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내장 역위증(Situs Inversus)을 동반한 말기 간경변 환자에게 시행된 뇌사자 전간이식
주선형(Sun Hyung Joo),박상훈(Sang Hoon Park),장명국(Myung Kook Jang),김한준(Han Jun Kim),김인규(In Kyu Kim),전장용(Jang Yeong Jeon),전성은(Sung Eun Jeon),이삼열(Samuel Lee),김주섭(Joo Seop Kim) 대한외과학회 2007 Annals of Surgical Treatment and Research(ASRT) Vol.72 No.5
Situs inversus refers to a mirror image of the viscera, while situs solitus is defined as the normal anatomical situation. Several cases of successful liver transplantation for situs inversus recipients have been reported, and modifications of the standard surgical techniques were used. We report here on a case of cadaveric liver transplantation in an end-stage liver disease patient with situs inversus. The donor liver was rotated clockwise 90 degrees to the left with the right lobe lying in the left upper quadrant and the left lobe pointing down into the left iliac fossa. The donor’s suprahepatic vena cava was oversewn and the infrahepatic vena cava anastomosed end to side to the recipient’s inferior vena cava. The postoperative course was good until the postoperative 26th day, when rupture of a hepatic artery pseudoaneurysm occurred. An emergency laparotomy was done and the hepatic artery was ligated. Despite the hepatic artery ligation, the liver function recovered quite well. But sudden intracranial hemorrhage developed on the postoperative 28th day and sadly, the patient expired on the postoperative 30th day. Complete preoperative evaluation of the recipient is essential for the operative planning, and careful donor selection should be attempted to obtain a smaller graft to allow maximum flexibility for placing the donor liver. The use of a reduced-sized graft should be considered in the case for which a smaller graft is not available. In conclusion, adult situs inversus is no longer a contraindication for a liver transplant, although technical difficulties do exist for this procedure.
증 례 : 경피적 접근이 어려워 초음파내시경 유도 하 배액술로 치료한 췌십이지장 절제술 후 발생한 복강 소낭 내 체액 저류 1예
최청조 ( Chung Jo Choi ),문성훈 ( Sung Hoon Moon ),김종혁 ( Jong Hyeok Kim ),박지원 ( Ji Won Park ),김성은 ( Sung Eun Kim ),박충기 ( Choong Kee Park ),전장용 ( Jang Yong Jeon ) 대한췌담도학회 2015 대한췌담도학회지 Vol.20 No.4
수술 후 체액 저류는 췌십이지장절제술 후 발생할 수 있는 중요한 합병증 중 하나로 이로 인해 사망률과 재원 기간이 증가할 수도 있다. 초음파내시경 유도 하 배액은 췌장 가성낭종의 치료 방법 중 하나이며 최근에는 수술 후 발생한 체액 저류 치료에 있어서도 성공적인 사례들이 보고되고 있다. 60세 여성이 한 달 동안 4 kg의 체중감소와 5일 전부터 발생한 황달을 주소로 내원하였다. 복부 전산화단층촬영 및 내시경 역행성 담췌관 조영술을 이용한 조직검사를 통하여 총담관암이 진단되어 췌십이지장절제술을 시행하였고 수술 2주째 발열, 복통, 백혈구 증가의 임상증상을 보였다. 진단을 위해 시행한 복부 전산화단층촬영에서 소낭의 위오목에 체액저류가 증가하여 내시경적 배액술을 시행하였고 이후 합병증 없이 증상이 호전되었다. 국내에서는 아직 췌십이지장절제술 후 발생한 체액 저류를 내시경적 배액으로 치료한 증례가 보고된 바 없기에 문헌 고찰과 함께 보고하는 바이다. Postoperative fluid collection is a major complication after pancreaticoduodenectomy and can lead to increased mortality and hospital length of stay. External drainage has widely been used for postoperative fluid collections. Recently, EUS-guided drainage has also been used successfully in treating postoperative fluid collections. A 60-year-old woman was admitted due to weight loss and jaundice. She underwent pancreaticoduodenectomy for cholangiocarcinoma of the common bile duct. After 2 weeks, she had fever with abdominal pain and leukocytosis. CT showed a increased fluid collection in superior recess of lesser sac and EUS-guided drainage was performed. The symptoms resolved without any complication after drainage. This is the first case report of EUS-guided drainage for lesser sac in Korea.