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[20120128. Complications of EMR/ESD (23): Perforation (15) - Ç×»ýÁ¦ÀÇ ¼±Åðú IV TPN]

1. Ç×»ýÁ¦ÀÇ ¼±ÅÃ

õ°øÀ» ³»½Ã°æ Ä¡·á ÈÄ (microperforationÀ¸·Î ³»°úÀû Ä¡·á¸¸ ½ÃÇàÇÒ °æ¿ì Æ÷ÇÔ) Ç×»ýÁ¦´Â ¾î¶»°Ô ¼±ÅÃÇÒ °ÍÀΰ¡?

¸é¿ªÀÌ Á¤»óÀΠȯÀÚ¿¡¼­ perforating hole¸¸ Àß closureµÇ¾ú´Ù¸é Ç×»ýÁ¦´Â º°·Î Áß¿äÇÏÁö ¾ÊÀ» ¼ö ÀÖ´Ù. ¾²Áö ¾Ê¾Æµµ ¹«¹æÇÏ´Ù´Â ÁÖÀåµµ ÀÖÀ» Á¤µµÀÌ´Ù. ±×·¯³ª Ç×»ýÁ¦¸¦ ¾²Áö ¾ÊÀÚ´Ï ¹«Ã´ ºÒ¾ÈÇÏ´Ù. ¹º°¡¸¦ ¾²´Â °ÍÀÌ ÁÁ°Ú´Ù. ¾²·Á¸é Á¤È®È÷ ¾²´Â °ÍÀÌ ÁÁ´Ù.

°¨¿°³»°ú Àü¹®ÀÇ¿¡°Ô ¹®ÀÇÇÏ¿© ¾Æ·¡¿Í °°Àº ´äº¯À» ¹Þ¾Ò´Ù. Micro-perforation¿¡ ´ëÇÑ ÀÚ¹®³»¿ëÀÌÁö¸¸ frank perforation¿¡¼­µµ µ¿ÀÏÇÏ°Ô Àû¿ëÇصµ µÈ´Ù°í »ý°¢ÇÑ´Ù.

[°¨¿°³»°ú Àü¹®ÀÇ ´äº¯ (2012)]

Quinolone °è¿­Àº anaerobe coverage°¡ ¾È µÇ°í ³»¼º·üÀÌ 50%¿¡ À°¹ÚÇϱ⠶§¹®¿¡ ¾²Áö ¾Ê´Â °ÍÀÌ ÁÁÀ½. ÈçÈ÷ ¾²´Â ceftriaxoneÀº anaeorbe coverage°¡ ¾àÇؼ­ metronidazoleÀ» ÇÔ²² ½á¾ß ÇϹǷΠ¹ø°Å·¯¿î Á¡ÀÌ ÀÖÀ½. Anaerobe coverage°¡ °¡´ÉÇÑ broad spectrum penicllinÀ» ´Üµ¶À¸·Î ¾²´Â °ÍÀÌ °¡Àå ÁÁ°Ú°í ±¸Ã¼ÀûÀ¸·Î´Â ¾Æ·¡¿Í °°ÀÌ ÃßõÇÔ

1. »óºÎ À§Àå°ü micro-perforation: Unasyn (ampicillin/sulbactam)

2. ÇϺΠÀ§Àå°ü micro-perforation: Unasyn (ampicillin/sulbactam)

3. ȯÀÚ°¡ Áõ»óÀÌ ÀÖÀ¸¸é Tazosin (piperacillin/tazobactam)


[2022-3-23. EndoTODAY ³»½Ã°æ¼¼¹Ì³ª] ¼ÒÈ­±â Áúȯ¿¡¼­ ¿Ã¹Ù¸¥ Ç×»ýÁ¦ »ç¿ë (°­Ã¶ÀÎ)


2. IV TPNÀº ²À ÇÊ¿äÇÑ°¡?

À§ ÀüÁ¤ºÎ Á¶±âÀ§¾ÏÀ¸·Î ³»½Ã°æÄ¡·á¸¦ ÇÏ¿´½À´Ï´Ù. ½Ã¼ú µµÁß Ãµ°øÀÌ À־ clippingÀ» ÇÏ¿´½À´Ï´Ù. Ç×»ýÁ¦¸¦ »ç¿ëÇϸ鼭 3-4ÀÏ ±Ý½Ä ÈÄ ½Ä»ç¸¦ ½ÃÀÛÇÏ¿´´Âµ¥ º° ¹®Á¦´Â ¾ø¾ú½À´Ï´Ù.


Stomach, #1x1 : mid antrum, biopsy(ESD) :
. Early gastric carcinoma
1. Location : mid antrum
2. Gross type : EGC type IIc
3. Histologic type : tubular adenocarcinoma, moderately differentiated
4. Histologic type by Lauren : intestinal
5. Size of carcinoma : (1) longest diameter, 12 mm (2) vertical diameter, 8 mm
6. Depth of invasion : invades mucosa (muscularis mucosa) (pT1a)
7. Resection margin : free from carcinoma(N)- safety margin : distal 9 mm, proximal 13 mm, anterior 10 mm, posterior 10 mm
8. Lymphatic invasion : not identified(N)
9. Venous invasion : not identified(N)
10. Perineural invasion : not identified(N)
11. Microscopic ulcer : absent
12. Histologic heterogeneity: absent

Ä¡·á °úÁ¤¿¡¼­ ȯÀÚ°¡ °¡Àå ºÒÆíÇØ Çß´ø °ÍÀº IV TPNÀ̾ú½À´Ï´Ù. ÇϾá»ö TPN ÁÖ»ç ¶§¹®¿¡ Ç÷°üÀÌ º×°í ¾ÆÆÍ´ø °ÍÀÔ´Ï´Ù. °ú¿¬ IV TPNÀÌ ²À ÇÊ¿äÇß´ø °ÍÀϱî¿ä? 1ÁÖÀÏ À̳»ÀÇ ±Ý½ÄÀÌ ¿¹»óµÇ´Â °æ¿ì´Â Ưº°ÇÑ °íÄ®·Î¸® ¼ö¾×ÀÌ ¾Æ´Ï¶ó DNK2¸é ÃæºÐÇÏÁö ¾Ê¾ÒÀ»±î¿ä?

Á¦°¡ ³»°ú trainingÀ» ¹ÞÀ» ¶§ ´Ã ÇÔ²²ÇÏ¿´´ø Washington manualÀ» ´Ù½Ã µéÃĺ¸¾Æ¾ß ÇÒ °Í °°½À´Ï´Ù. ¿äÁòÀº ´Ã °úÀ× Ä¡·á°¡ ¹®Á¦ÀÔ´Ï´Ù.

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