위정맥류 출혈 환자에서 N-butyl-2-cyanoacrylate를 이용한 내시경경화요법의 치료 효과
Effect of Endoscopic Sclerotherapy Using N-butyl-2-cyanoacrylate in Patients with Gastric Variceal Bleeding
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목적: 위정맥류 출혈 환자에서 n-butyl-2- cyanoacrylate (HistoacrylⓇ)를 이용한 내시경경화요법의 효용성에 대해 알아보고자 하였다. 대상과 방법: 2002년 4월부터 2005년 7월까지 위정맥류 출혈로 본원에 내원하여 HistoacrylⓇ 치료를 받은 총 86명의 간경변증 환자를 대상으로 평균 44주(2-136주) 동안 추적관찰하였다. 초기 지혈 성공률, 재출혈률과 같은 내시경경화요법의 치료 효과와 누적 생존율을 조사하고, MELD 점수, Child- Pugh 점수, 간세포암종 여부, 저나트륨혈증 유무, HistoacrylⓇ 주입량 등에 따른 생존율을 분석하였다. 결과: 초기 지혈률은 93%였고, 1달 내 재출혈률은 16.1%였다. 초기 지혈을 이루기 위해 필요했던 HistoacrylⓇ 주입 횟수는 1.2±0.4회였고 경화제의 총량은 2.7±1.2 mL였다. 내시경 경화술을 받은 후 재출혈이 일어나지 않을 누적 확률은 1개월, 12개월, 34개월에 각각 95.1%, 83.2%, 74%였으며, 누적 생존율은 각각 78.3%, 61.9%, 54.6%였다. 치명적 합병증인 색전증의 발생은 없었다. 연령, 저나트륨혈증, MELD 점수, Child-Pugh 점수, 간세포암종 여부, HistoacrylⓇ 주입량에 따른 Cox 회귀분석을 시행한 결과 MELD 점수(<15)가 내시경경화요법을 시행받은 위정맥류 출혈 환자의 생존율 예측에 유용한 독립 인자였다. 결론: HistoacrylⓇ을 이용한 내시경경화요법은 위정맥류 출혈의 안전하고 효과적인 치료 방법이며, MELD 점수는 경화요법을 시행받은 위정맥류 출혈 환자의 생존 예측에 유용한 인자이다.
Abstract
Background/Aims: Gastric variceal bleeding is a severe complication of cirrhosis, and it has a high mortality rate. This study was conducted to evaluate the efficacy of n-butyl-2-cyanoacrylate injection therapy for patients suffering with gastric variceal bleeding. Methods: A total of 86 patients diagnosed with gastric variceal bleeding underwent endoscopic n-butyl-2-cyanoacrylate (HistoacrylⓇ) injection therapy at our department between April, 2002 and July, 2005, with a mean follow-up period of 44 weeks (range: 2 to 136 weeks). The initial hemostasis rate and the rebleeding rate of endoscopic sclerotherapy were analyzed. Also, the cumulative survival rate was analyzed according to the status of hepatocellular carcinoma and hyponatremia, the MELD score, the Child-Pugh score and the amount of injected HistoacrylⓇ. Results: The initial hemostasis rate of HistoacrylⓇ injection therapy was 93% and the 1 month rebleeding rate was 16.1%. The total number of session for treating the initial hemostasis was 1.2±0.4 and the total volume of HistoacrylⓇ was 2.7±1.2 mL. The cumulative rebleeding-free rates for the patients treated by the HistoacrylⓇ injection method at 1 month, 12 months and 34 months period were 95.1%, 83.2% and 74%, respectively. The cumulative survival rates were 78.3% at 1 month, 61.9% at 12 months and 54.6% at 34 months, respectively. No thromboembolic phenomenon occurred. According to the Cox’s proportional hazards analysis, only the MELD score (<15) was an independent predicting factor for survival of the patients with gastric variceal bleeding. Conclusions: Endoscopic sclerotherapy using n-butyl-2-cyanoacrylate was a safe and effective hemostatic method for patients with gastric variceal bleeding. Also, the MELD score (<15) contributed to predicting survival of the patients with gastric variceal bleeding.
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