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EndoTODAY ³»½Ã°æ ±³½Ç


[Mallory Weiss tear, À§½Äµµ¿­°ø¿­»ó, ¸»·Î¸® ¹ÙÀ̽º ÁõÈıº] - ðû

1. ¿ª»ç

2. Active bleeding - pumping - due to Mallory Wiss tear

3. Mallory Weiss tear¸¦ º¸ÀÏ ¼ö ÀÖ´Â ¿©·¯ »óȲ

4. ¾îµð°¡ Âõ¾îÁö´Â°¡?

5. Hiatal hernia¿ÍÀÇ °ü·Ã¼º

6. Ä¡·á

7. º¸ÇϺ£ ÁõÈıº

8. FAQs

9. References


1. ¿ª»ç

George Kenneth Mallory´Â 1890³â º¸½ºÅæ¿¡¼­ ž ÇϹöµåÀǴ븦 Á¹¾÷ÇÑ º´¸®ÀÇ»ç´Ù. ±×ÀÇ ¾Æ¹öÁö Frank Burr Malloryµµ º´¸®Àǻ翴´Âµ¥ Boston City Hospital¿¡¼­ ÀÏÇÏ´Ù°¡ Mallory Institute of Pathology¸¦ ¼¼¿î À庻ÀÎÀÌ´Ù. ¾Æµé Kenneth Mallory´Â ¾Æ¹öÁö°¡ ¼¼¿î Mallory Institute of Pathology¿¡¼­ °æ·ÂÀ» ½×¾Ò°í °á±¹ ±× ¿¬±¸¼ÒÀÇ director°¡ µÇ¾ú´Ù. ¾Æ¹öÁö°¡ ¼¼¿î ¿¬±¸¼Ò¿¡ ¾ÆµéÀÌ director°¡ µÇ¾ú´Ù´Â ¾Æ¸§´Ù¿î À̾߱â´Ù.

Somma Weiss´Â 1898³â µå¶óŧ¶óÀÇ °íÇâÀÎ Çë°¡¸®ÀÇ Transylvania¿¡¼­ ž Budapest¿¡¼­ °øºÎÇÑ ³»°úÀÇ»ç´Ù. ¹Ì±¹À¸·Î °Ç³Ê¿Í CornellÀ» °ÅÃÄ ÇϹöµå¿¡¼­ physician-in-chief°¡ µÇ¾ú´Ù. ¾ÆÁ÷µµ Brigham and Women's Hospital¿¡´Â ±×¸¦ ±â³äÇÏ¿© ¸¸µç Soma Weiss Award°¡ ¸Å³â ¼ö»óµÈ´Ù°í ÇÑ´Ù.

¾Æ¹öÁö Frank Burr Mallory

¾Æµé George Kenneth Mallory

Soma Weiss

º´¸®ÀÇ»ç Mallory¿Í ³»°úÀÇ»ç Weiss´Â ±¸Åä ÈÄ ÅäÇ÷À» º¸ÀΠȯÀÚ¿¡ ´ëÇÑ µÎ °³ÀÇ ±ÛÀ» ¹ßÇ¥ÇÏ¿´´Ù. ù Áõ·Ê º¸°í´Â º´¸®ÇÐÀû °üÁ¡ÀÌ Áß¿äÇÏ¿´À¸¹Ç·Î Mallory°¡ ù ÀúÀÚ·Î ³í¹®À» ¹ßÇ¥ÇÏ¿´°í, µÎ¹ø° ±ÛÀº ³»°úÀÇ»çÀÇ ÀÔÀå¿¡¼­ ¿©·¯ ȯÀÚ¸¦ ¸ð¾Æ¼­ ¹ßÇ¥ÇÑ °ÍÀ̹ǷΠWeiss°¡ ù ÀúÀÚ¿´´Ù. ±×µéÀº cardiac orfice¿¡ º´º¯ÀÌ ÀÖ¾ú´Ù°í ±â¼úÇÏ¿´´Ù.

1) Mallory GK, Weiss S. Hemorrhages from lacerations of the cardiac orifice of the stomach due to vomiting. Am J Med Sci 1929;178:506-515

2) Weiss S, Mallory GK. Lesions of the cardiac orifice of the stomach produced by vomiting. Journal of the American Medical Association 1932;98:1353-1355


ÀÌÈÄ ÇÑ µ¿¾È º° ÁøÀüÀÌ ¾ø´Ù°¡ 1970³â´ëºÎÅÍ ¸î °³ÀÇ Áß¿äÇÑ ³í¹®ÀÌ ¹ßÇ¥µÇ¸é¼­ Mallory-Weiss syndrome¿¡ ´ëÇÑ °³³äÀÌ È®½ÇÈ÷ Á¤¸³µÇ¾ú´Ù.

1) Foster DN, Miloszewski K, Losowsky MS. Diagnosis of Mallory-Weiss lesions. A common cause of upper gastrointestinal bleeding. Lancet. 1976;1(7984):483-4.

2) Knauer CM. Mallory-Weiss syndrome. Characterization of 75 Mallory-weiss lacerations in 528 patients with upper gastrointestinal hemorrhage. Gastroenterology. 1976;71:5-8.

3) Michel L, Serrano A, Malt RA. Mallory-Weiss syndrome. Evolution of diagnostic and therapeutic patterns over two decades. Ann Surg. 1980;192:716?721. - Àü¹® PDF


2. Active bleeding (pumping) due to Mallory Wiss tear

À§Àå°ü ÃâÇ÷Àº °£ÇæÀûÀÎ °ÍÀÌ Æ¯Â¡ÀÌ´Ù. Mallory-Weiss tear¸¦ °¡Áø ȯÀÚÀÇ ³»½Ã°æ¿¡¼­ active bleedingÀ» º¸ÀÌ´Â °æ¿ì´Â ¸¹Áö ¾Ê´Ù. ÇÊÀÚµµ pumpingÀ» º¸ÀÎ °æ¿ì´Â ´Ü Çѹø º¸¾Ò´Ù.


3. Mallory Weiss tear¸¦ º¸ÀÏ ¼ö ÀÖ´Â ¿©·¯ »óȲ

1) alcohol-related

Mallory-Weiss tearÀÇ Àý¹Ý ÀÌ»óÀº ¼ú°ú °ü·ÃµÇ¾î ÀÖ´Ù. Àü³¯ ¼ÒÁÖ µÎ º´À» ¸¶½Å ÈÄ ÅäÇ÷·Î ³»¿øÇÑ È¯ÀÚÀÇ ³»½Ã°æÀÌ´Ù.

»ç½Ç Mallory-Weiss¸¦ °æÇèÇÑ Àǻ簡 ÀûÁö ¾Ê´Ù. Mallory-Weiss tear ȯÀÚ¸¦ Ä¡·áÇÑ Àǻ縦 ¸»ÇÏ´Â °ÍÀÌ ¾Æ´Ï´Ù. ½º½º·Î Mallory-Weiss tear¿¡ ÀÇÇÑ ÃâÇ÷À» °æÇèÇÑ Àǻ簡 ¸¹´Ù´Â ¸»ÀÌ´Ù. ȯÀÚ¸¦ Ä¡·áÇϱ⿡ ¾Õ¼­, ÀÇ·áÁ¦µµ¸¦ °³¼±Çϱ⿡ ¾Õ¼­ ÀÇ»ç»çȸÀÇ ¼ú¹®È­ºÎÅÍ ¹Ù²ã¾ß ÇÏ´Â °Í ¾Æ´Ò±î?


2) A party disease

¿¬¸»ÀÌ¸é ³»½Ã°æ½ÇÀÌ ¹ÙºüÁø´Ù. ¾öû ¸¹Àº Mallory-Weiss ȯÀÚ°¡ ã¾Æ¿À±â ¶§¹®ÀÌ´Ù. ¼Û³âȸ Å¿ÀÌ´Ù.

»õÇб⿡´Â ³»½Ã°æ½ÇÀÌ ¹ÙºüÁø´Ù. ¾öû ¸¹Àº Mallory-Weiss ȯÀÚ°¡ ã¾Æ¿À±â ¶§¹®ÀÌ´Ù. ½ÅÀÔ»ý ȯ¿µÈ¸ Å¿ÀÌ´Ù.

3¿ù¿¡´Â ³»½Ã°æ½ÇÀÌ ¹ÙºüÁø´Ù. ¾öû ¸¹Àº Mallory-Weiss ȯÀÚ°¡ ã¾Æ¿À±â ¶§¹®ÀÌ´Ù. ½ÅÀÔ»ç¿ø ȯ¿µÈ¸ Å¿ÀÌ´Ù.

¼Û³âȸ ÈÄ ¹ß»ýÇÑ Mallory-Weiss tear

Mallory-Weiss tear´Â ¼ú±ÇÇÏ´Â »çȸÀÇ Áß¿ä ÇÕº´ÁõÀÌ´Ù. ½ÉÇϸé Á״´Ù. ¼ú¸¶½Ã´Ù Á×À¸¸é ¾ï¿ïÇÏÁö ¾ÊÀ»±î? ¼ú¹®È­¸¦ ¹Ù²ÙÀÚ.


3) Bowel preparation for colonoscopy

´ëÀå³»½Ã°æÀº Èûµé´Ù. Àǻ翡°Ô³ª ȯÀÚ¿¡°Ô³ª ¸ðµÎ Èûµé´Ù. Bowel preparationÀ» À§ÇÏ¿© ¸¹Àº ¾çÀÇ ¹°¾àÀ» ¸Ô´Â °ÍÀº °ïȤ½º·¯¿î °æÇèÀÌ´Ù. Áß°£¿¡ ÅäÇÏ´Â »ç¶÷ÀÌ ÀûÁö ¾Ê´Ù. ±×·¯´Ù Mallory-Weiss tear°¡ ¹ß»ýÇÒ ¼ö ÀÖ´Ù. ¾Æ·¡ 3¸íÀº ¸ðµÎ ´ëÀå³»½Ã°æ °Ë»ç¸¦ ÁغñÇÏ´Ù°¡ ¹ß»ýÇÑ MW tearÀÇ ¿¹ÀÌ´Ù.

ITP ȯÀÚ


4) EGD

À§³»½Ã°æµµ Èûµé´Ù. °Ë»ç µµÁß °è¼Ó belchingÇϴ ȯÀÚ°¡ ÀÖ´Ù. ±×·¯´Ù Çdzª´Â ȯÀÚ°¡ ÀÖ´Ù. Sedation°ú ¹«°üÇÏ´Ù.

³»½Ã°æ °Ë»ç µµÁß belchingÀ¸·Î ÀÎÇÏ¿© squamocolumnar junction Á÷»ó¹æÀÌ Âõ¾îÁö¸é¼­ ÃâÇ÷ÀÌ ¹ß»ýÇÑ ¿¹ÀÌ´Ù. Ŭ¸³À¸·Î ÁöÇ÷ÇÏ¿´°í ȸº¹½Ç¿¡¼­ µÎ ½Ã°£ °æ°ú°üÂû ÈÄ ±Í°¡Çϵµ·Ï ÇÏ¿´´Ù.

³»½Ã°æ °ü·Ã ȯÀÚ¾ÈÀü»ç°í(»ç¸Á·Ê)¸¦ »ìÆ캸¸é µå¹°°Ô Mallory Weiss tear°¡ ¿øÀÎÀÎ °æ¿ì°¡ ÀÖ´Ù. ÃâÇ÷ÀÌ ÀÖ¾ú´ø ȯÀÚ´Â clippingÀ» ÇÏ¿´°Å³ª ÇÏÁö ¾Ê°í ÁÁ¾ÆÁ³´õ¶óµµ ÀçÃâÇ÷ÀÇ À§ÇèÀ» ¾Ë·Á¾ß ÇÑ´Ù. ÃâÇ÷ ÈÄ 3ÀÏ Á¤µµ´Â Àý´ë·Î È¥ÀÚ °è½Ã¸é ¾È µÈ´Ù°í °­Á¶ÇϽñ⠹ٶõ´Ù. È¥ÀÚ °è½Ã´Ù ÃâÇ÷ÀÌ ¹ß»ýÇÏ¸é ´ëóÇϱⰡ ¾î·Æ±â ¶§¹®ÀÌ´Ù.

* Âü°í: EndoTODAY ³»½Ã°æ µµÁß ¹ß»ýÇÑ Mallory Weiss tear


5) Chemotherapy

¼úÀÌ ¾Æ´Ï´õ¶óµµ belchingÀ» Çϸé MW tear°¡ ¹ß»ýÇÒ ¼ö ÀÖ´Ù.

Glottic cancer¿¡ ´ëÇÑ Ç×¾ÏÄ¡·á Áß CMV esophagitis°¡ ¹ß»ýÇÏ¿´´ø ȯÀÚÀÌ´Ù. BelchingÀ» Çϸ鼭 MW tear°¡ ¹ß»ýÇÏ¿´´Ù. °á±¹ ÅäÇ÷·Î CMV esophagitis°¡ Áø´ÜµÈ ¿¹¿´´Ù.


6) Subtotal gastrectomy

¼úÀÌ ¾Æ´Ï´õ¶óµµ, ½Äµµ¿°ÀÌ ¾Æ´Ï´õ¶óµµ belchingÀ» Çϸé MW tear°¡ ¹ß»ýÇÒ ¼ö ÀÖ´Ù.

Subtotal gastrectomy¸¦ ¹Þ°í Àß Áö³»´ø ȯÀÚ°¡ Ưº°ÇÑ ÀÌÀ¯¾øÀÌ belchingÀ» Çϸ鼭 MW tear°¡ ¹ß»ýÇÏ¿´´Ù.

Á¤¸»·Î ¾Æ¹« ÀÌÀ¯ ¾øÀÌ MV tear°¡ ¹ß»ýÇϴ ȯÀÚµµ ÀÖ´Ù.


7) Gastric ESD

ESD µµÁß È¯ÀÚÀÇ belchingÀ¸·Î ÀÎÇÏ¿© ȤÀº °úµµÇÑ argon plasma coagulationÀ¸·Î ÀÎÇÏ¿© ±ä mucosal lacerationÀÌ ¹ß»ýÇÒ ¼ö ÀÖ½À´Ï´Ù. ÀÏÁ¾ÀÇ Mallory Weiss tear¶ó°í ÇÒ ¼ö ÀÖ½À´Ï´Ù. ½ÉÇϸé õ°øµµ °¡´ÉÇÕ´Ï´Ù.

Long lacerationÀ¸·Î ÀÎÇÏ¿© ÃâÇ÷ÀÌ ¹ß»ýÇÏ¿´À¸³ª clippingÀ¸·Î Á¶ÀýÇÒ ¼ö ÀÖ¾ú´Ù. õ°øÀº µ¿¹ÝµÇÁö ¾Ê¾Ò´Ù.

290HQ ³»½Ã°æÀº È­ÁúÀº ÁÁÁö¸¸ angulationÀÌ ÁÁÁö ¾Ê´Ù. ESD¿¡ ÀûÁö ¾ÊÀº ¾î·Á¿òÀÌ ÀÖ´Ù. 290HQ¸¦ ÀÌ¿ëÇÑ ESD¸¦ ÇÏ¿´°í °ø±â¸¦ ´Ù¼Ò ¸¹ÀÌ ³ÖÀ» ¼ö ¹Û¿¡ ¾ø¾ú°í ȯÀÚ°¡ belchingÀ» Çϸ鼭 ÃâÇ÷ÀÌ ÀÖ¾ú´Ù. 260J·Î ¹Ù²Ù¾î Àü±â¼ÒÀÛÀ» ÇÏ¿´À¸³ª ¿Ïº®ÇÑ ÁöÇ÷ÀÌ µÇÁö ¾Ê¾Æ clippingÀ» ÇÏ¿´´Ù.


8) Ablation therapy using APC

APC ablationÀº ¾Æ¸£°ï °¡½º¸¦ »ç¿ëÇϹǷΠÀ§°¡ ÆØâµÉ ¼ö ÀÖ°í ÀÌ ¶§ ȯÀÚ°¡ ±¸¿ªÀ» Çϸé Mallory Weiss tear°¡ ¹ß»ýÇÒ ¼ö ÀÖ½À´Ï´Ù.

½ÊÀÌÁöÀå ¼±Á¾ APC Ä¡·á Áß ¹ß»ýÇÑ MW tear


4. ¾îµð°¡ Âõ¾îÁö´Â°¡? Laceration of the cardiac orfice of the stomach?

1. Mallory GK, Weiss S. Hemorrhages from lacerations of the cardiac orifice of the stomach due to vomiting. Am J Med Sci 1929;178:506-515

2. Weiss S, Mallory GK. Lesions of the cardiac orifice of the stomach produced by vomiting. Journal of the American Medical Association 1932;98:1353-1355

1929³â°ú 1932³â¿¡ º´¸®ÀÇ»ç Mallory¿Í ³»°úÀÇ»ç Weiss´Â cardiac orfice of the stomach¿¡ laceration ÀÖ´Ù°í ±â¼úÇÏ¿´´Ù. ´ç½Ã¿¡´Â EG junction¿¡ ´ëÇÑ ÇغÎÇÐÀû °³³äÀÌ ÇöÀçó·³ ¶Ñ·ÇÇÏÁö ¾Ê¾Ò´Ù. ±×µéÀÌ cardiac orfice¶ó°í ¾´ °ÍÀº esophagogastric junction ¾ðÀú¸®¸¦ ´ë°­ ¸»ÇÏ´Â °ÍÀÌ ¾Æ´Ï¾ú³ª »ý°¢µÈ´Ù. ³»½Ã°æÀÌ ¾ø´ø ´ç½Ã·Î¼­´Â Mallory-Weiss tear¿¡¼­ Á¤È®È÷ ¾îµð°¡ Âõ¾îÁö´Â°¡´Â ¾Ë±â ¾î·Á¿üÀ» °ÍÀÌ´Ù.

¾Æ·¡ »çÁøÀº squamocolumnanr junctionÀ» Áß°£¿¡ µÎ°í ±× »óºÎ¿Í ±× ÇϺΰ¡ Âõ¾îÁø ¿¹ÀÌ´Ù. Mallory¿Í Weiss´Â ÀÌ·± °æ¿ì¸¦ º¸Áö ¾Ê¾Ò´ø °ÍÀϱî ÃßÁ¤µÈ´Ù.

MW tear ȯÀÚµéÀÇ »çÁøÀ» º¸¸é Âõ¾îÁö´Â ºÎÀ§´Â ´ëºÎºÐ stomachÀÌ´Ù. Squamocolumnar junction ¾Æ·¡ÀÇ À§Á¡¸·¸¸ Âõ¾îÁø °æ¿ì°¡ ¸¹´Ù. ½ÉÇÑ °æ¿ì¿¡´Â stomach¿¡¼­ ½ÃÀÛÇÏ¿´À¸³ª SC junctionÀ» ³Ñ¾î ½Äµµ±îÁö Âõ¾îÁö´Â °ÍÀ¸·Î »ý°¢µÈ´Ù. SC junction »óºÎÀÇ ½Äµµ¸¸ Âõ¾îÁö´Â ¿¹´Â ¸¹Áö ¾ÊÀº °Í °°´Ù.

SC junction Á÷ÇϺΠÀ§Á¡¸·¸¸ Âõ¾îÁø ¿¹. ÀÌ·± °æ¿ì°¡ ¸Å¿ì ¸¹´Ù.


5. Hiatal hernia¿ÍÀÇ °ü·Ã¼º. Location of the MW tear and relationship with hiatal hernia

MW tearÀÇ À§Ä¡¿Í hiatal hernia´Â ¾à°£ÀÇ °ü·Ã¼ºÀÌ ÀÖ´Ù. ÀÌ¿¡ ´ëÇÑ ÃÖ±Ù ÀÚ·á´Â µå¹°±â ¶§¹®¿¡ 1980³â MGH¿¡¼­ ¹ßÇ¥ÇÑ ³í¹®ÀÇ tableÀ» captureÇÏ¿´´Ù.

ÇÊÀÚÀÇ °æÇè°ú´Â ´Þ¸® 30¿©³âÀü MGH¿¡¼­´Â ½Äµµ¿Í À§¿¡ °ÉÄ£ °æ¿ì°¡ °¡Àå ¸¹¾Ò°í ½Äµµ¿¡¸¸ À§Ä¡ÇÑ ¿¹µµ ÀûÁö ¾Ê¾Ò´ø ¸ð¾çÀÌ´Ù. Èï¹Ì·Î¿î °ÍÀº stomach¿¡ À§Ä¡ÇÑ MWÀÇ ´ëºÎºÐÀÌ hiatal hernia°¡ ÀÖ´ø ȯÀÚ¿¡¼­ ¹ß»ýÇÏ¿´´Ù´Â °ÍÀÌ´Ù.


Á¤È®ÇÑ ÀÚ·á´Â ¾øÁö¸¸ ÇÊÀÚ´Â ÀÌ·¸°Ô »ý°¢ÇÑ´Ù. Hiatal hernia°¡ ¶Ñ·ÇÇÑ È¯ÀÚ¿¡¼­ MW tear´Â stomach¿¡ ¹ß»ýÇϱ⠽±´Ù´Â Á¡Àº µ¿ÀÇÇÑ´Ù. ±×·¯³ª hiatal hernia°¡ ¶Ñ·ÇÇÏÁö ¾Ê´õ¶óµµ ´ëºÎºÐÀÇ MW tear´Â stomach¿¡¼­ ½ÃÀÛÇÑ °ÍÀÌ ¾Æ´Ò±î?

À§¿¡¼­ ½ÃÀÛÇÏ¿© ½ÄµµÂÊÀ¸·Î ¾à°£ progressionÇÑ ¿¹°¡ ¾Æ´Ò±î?


6. Ä¡·á

MW tear´Â »ç¸ÁÇÒ ¼ö ÀÖ´Â ÁúȯÀÔ´Ï´Ù. ½ÇÁ¦·Î ÇÊÀÚµµ »ç¸Á·Ê¸¦ °æÇèÇÏ¿´½À´Ï´Ù. ¸Å¿ì ÁøÁöÇÏ°Ô Á¢±ÙÇØ¾ß ÇÕ´Ï´Ù.

MW tear°¡ °æÇϸé À§»êºÐºñ¾ïÁ¦Á¦¸¸ Åõ¿©ÇÏ°í °æ°ú°üÂû ÇÒ ¼ö ÀÖ½À´Ï´Ù.

»ç½Ç ÀÌ·± °æ¿ì¿¡ À§»ê ºÐºñ ¾ïÁ¦Á¦°¡ ²À ÇÊ¿äÇÑÁö ¸íÈ®ÇÏÁö ¾Ê½À´Ï´Ù. ÇÊÀÚ´Â º¸Åë PPI¸¦ 2ÁÖ Åõ¾àÇÕ´Ï´Ù.


MW tear°¡ Á¶±Ý ´õ ½ÉÇϰųª active bleedingÀÌ ÀÖÀ¸¸é clippingÀ» ÇÒ ¼ö ÀÖ´Ù. º¸Åë ±ä lacerationÀÌ ÀÖ´Â °æ¿ì clipÀÌ °¡Àå ÁÁ½À´Ï´Ù.


MW tear Áß ÃâÇ÷º´¼Ò°¡ focalÇÏ°Ô °üÂûµÇ¸é band ligationÀ» ÇÒ ¼ö ÀÖ½À´Ï´Ù.


7. Perforation - º¸ÇϺ£ ½Åµå·Ò

MW tear°¡ ½ÉÇϸé õ°øÀÌ ¹ß»ýÇÒ ¼ö ÀÖ´Ù. º¸ÇϺ£¶ó°í ºÎ¸£´Â »óȲÀÌ´Ù.

»¡¸® ¼ú ±ÇÇÏ´Â ¹®È­¸¦ ¹Ù²ã¾ß°Ú´Ù. ÀÌ¹Ì ³Ê¹« ¸¹Àº »ç¶÷µéÀÌ Á×¾ú°í, ¾ÆÁ÷µµ ´õ ¸¹Àº »ç¶÷µéÀÌ Á×À½ÀÇ ¹®Åο¡¼­ ¼­¼ºÀÌ°í ÀÖ´Ù.


[FAQ]

[2018-10-21. DEX workshop Áú¹®]

³»½Ã°æ °Ë»ç µµÁß Mallory-Weiss tear°¡ ¹ß°ßµÇ¸é ¾î¶»°Ô ÇØ¾ß ÇÕ´Ï´Ù. ³»½Ã°æ Ä¡·á°¡ ¾î·Á¿î ȯ°æÀε¥ ¾ðÁ¦ Àü¿øÀ» ÇØ¾ß ÇÏ´ÂÁö¿ä?

[2018-10-21. ÀÌÁØÇà ´äº¯]

ÀÓ»ó »óȲÀÌ Áß¿äÇÒ °Í °°½À´Ï´Ù.

1) ÅäÇ÷·Î ÀÀ±Þ½ÇÀ» ³»¿øÇÏ¿© vitalÀÌ ¾ÈÁ¤ÀûÀÌÁö ¾Ê°Å³ª ºóÇ÷ÀÌ ¹ß»ýÇÑ °æ¿ì : ³»½Ã°æ Ä¡·á¸¦ °í·ÁÇØ¾ß ÇÕ´Ï´Ù. Active bleedingÀÌ ¾ø´õ¶óµµ ÇÏ·ç ÀÌƲ Á¤µµ´Â ÀÔ¿øÇÏ¿© °æ°ú°üÂûÀ» ÇÏ´Â °ÍÀÌ ÁÁ°Ú½À´Ï´Ù. Àá½Ã ±Ý½ÄÇÏ°í IV PPI¸¦ ¾²¸é ÁÁ½À´Ï´Ù.

2) ¼Ò·®ÀÇ ÅäÇ÷À̳ª Èæ»öº¯À» º¸¾Ò°í ÀÀ±Þ½ÇÀ» ³»¿øÇÏ¿´°Å³ª °³¿ø°¡ ¿Ü·¡¸¦ ¹æ¹®ÇÑ °æ¿ì : vitalÀÌ stableÇÏ°í ºóÇ÷ÀÌ ¹ß»ýÇÏÁö ¾Ê¾ÒÀ¸¸é ¾ÆÁÖ ±ÞÇÑ ³»½Ã°æ °Ë»ç°¡ ÇÊ¿äÇÏÁö ¾Ê½À´Ï´Ù. 24À̳»¿¡ ³»½Ã°æ °Ë»ç¸¦ ½ÃÇàÇÏ¿© È®ÀÎÇØ ÁÖ´Â °ÍÀÌ ÁÁ°Ú½À´Ï´Ù. Active bleedingÀÌ ¾øÀ¸¸é ´çºÐ°£ soft diet¸¦ Çϵµ·Ï ¼³¸íÇÑ ÈÄ À§»êºÐºñ¾ïÁ¦Á¦¸¦ 1ÁÖ µå¸®°í Åð¿øÁ¶Ä¡ ÇϽñ⠹ٶø´Ï´Ù.

3) ÅäÇ÷À̳ª Èæ»öº¯Àº ¾ø¾úÁö¸¸ À½ÁÖ ÈÄ ±¸¿ªÀÌ ÀÖ¾ú°í ³»½Ã°æ¿¡¼­ ÃâÇ÷Àº ¾ø°í tear¸¸ ÀÖ´Â °æ¿ì : ´çºÐ°£ soft diet¸¦ Çϵµ·Ï ¼³¸íÇÑ ÈÄ À§»êºÐºñ¾ïÁ¦Á¦¸¦ 1ÁÖ Ã³¹æÇÕ´Ï´Ù.

4) ³»½Ã°æ µµÁß ±¸¿ªÀ» Çϸ鼭 tear°¡ ¹ß»ýÇÑ °æ¿ì : tear°¡ ¸Å¿ì ½ÉÇÏÁö ¾Ê´Â ÇÑ ÃâÇ÷ÀÌ ¾øÀ¸¸é º°´Ù¸¥ Á¶Ä¡´Â ÇÊ¿äÇÏÁö ¾Ê½À´Ï´Ù. È°µ¿¼º ÃâÇ÷ÀÌ ÀÖÀ¸¸é Àá½Ã ±â´Ù¸®°í ÃâÇ÷ÀÌ °è¼ÓµÇ¸é ÁöÇ÷¼úÀ» ÇÒ ¼ö ÀÖ½À´Ï´Ù. È°µ¿¼º ÃâÇ÷ÀÌ ¹ß»ýÇÑ È¯ÀÚ¿¡¼­´Â À§»êºÐºñ¾ïÁ¦Á¦¸¦ 1ÁÖ Ã³¹æÇÏ¸é µÉ °Í °°½À´Ï´Ù.

¿äÄÁµ¥ °³¿ø°¡ ³»½Ã°æ½Ç¿¡¼­ °Ë»ç µµÁß ¿ì¿¬È÷ ¹ß°ßµÈ Mallory Weiss tearÀÇ °æ¿ì active bleeding »óȲÀÌ ¾Æ´Ï¸é Àü¿ø±îÁö´Â ÇÊ¿äÇÏÁö ¾Ê´Ù°í »ý°¢µË´Ï´Ù. ¾à°£ÀÇ ¼³¸í, ÁÖÀÇ»çÇ× °íÁö¿Í ÇÔ²² À§»êºÐºñ¾ïÁ¦Á¦¸¦ ¾ÆÁÖ Á¶±Ý Åõ¿©ÇÏ´Â Á¤µµ¸¦ ±ÇÇÕ´Ï´Ù.


[References]

1) EndoTODAY ³»½Ã°æ µµÁß ¹ß»ýÇÑ Mallory Weiss tear



© ÀÏ¿ø³»½Ã°æ±³½Ç ¹Ù¸¥³»½Ã°æ¿¬±¸¼Ò ÀÌÁØÇà. EndoTODAY Endoscopy Learning Center. Lee Jun Haeng.