elective surgery and 3 died because of the underlying condition, In the group with 10 acalculous cholecystitis performed PTC("D, 8 patients need nr further treatment except drainage and remaining 2 patients underwent elective surgery. Jn the group with 12 calculous cholecystitis treated by ENGBD, 10 underwent elective surgery, l F.SWI. And I gallstone dissolu- tion with MTBE. In 2 acalculous cholecystitis treated by ENGBD, the one patient took no further treatment and the other underwent elective surgery. Complications related to PT( CD occurred in 10 of 45 patients, but there was no mortality re]ated to this procedure. No complications were noted related to ENGBD. Conclusions: We conclude that nonsurgical cholecystic drainage witli ENGBD and PTCCD were safe, effective and useful procedures for the management of acute cholecystitis, especially in high surgical risk group, (Korean J Gastroenterol 1997; 30:81 - 89)