논문 상세보기
pp.39-44
감염성 췌장괴사의 고전적인 치료는 개복 수술이었다. 하지만 개복 수술 후 합병증, 사망률의 유의한 증가가 보고되면서 항생제와 보존적 치료가 일차적 치료로서 우선적으로 선택되고 있다. 보존 치료에 반응이 없는 경우에는 다양한 경로를 통한 배액법 및 괴사제거술 등의 최소 침습시술이 대두되고 있으며, 이러한 최소 침습 시술의 선택은 환자의 임상 양상, 보존적 치료에 대한 치료 반응, 괴사 조직과 위장관의 해부학적 위치 관계에 대한 정확한 평가 및 그에 따른 시술 방법의 선택이 이루어져야 한다. 저자들은 급성 감염성 췌장 괴사에서 항생제 등의 보존적 치료와 경피적 배액술을 시행하였으나 치료반응이 없는 환자에서 경피적 내시경적 괴사 제거술을 통한 성공적인 괴사 치료1예를 경험하였기에 보고하는 바이다.
Percutaneous endoscopic necrosectomy in acute severe pancreatitis with infected necrosis: a case report. Patients with acute infected necrotizing pancreatitis undergoing surgical management may have high risks of complications and mortality. Thus, as an alternative to surgical management, an endoscopic approach has been introduced. We report a case of successful treatment of acute severe pancreatitis with infected necrosis by percutaneous endoscopic necrosectomy (PEN). A 42-year-old man was hospitalized for acute pancreatitis resulting from biliary sludges. He had some fluid collections around the pancreas with severe epigastric pain. Emergency ERCP with EST was performed, and plastic stents were inserted into the bile duct and pancreatic duct for drainage. Despite using the antibiotics, fever developed with increased fluid collections and necrotic tissues which were found on the follow-up abdominal CT scan. Percutaneous catheter drainage (PCD) was performed, but fever did not go down even though several changes of catheter. We then performed the PEN through the opening of PCD. After four sessions of the procedure, much improvement was seen on the follow-up CT scan. With more research and progress, PEN will become a suitable alternative treatment for infected necrotizing pancreatitis
