총담관 결석은 담낭 결석 환자의 약 10-20%에서 동반되며 폐쇄성 황달, 급성 담관염, 급성 췌장염과 같은 심각한 합병증을 초래할 수 있다. 본 종설은 담낭 절제술이 예정된 환자에서 총담관 결석의 진단과 치료 전략을 종합적으로 고찰하였다. 진단은 병력청취, 혈액 검사, 복부 초음파, 내시경 초음파, 자기공명담췌관조영술 등을 활용해 이루어지며 정확한 진단은 적절한 치료 방침 결정에 필수적이다. 치료 전략은 복강경 담낭절제술과 총담관 탐색을 동시에 시행하는 1단계 접근법과 내시경역행담췌관조영술로 결석을 제거한 후 담낭 절제술을 시행하는 2단계 접근법으로 구분된다. 국내에서는 내시경역행 담췌관조영술 기술의 표준화와 숙련된 내시경 전문의가 갖추어져 있어 2단계 접근법이 주로 선호된다. 총담관 결석 치료는 환자의 상태, 병변 특성, 병원 자원에 따라 치료 방침을 조율해야 하며 내과와 외과의 긴밀한 협력이 중요하다. 향후 이를 뒷받침할 대규모 다기관 연구가 필요하다.

Choledocholithiasis occurs in approximately 10-20% of patients with gallstones and can lead to severe complications, including obstructive jaundice, acute cholangitis, and acute pancreatitis. This review evaluates the diagnostic and therapeutic approaches for choledocholithiasis in patients scheduled for cholecystectomy. Diagnosis is based on clinical history, laboratory tests, ultrasonography, endoscopic ultrasound, and magnetic resonance cholangiopancreatography. Management strategies include the one-step approach, combining laparoscopic cholecystectomy and bile duct exploration, and the two-step approach, performing endoscopic retrograde cholangiopancreatography (ERCP) before cholecystectomy. The one-step approach offers advantages such as shorter hospitalization but requires experienced surgeons. The two-step approach is more suitable for patients with acute cholangitis, pancreatitis, narrow bile ducts, impacted stones, or multiple stones. In South Korea, the two-step approach is predominantly favored due to the widespread availability of advanced endoscopic techniques and the expertise of gastroenterologists. ERCP is highly standardized and effective for biliary drainage, particularly in emergency settings. Effective management of choledocholithiasis requires a tailored approach that considers patient condition, stone characteristics, and available resources. Collaboration between gastroenterologists and surgeons is critical to achieving optimal outcomes. Further research, particularly large-scale multicenter studies, is necessary to refine treatment guidelines and improve patient care.

서 론
본 론
    1. 총담관 결석의 진단
    2. 총담관 결석의 치료
결 론
요 약
ORCID
FUNDING
REFERENCES

• 이윤채(전북대학교 의과대학 내과학교실, 전북대학교 임상의학연구소-전북대학교병원 의생명연구원) | Yun Chae Lee (Division of Gastroenterology, Department of Internal Medicine, Jeonbuk National University Medical School, Jeonju, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea)
• 김성훈(전북대학교 의과대학 내과학교실, 전북대학교 임상의학연구소-전북대학교병원 의생명연구원) | Seong-Hun Kim (Division of Gastroenterology, Department of Internal Medicine, Jeonbuk National University Medical School, Jeonju, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea) Corresponding author