[20120114. Complications of EMR/ESD (9): Perforation (1)]
¹Ì¼¼Ãµ°ø¿¡¼µµ ÀÌ·¸°Ô ¸¹Àº °ø±â°¡ µé¾î°¥ ¼ö ÀÖ½À´Ï´Ù. ½Ã¼ú Áß ÀÛÀº ±¸¸ÛÀÌ »ý°å´Âµ¥ °ø±â¸¦ ³ÖÀ¸¸é¼ ±ä ½Ã¼úÀ» Çϱ⠶§¹®ÀÔ´Ï´Ù.
EMR/ESD °ü·Ã õ°øÀº ¾ó¸¶³ª ¹ß»ýÇϴ°¡? ´äÀº "¾Ë ¼ö ¾ø´Ù". ÀÌÀ¯´Â ¼¼ °¡Áö´Ù.
1. õ°øÀ̶õ ¹«¾ùÀΰ¡? (1) ½Ã¼ú µµÁß perforating holeÀÌ º¸À̸é õ°øÀΰ¡? À̸¦ º¸Åë frank perforationÀ̶ó ºÎ¸¥´Ù. (2) ½Ã¼ú µµÁß perforating holeÀÌ º¸ÀÌÁö ¾Ê¾ÒÁö¸¸ chest X-ray¿¡¼ free air°¡ º¸À̸é õ°øÀΰ¡? À̰ÍÀº microperforationÀ̶ó ºÎ¸¥´Ù. (3) ½Ã¼ú Á÷ÈÄ¿¡´Â õ°øÀÌ ¾ø¾ú´Âµ¥ ´ÙÀ½ ³¯, ȤÀº ±× ÀÌÈÄ¿¡ õ°øÀÌ º¸ÀÌ´Â °Íµµ EMR/ESD °ü·Ã õ°øÀΰ¡? ¿ä°Ç delayed perforationÀ̶ó ºÎ¸¥´Ù. õ°ø¿¡ ´ëÇÏ¿© Á¤È®È÷ Á¤ÀÇÇÏ°í µ¥ÀÌŸ¸¦ Á¦½ÃÇÑ ³í¹®Àº °ÅÀÇ ¾ø´Ù. ±×³É ¸î %¶ó°í ¸»ÇÒ »ÓÀÌÁö, ±× Á¤Àǰ¡ ¾øÀ¸´Ï ´Ù¼Ò Ȳ´çÇÑ »óȲÀÌ´Ù. ±× °á°ú õ°øÀÇ ¹ß»ý·üÀ» ¾Ë ¼ö ¾ø´Â °ÍÀÌ´Ù.
½Ã¼ú ´ÙÀ½ ³¯ ¹ß°ßµÈ free air. Á¤ÀÇ »ó delayed perforationÀÌÁö¸¸ õ°øÀÌ delayedÇÏ°Ô ¹ß»ýÇÑ °ÍÀÎÁö delayedÇÏ°Ô ¹ß°ßµÈ °ÍÀÎÁö ¾Ë ¼ö ¾ø½À´Ï´Ù. ÀÌ È¯ÀÚÀÇ °æ¿ì´Â delayed ÇÏ°Ô ¹ß°ßµÈ °ÍÀÏ ¼ö ÀÖ½À´Ï´Ù. ¾î·Á¿î À§Ä¡ÀÇ º´¼Ò¿´°í, ºñ·Ï ´ÙÀ½ ³¯ ¹ß°ßµÇ¾úÀ¸³ª ¸çÄ¥ ±Ý½Ä°ú Ç×»ýÁ¦·Î ±ú²ýÇÏ°Ô È£ÀüµÇ¾ú½À´Ï´Ù.
2. õ°ø ¿©ºÎ¸¦ È®ÀÎÇϱâ À§ÇÏ¿© ¾î¶² °Ë»ç¸¦ ÇØ¾ß ÇÒ±î? ¿ì¸®³ª¶ó ÀÇ»çµéÀº EMR/ESD ÈÄ chest X-ray¸¦ ²À Âï¾î¾ß ÇÏ´Â °ÍÀ¸·Î ¾Ë°í ÀÖ´Ù. ±×·¯³ª ÀÌ´Â ¿ì¸®ÀÇ ¹æ½ÄÀÏ »ÓÀÌ´Ù (¿ì¸®´Â ¾ðÁ¦³ª °úÀ×Áø·á¸¦ ÇÏ´Â ÂÊÀ¸·Î decision makingÀ» ÇÏ´Â ±â¹¦ÇÑ ÀǷṮȸ¦ °¡Áö°í ÀÖ´Ù). ÀϺ»¿¡¼´Â EMR/ESD ÈÄ chest X-ray¸¦ ÂïÁö ¾Ê´Â °æ¿ì°¡ ´õ ¸¹Àº °Í °°´Ù. ÇÊÀÚ°¡ °æÇèÇÑ Ãµ°øÀº ´ëºÎºÐ microperforationÀ̾ú´Ù. Chest X-ray¸¦ È®ÀÎÇÏÁö ¾ÊÀ¸¸é ¸ð¸£°í ³Ñ¾î°¡°Ô µÈ´Ù (»ç½Ç ´ëºÎºÐ ¸ô¶óµµ µÈ´Ù). ¿ì¸®³ª¶óÀÇ Ãµ°ø·üÀÌ ÀϺ»º¸´Ù ³ôÀº °ÍÀº ÀÌ·± ÀÌÀ¯´Ù. ÀϺ» ³í¹®ÀÇ Ãµ°ø¿¡´Â microperforationÀÌ Æ÷ÇÔµÇÁö ¾Ê¾Ò±â ¶§¹®¿¡ õ°ø·üÀÌ ³·Àº °ÍÀÌ´Ù. õ°øÀ» ¿¬±¸ÇÑ´Ù°í routineÀ¸·Î CT¸¦ Âï´Â °æ¿ìµµ ÀÖ´Ù (ÀÌ´Â over ÁßÀÇ over´Ù). õ°øÀ» º¸±â À§ÇÑ ¹æ¹ýÀÌ Á¦°¢°¢ÀÌ´Ï Ãµ°ø·üÀ» ¾Ë ¼ö ¾ø´Â °ÍÀÌ´Ù.
3. EMR/ESD ³í¹®Àº ´ëºÎºÐ ÈÄÇ⿬±¸´Ù. ÀüÇâÀû µ¥ÀÌŸ°¡ ¸¹Áö ¾Ê´Ù. °¢ ±â°ü registryÀÇ data qualityµµ ¹Ì½É½´Ù. °´°ü¼ºÀÌ ¾ø±â ¶§¹®ÀÌ´Ù. ±×·¯´Ï ¾Ë ¼ö ¾ø´Â °ÍÀÌ´Ù.
¿äÄÁµ¥ EMR/ESDÀÇ Ãµ°ø·üÀº ¾Ë ¼ö ¾ø´Ù.
[2016-9-16. ÀÌÁØÇà Ãß°¡] ¿¬¼¼´ëÇб³¿¡¼ »óºÎÀ§Àå°ü ESD õ°ø¿¡ ´ëÇÑ ÀڷḦ ¹ßÇ¥ÇÏ¿´½À´Ï´Ù (Kim HJ. Surg Endosc 2016). õ°ø ¹ß»ý·üÀÌ 2.4%¿´´Ù°í ÇÕ´Ï´Ù.
METHODS: Between February 2010 and April 2014, a total of 3821 patients who underwent ESD for an upper gastrointestinal epithelial neoplasm were analyzed using the Yonsei University Severance Hospital database. Clinical outcomes of and management strategies for perforations in 90 patients (2.4 %) were analyzed.
[2012-12-19. ÀÌÁØÇà Ãß°¡] ESD ÈÄ chest PA Âï´Â ÀÏÀº ¿©°£ ÈûµéÁö ¾Ê½À´Ï´Ù. ³«»ó À§ÇèÀÌ Å©±â ¶§¹®Àä... ¿µ»óÀÇÇаú Á÷¿øµéÀÌ ¾ÆÀ̵ð¾î¸¦ ¸ð¾Æ ÁÁÀº ¹æ¹ýÀ» ¸¸µé¾ú½À´Ï´Ù.
1) Delayed Perforation Occurring after Gastric Endoscopic Submucosal Dissection ±èż¼ Gut Liver 2024
© ÀÏ¿ø³»½Ã°æ±³½Ç ¹Ù¸¥³»½Ã°æ¿¬±¸¼Ò ÀÌÁØÇà. EndoTODAY Endoscopy Learning Centr. Lee Jun Haeng.