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외상성 대량 간 손상 환자에서 수술 후 간 동맥 색전술의 유용성
차수현 ( Soo Hyun Cha ),정용식 ( Yong Sik Jung ),원제환 ( Jae Hwan Won ),김욱환 ( Wook Whan Kim ),왕희정 ( Hee Jung Wang ),김명욱 ( Myung Wook Kim ),이국종 ( Kug Jong Lee ) 대한외상학회 2006 大韓外傷學會誌 Vol.19 No.1
Purpose: Acute liver failure after massive partial hepatectomy is critical condition with high mortality. To prevent postoperative liver failure from being induced by a massive partial hepatectomy, many doctors do a minimal resection on the single lobe of the liver that might cause postoperative bleeding from the remaining ruptured parenchyma. The objective of this study was to assess clinical experience with postoperative hepatic arterial embolization to control bleeding from the remaining ruptured liver during the postoperative period. Methods: This retrospective 4-year study was conducted from May 2002 to April 2006 and included consecutive patients who had sustained massive hepatic injuries and who had undergone a laparotomy, followed by postoperative hepatic arterial angiographic embolization to control bleeding. Data on the injury characteristics, the operative treatment and embolization, and the amount of transfused packed red cells (PRBC) were gathered and analyzed. In addition, data on the overall complications and survival rate were collected and analyzed. Results: Every case showed severe liver injury, higher liver injury scaling grade IV. Only ten cases involved a ruptured bilateral liver lobe. A lobectomy was done in 6 cases, a left lobectomy was done in 3 cases, and a primary suture closure of the liver was done in 2 cases. Suture closure was also done on the remaining ruptured liver parenchyma in cases of lobectomies. The postoperative hepatic arterial embolizations were done by using the super-selection technique. There were some cases of arterio-venous malformations and anomalous vessel branches. The average amount of transfused PRBC during 24 hours after embolization was 2.36±1.75, which statistically significantly lower than that before embolization. Among the 11 cases, 9 patients survived, and 2 died. There was no specific complications induced by the embolization. Conclusion: In cases of postoperative bleeding in severe hepatic injury, if there is still a large amount of bleeding, postoperative hepatic arterial embolization might be a good therapeutic option. (K Korean Soc Traumatol 2006;19:59-66)
개방성 치조골 골절의 고정법: 응급실에서 간편하게 적용할 수 있는 방법
설승환 ( Seung Hwan Seol ),차수현 ( Soo Hyun Cha ),최상천 ( Sang Cheon Choi ),안정환 ( Jung Hwan Ahn ),김기운 ( Gi Woon Kim ),최혜경 ( Hea Kyung Choi ),조준필 ( Joon Pil Cho ),정윤석 ( Yoon Seok Jung ) 대한외상학회 2007 大韓外傷學會誌 Vol.20 No.2
Purpose: The purpose of this clinical trial was to evaluate the fixation method for treating alveolar fractures in an emergency department. Methods: The efficiency of using the fixation method was judged on the basis of clinical criteria. Stability, occlusion state, bleeding amount after fixation, operation time, and difficulties during procedural operation were recorded. Results: Eight patients were enrolled in this study. In all instances, the fixation method was effective in bleeding control. Each patient had a noticeable decrement in bleeding. A wire was used for four of the eight patients, and nylon strings was used for the others. The average operation time was 6.3 minutes for the wire patients and 2.8 minutes for the Nylon string patients. No specific problem was identified during the procedural operation. However, the difference in the fixation material influenced the effectiveness of the procedure, the operation time, and the satisfaction of the doctor. Conclusion: In the emergency department, the fixation method using wire or nylon string in the treatment of alveolar fractures is effective in bleeding control (J Korean Soc Traumatol 2007;20:72-76)