DOI QR코드

DOI QR Code

복부 고형 장기 외상에 대한 인터벤션의 임상적 역할

Clinical Role of Interventional Radiology in Abdominal Solid Organ Trauma

  • 정현석 (원광대학교병원 영상의학과) ;
  • 전창호 (가톨릭대학교 의과대학 은평성모병원 영상의학과) ;
  • 서상현 (원광대학교병원 영상의학과)
  • Hyun Seok Jung (Department of Radiology, Wonkwang University Hospital) ;
  • Chang Ho Jeon (Department of Radiology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Sang Hyun Seo (Department of Radiology, Wonkwang University Hospital)
  • 투고 : 2023.04.25
  • 심사 : 2023.07.12
  • 발행 : 2023.07.01

초록

외상성 복부 장기 손상 환자의 치료에서 비수술적 치료의 비중이 증가하고 있으며, 이는 혈관 내 인터벤션 치료의 발전과 보편화와 연관이 있다. 최근 American Association for the Surgery of Trauma (AAST)의 Organ Injury Scaling System과 World Society of Emergency Surgery (WSES)에서 간, 비장, 신장 외상 진료 및 치료에 대한 가이드라인을 발표하였고, 인터벤션 치료의 역할을 명확히 제시하였다. 이를 바탕으로 인터벤션 영상의학의 관점에서 외상 환자 치료에 참여하면서 기본적으로 알고 있어야 할 내용 및 각 장기별 인터벤션 치료시 고려할 사항에 대해 알아보고자 한다.

Interventional management is commonly used for traumatic injuries to the abdominal solid organs. The American Association for the Surgery of Trauma (AAST) and the World Society of Emergency Surgery (WSES) recently published guidelines for the management and treatment of liver, spleen, and kidney injuries, emphasizing the importance of interventions. Here, we discuss the characteristics of each organ and the procedure method for each organ that interventional radiologists need to know when treating trauma patients.

키워드

참고문헌

  1. Coccolini F, Coimbra R, Ordonez C, Kluger Y, Vega F, Moore EE, et al. Liver trauma: WSES 2020 guidelines. World J Emerg Surg 2020;15:24 
  2. Coccolini F, Montori G, Catena F, Kluger Y, Biffl W, Moore EE, et al. Splenic trauma: WSES classification and guidelines for adult and pediatric patients. World J Emerg Surg 2017;12:40 
  3. Coccolini F, Moore EE, Kluger Y, Biffl W, Leppaniemi A, Matsumura Y, et al. Kidney and uro-trauma: WSES-AAST guidelines. World J Emerg Surg 2019;14:54 
  4. Inukai K, Uehara S, Furuta Y, Miura M. Nonoperative management of blunt liver injury in hemodynamically stable versus unstable patients: a retrospective study. Emerg Radiol 2018;25:647-652 
  5. Yuan KC, Wong YC, Lin BC, Kang SC, Liu EH, Hsu YP. Negative catheter angiography after vascular contrast extravasations on computed tomography in blunt torso trauma: an experience review of a clinical dilemma. Scand J Trauma Resusc Emerg Med 2012;20:46 
  6. Yonemitsu T, Kawai N, Sato M, Tanihata H, Takasaka I, Nakai M, et al. Evaluation of transcatheter arterial embolization with gelatin sponge particles, microcoils, and N-butyl cyanoacrylate for acute arterial bleeding in a coagulopathic condition. J Vasc Interv Radiol 2009;20:1176-1187 
  7. Singh A, Kumar A, Kumar P, Kumar S, Gamanagatti S. "Beyond saving lives": current perspectives of interventional radiology in trauma. World J Radiol 2017;9:155-177 
  8. Virdis F, Reccia I, Di Saverio S, Tugnoli G, Kwan SH, Kumar J, et al. Clinical outcomes of primary arterial embolization in severe hepatic trauma: a systematic review. Diagn Interv Imaging 2019;100:65-75 
  9. Green CS, Bulger EM, Kwan SW. Outcomes and complications of angioembolization for hepatic trauma: a systematic review of the literature. J Trauma Acute Care Surg 2016;80:529-537 
  10. Saltzherr TP, van der Vlies CH, van Lienden KP, Beenen LF, Ponsen KJ, van Gulik TM, et al. Improved outcomes in the non-operative management of liver injuries. HPB (Oxford) 2011;13:350-355 
  11. Song SY, Chung JW, Yin YH, Jae HJ, Kim HC, Jeon UB, et al. Celiac axis and common hepatic artery variations in 5002 patients: systematic analysis with spiral CT and DSA. Radiology 2010;255:278-288 
  12. Gilyard S, Shinn K, Nezami N, Findeiss LK, Dariushnia S, Grant AA, et al. Contemporary management of hepatic trauma: what IRs need to know. Semin Intervent Radiol 2020;37:35-43 
  13. Tzeng WS, Wu RH, Chang JM, Lin CY, Koay LB, Uen YH, et al. Transcatheter arterial embolization for hemorrhage caused by injury of the hepatic artery. J Gastroenterol Hepatol 2005;20:1062-1068 
  14. Sabe AA, Claridge JA, Rosenblum DI, Lie K, Malangoni MA. The effects of splenic artery embolization on nonoperative management of blunt splenic injury: a 16-year experience. J Trauma 2009;67:565-572; discussion 571-572 
  15. Kristinsson SY, Gridley G, Hoover RN, Check D, Landgren O. Long-term risks after splenectomy among 8,149 cancer-free American veterans: a cohort study with up to 27 years follow-up. Haematologica 2014;99:392-398 
  16. Pisters PW, Pachter HL. Autologous splenic transplantation for splenic trauma. Ann Surg 1994;219:225-235 
  17. Lee R, Jeon CH, Kim CW, Kwon H, Kim JH, Kim H, et al. Clinical results of distal embolization in grade V splenic injury: four-year experience from a single regional trauma center. J Vasc Interv Radiol 2020;31:1570-1577.e2 
  18. Haan JM, Biffl W, Knudson MM, Davis KA, Oka T, Majercik S, et al. Splenic embolization revisited: a multicenter review. J Trauma 2004;56:542-547 
  19. Enslow MS, Preece SR, Wildman-Tobriner B, Enslow RA, Mazurowski M, Nelson RC. Splenic contraction: a new member of the hypovolemic shock complex. Abdom Radiol (NY) 2018;43:2375-2383 
  20. Walker TG. Mesenteric vasculature and collateral pathways. Semin Intervent Radiol 2009;26:167-174 
  21. Quencer KB, Smith TA. Review of proximal splenic artery embolization in blunt abdominal trauma. CVIR Endovasc 2019;2:11 
  22. Lopera JE. Embolization in trauma: principles and techniques. Semin Intervent Radiol 2010;27:14-28 
  23. Kwon H, Bae M, Jeon CH, Hwangbo L, Lee CM, Kim CW. Volume preservation of a shattered kidney after blunt trauma by superselective renal artery embolization. Diagn Interv Radiol 2022;28:72-78 
  24. Knudson MM, Harrison PB, Hoyt DB, Shatz DV, Zietlow SP, Bergstein JM, et al. Outcome after major renovascular injuries: a Western trauma association multicenter report. J Trauma 2000;49:1116-1122 
  25. Ozkan U, Og˘uzkurt L, Tercan F, Kizilkilic O, Koc Z, Koca N. Renal artery origins and variations: angiographic evaluation of 855 consecutive patients. Diagn Interv Radiol 2006;12:183-186 
  26. Kwon H, Jeon CH, Kim CW. Intervention for urologic trauma. J Korean Soc Radiol 2019;80:667-683