Journal of the Korean Society of Radiology (대한영상의학회지)

The Korean Society of Radiology (대한영상의학회)
권호 표지

Proper Treatment of Acute Mesenteric Ischemia

급성 장간막 허혈: 어떻게 치료할 것인가

  • Kim, Sung-Kwan (Department of Radiology, Chonbuk National University Hospital and Medical School) ;
  • Han, Young-Min (Department of Radiology, Chonbuk National University Hospital and Medical School) ;
  • Kwak, Hyo-Sung (Department of Radiology, Chonbuk National University Hospital and Medical School) ;
  • Yu, Hee-Chul (Department of Surgery, Chonbuk National University Hospital and Medical School)
  • 김성관 (전북대학교 의학전문대학원 전북대학교병원 영상의학과학교실) ;
  • 한영민 (전북대학교 의학전문대학원 전북대학교병원 영상의학과학교실) ;
  • 곽효성 (전북대학교 의학전문대학원 전북대학교병원 영상의학과학교실) ;
  • 유희철 (전북대학교 의학전문대학원 전북대학교병원 외과학교실)
  • Published : 2011.10.01
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Abstract

Purpose: To evaluate the effectiveness of treatment options for Acute Mesenteric Ischemia and establish proper treatment guidelines. Materials and Methods: From January 2007 to May 2010, 14 patients (13 men and 1 woman, mean age: 52.1 years) with acute mesenteric ischemia were enrolled in this study. All of the lesions were detected by CT scan and angiography. Initially, 4 patients underwent conservative treatment. Eleven patients were managed by endovascular treatment. We evaluated the therapeutic success and survival rate of each patient. Results: The causes of ischemia included thromboembolism in 6 patients and dissection in 8 patients. Nine patients showed bowel ischemia on CT scans, 4 dissection patients underwent conservative treatment, 3 patients had recurring symptoms, and 5 dissection patients underwent endovascular treatment. Overall success and survival rate was 100%. However, overall success was 83% and survival rate was 40% in the 6 thromboembolism patients. The choice of 20 hours as the critical time in which the procedure is ideally performed was statistically significant (p = 0.0476). Conclusion: A percutaneous endovascular procedure is an effective treatment for acute mesenteric ischemia, especially in patients who underwent treatment within 20 hours. However, further study and a long term follow-up are needed.

목적: 급성 장간막 허혈의 치료 방법에 따른 효과를 평가하고 이를 토대로 적절한 치료 지침을 제시하고자 하였다. 대상과 방법: 2007년 1월에서 2010년 5월까지 14명의 급성 장간막 허혈 환자를 대상으로 하였다. 남자가 13명, 여자가 1명, 평균 연령은 52.1세였다. 모든 병변은 전산화단층촬영 및 혈관조영술로 확인하였다. 4명의 환자는 보존적 치료, 11명의 환자는 중재적 치료를 시행받았고 치료의 성공률 및 생존율을 분석하였다. 결과: 장간막 허혈의 원인은 혈전색전증이 6명, 장간막 동맥 박리가 8명이었다. 이 중 9명의 환자에서 전산화단층촬영 상 장 허혈 소견이 확인되었다. 동맥 박리가 있던 4명의 환자가 보존적 치료를 받았고 3명에서 증상이 재발하였다. 이 중 1명은 추가적으로 중재적 치료를 시행하였고 이를 포함한 총 5명의 환자가 중재적 치료를 받았으며 치료 성공률 및 1년 생존율은 100%였다. 6명의 혈전색전증 환자 모두가 중재적 치료를 받았고 치료 성공률은 83%였으나 1년 생존율은 40%였다. 시술의 골든 타임으로 20시간을 기준으로 하였을 때 통계학적으로 유의하게 예후가 좋았다(p = 0.0476). 결론: 경피적 혈관 내 중재술은 특히 20시간 이내에 시행될 경우 급성 장간막 허혈에 안전하고 효과적인 치료 방법이다. 그러나 더 많은 연구와 장기간의 추적 관찰이 필요하겠다.

Keywords

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