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경내경정맥 간내 문맥전신성 단락술 후에도 재발성 출혈을 보여 내시경적 치료로 치유한 십이지장 정맥류 출혈 1예
기영우,정순일,박민호,신용주,오동현,박상욱,박주채,손희경,박정환,서강석 대한소화기내시경학회 2002 Clinical Endoscopy Vol.24 No.5
십이지장 정맥류 출혈은 간문맥 고혈압 환자에서 드물게 발생하며 대량의 출혈을 초래할 수 있다. 치료 방법으로는 내시경적 경화요법, 결찰술, 수술적 단락술 등이 이용된다. 저자 등은 내시경 시술을 시행하기 어려울 정도로 혈역동학적으로 불안정한 상태의 십이지장 정맥류 출혈 환자에서 응급으로 경내경정맥 간내 문맥전신성 단락술에도 불구하고 재출혈이 발생하여 내시경적 결찰술과 내시경적 경화 요법을 시행하여 성공적으로 치유한 십이지장 정맥류 1예를 경험하였기에 문헌고찰과 함께 보고하는 바이다. Duodenal varix is a rare site of bleeding in patient with portal hypertension and frequently causes massive bleeding. Treatment modalities are endoscopic sclerotherapy, endoscopic ligation, transjugular intrahepatic portosystemic shunt (TIPS), and shunt operation. A patient with duodenal varix was hemodynamically unstable and an emergent salvage transjugular intrahepatic portosystemic shunt was performed. In spite of TIPS procedure, varix bleeding was not controlled and endoscopic band ligation and endoscopic sclerotherapy were performed with successful hemostasis and eradication of duodenal varix. (Korean J Gastrointest Endosc 2002;24:294-298)
박민호,정순일,기영우,신용주,오동현,서강석,임연근 대한내과학회 2002 대한내과학회지 Vol.63 No.5
The migratory thrombophlebitis and thromboembolic disorders of the venous and arterial systems in the setting of malignancy are termed Trousseau's syndrome. The overall incidence of clinical thromboembolic events in patients with cancer has been reported to vary between 1∼11%. Pancreatic carcinoma has been associated with the greatest risk of thromboembolic events. Other tumor type also prone to an increased risk of thromboembolic events, including lung, prostate, stomach, acute leukemia and colon cancer. Hypercoagulability associated cancer may result from activation of coagulation, injury to the endothelium, or alteration of blood flow. Unlike other coagulopathies, Trousseau's syndrome may manifest with thromboses in unusal areas, including the upper extremities, face and visceral organs. Neck vein thrombosis associated with distant cancers have been rarely reported. Jugular vein thrombosis associated with gastrc cancer is very rare. We report one case of gastic adenocarcinoma presented as internal jugular vein thrombosis.
췌장암에 의해 발생한 총담도와 십이지장 폐쇄 부위에 각각 적용된 이중 스텐트 삽입 1 예
신용주(Yong Ju Shin),오동현(Dong Hyun Oh),기영우(Young Woo Kee),박민호(Min Ho Park),정순일(Sun Il Jeong),강성진(Sung Jin Kang),서강석(Kang Seok Seo),임연근(Yeun Keun Lim) 대한소화기학회 2002 대한소화기학회지 Vol.40 No.4
Pancreatic cancer is not amenable to curative resection generally and therapeutic efforts are directed at palliation of symptoms. Endoscopic palliation of malignant biliary and/or gastrointestinal tract obstruction is available and contributes to improving quality of life. We describe a patient, with unresectable pancreatic cancer who initially presented with malignant biliary obstruction and subsequently complicated by duodenal obstruction. The patient had previously undergone biliary stenting with uncovered metal stent and six weeks later, percutaneous biliary drainage was performed due to stent obstruction by tumor ingrowth. Insertion of an uncovered duodenal stent effectively relieved obstructive symptoms for 6 weeks until restenosis by tumor ingrowth occured. Subsequent insertion of a covered duodenal stent resulted in symptomatic improvement again. Insertion of an another covered biliary stent effectively decompressed biliary obstruction. We report our experience of placement of two double metal stents for simultaneous decompression of malignant biliary and duodenal obstruction. (Korean J Gastroenterol 2002; 40: 278-281)