위 정맥류 출혈에서 비중차를 이용한 HistoacrylTM (enbucrilate)- LipiodolTM (ethiodized oil) 연속 주입법의 성적
Results of Histoacryl-Lipiodol Sequential Injection Using Specific Gradient Difference for Bleeding Gastric Varices
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목적: Histoacryl은 극성 액체, 혈액 혹은 체온에 노출 후 짧은 시간 안에 굳어지는 성질 때문에 내시경 겸자 구멍 및 천자침 막힘이 종종 발생하고 주입 도중 주위로 비산되어 실명이 야기될 수도 있어 시술자나 보조자는 상당한 주의를 요한다. 저자들은 시술이 용이한 비중차를 이용한 Histoacryl-lipiodol 연속 주입법을 고안하여 치료 성적과 함께 보고하는 바이다. 대상 및 방법: 2001년 5월부터 2004년 8월까지 위정맥류 출혈 환자 30명에 대해 비중차에 의한 Histoacryl-lipiodol 연속 주입법이 시술되었다. 2.5 mL 주사기에 16 G 주사바늘을 사용하여 상층은 Histoacryl (비중 1.0) 1 mL, 하층은 lipiodol (비중 1.28) 1～1.5 mL로 분획되도록 조심스럽게 채운다. 주사기의 주입구가 위로 향하도록 세운 상태로 생리식염수가 채워진 천자침을 병변부에 주입한 후 생리식염수 5 mL를 신속하게 관류한 다음 천자침을 퇴출하였다. 결과: 환자는 30명으로 남자 26명, 여자 4명이었으며, 평균 연령은 57세였다. 내시경 시 출혈 중인 경우가 4명, 혈관 노출과 혈괴가 부착된 경우가 26명이었다. 병변 위치는 Lg-c 10명, Lg-cf 16명, Lg-f 4명이었고, Child-Pugh 분류는 class A 5명(17%), B 16명(53%), C 9명(30%)이었다. 사용한 Histoacryl 양은 평균 1.53 mL이었다. 초기 지혈률은 97% (29/30), 4주내 재출혈률은 10% (3/30), 후기 출혈률은 7% (2/30)이었다. 시술 후 출혈을 보인 1명에서 지혈되지 않아 사망하였고, 1명에서 시술과 관련하여 그람 음성 세균에 의한 균혈증이 발생하였다. 결론: 위 정맥류 출혈 지혈술에 있어서 비중차를 이용한 Histoacryl-lipiodol 연속 주입법은 시술이 용이하고 미세 혈관 색전증 및 기구의 손상이 적어 임상에 적용 시 이점이 있을 것으로 생각한다.
Abstract
Background/Aims: Histoacryl forms hard substances in an instance after a brief exposure to polar liquid, blood or body temperature. This often causes obstruction of injector and endoscopic channel. Furthermore, splashed Histoacryl during injection can lead to accidental loss of vision. We propose a new convenient method of Histoacryl-lipiodol sequential injection and report the results. Methods: From May 2001 to August 2004, sequential injector method was performed in treating consecutive thirty gastric varices patients. Histoacryl (S.G. 1.0) 1 mL and lipiodol (S.G. 1.28) 1∼1.5 mL are filled in 2.5 mL disposable syringe with 16 gauge needle, which are separated into two compartments by specific gravity difference. The injector attached side of charged syringe is gently placed upward and the piston is pushed after the lesion site puncture. Then, normal saline is promptly infused to wash out and the needle is withdrawn. Results: There were 26 males and 4 females. 4 had active bleeding and 26 had the stigmata of bleeding. Varices types were Lg-c in 10, Lg-cf in 16 and Lg-f in 4 patients and the Child-Pugh classification were A in 17%, B in 53% and C in 30%. The average amount was 1.53 mL. Initial hemostasis rate was 97%, 3 of patients re-bled in 4 weeks and 2 patients later. One patient died after the procedure and a case of procedure related bacteremia has occurred. Conclusions: Histoacryl-lipiodol sequential injection by specific gravity difference is convenient and safe. Also, it carries less damage to the instruments.
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