내시경적 점막절제술 후 발생한 위천공의 성공적인 보존적 치료 1예
Successful conservative management of perforation in stomach caused by endoscopic mucosal resection (EMR)
2
조회
0
다운로드
2
인용
0
참고문헌
초록
위장관 천공은 내시경적 점막절제술 후 발생할 수 있는 중대한 합병증으로 현재까지 이에 대한 치료 방법은 정립되지 않은 상태이다. 본 증례는 점막층에 국한된 위선암에 대한 내시경적 점막절제술 후 위천공이 발생한 경우로서 아주 작은 미세천공(microperforation)이었고, 최근 시도되고 있는 내시경적 클립 시술의 적응이 되지 못했다. 하지만 임상적인 복막염 발생 및 진행의 징후가 보이지 않아 금식, 광범위 항생제 투여 등의 보존적 요법으로 치료를 시행하였고, 시술 일주일 후 복막염의 발생이나 진행 없이 호전되어 퇴원하였다.본 증례는 내시경적 점막절제술 후 발생한 미세 천공의 제한적인 경우에 한하여 수술이나 내시경적 치료를 하지 않고 보존적 요법만으로 성공적인 치료를 시행한 예로 문헌고찰과 함께 보고하는 바이다.
Abstract
The serious complication after endoscopic mucosal resection (EMR) was bleeding and perforation. Most of bleedings could be controlled by endoscopic procedure. However, the strategy of treatment for perforation was not established. A 60-year-old man was admitted to our center for EMR of gastric adenomatous lesion. After EMR, perforation in stomach was detected by peumoperitoneum on plain upright chest X-ray. We treated with conservative management such as withholding of oral intake, administration of broad-spectrum antibiotics, parenteral nutrition and close monitoring. There were no worsening clinical sings of peritoneal inflammation except mild leukocytosis during the in-hospital course. On the third hospital day after EMR, the patient resumed oral intake. The seventh hospital day, he was discharged. Our experience showed that selected small microperforation in stomach after EMR could be treated by not endoscopic procedures or surgical interventions but conservative management.(Korean J Med 66:526-531, 2004)
참고문헌 (18)
- "조기위암의 근치적 치료로서의 내시경적 점막절제술", 16, pp.928~936 (1996)
- "Outcome of endoscopic mucosal resection for early gastric cancer:review of Japanese literature", 48, pp.550~555 (1998)
- "Endoscopic mucosal resection for treatment of early gastric cancer", 48, pp.225~229 (2001)
- "위 편평선종에서 내시경적 점막절제술의 진단적 가치", 64, pp.516~522 (2003)
- "Endoscopic mucosal resection for early gastric cancer: aiming at safty, speed, and reliability", 15, pp.8~11 (2003)
- "The results of questionnaire about endoscopic mucosal resection in the stomach", 15, pp.2~7 (2003)
- "Endoscopic closure of a perforation using metallic clips after snare excision of a gastric leiomyoma", 39, pp.172~174 (1993)
- "Endoscopic repair by clipping of iatrogenic colonic perforation", 46, pp.464~466 (1997)
- "Nonsurgical treatment of duodenal perforation by endoscopic repair using a clipping device", 50, pp.410~413 (1999)
- "Successful endoscopic management of a perforated gastric dysplastic lesion after endoscopic mucosal resection", 51, pp.613~615 (2000)
- "조기위암에 대한 내시경적 점막절제술", pp.65~78 (2000)
- "Endoscopic mucosal resection", 57, pp.567~579 (2003)
- "Predictors of bleeding after endoscopic mucosal resection of gastric tumors", 57, pp.687~690 (2003)
- "An endoscopic rescue from perforation after endoscopic mucosal resection for early gastric cancer", 51 (2000)
- "Endoscopic closure of perforations caused by EMR in the stomach by application of metallic clips", 57, pp.948~951 (2003)
- "Experimental endoscopic repair of gastric perforations with an omental patch and clips", 54, pp.500~504 (2001)
- "Selective management of colonic perforations", 179, pp.333~337 (1994)
- "Colonic perforation after endoscopic biopsy of a submucosal tumor:successful conservative management", 14, pp.181~183 (2002)