혈액투석환자의 중심정맥 폐색: 경피적 치료의 유용성

구동억,김대호,홍현숙,이혜경,최득린,Gu, Dong-Eok,Kim, Dae-Ho,Hong, Hyeon-Suk,Lee, Hye-Gyeong,Choe, Deuk-Rin 대한영상의학회 2002 대한영상의학회지 Vol.46 No.4

Purpose: To analyse the effectiveness of percutaneous treatment of central venous obstruction in patients undergoing hemodialysis. Materials and Methods: In 100 patients, 107 central venous strictures [56 subclavian (occlusion:21, stenosis:35) and 51 innominate (occlusion:23, stenosis:28)] were assessed, and 170 percutaneous angioplasty procedures were performed. Balloon dilation of the venous lumen was the preferred mode, but if dilation was incomplete we inserted a stent at the site of the stricture. Technical success, procedural complications and the long-term patency rate were evaluated, and the patency difference according to location and degree of stricture, the existence of DM, and any history of central catheter insertion were also determined. Results: We inserted 52 stents in 170 procedures, in 157 (92.4%) of which initial technical success was achieved. Stent migration occurred in two cases and balloon rupture in three. The 6- and 12-month primary patency rates were 46.2% and 24.1%, respectively, and the mean patency rate was 8.5 months. The 1-, 2- and 3-year accumulative patency rates were 59.8%, 47.5% and 35.7%, respectively, and the mean patency rate was 23.5 months. Other than in the history of central catheter insertion, there were no statistically significant differences in patency rates (p=0.0128). Conclusion: In hemodialysis patients with a central venous stricture, percutaneous angioplasty is a safe and useful procedure, but to maintain long-term central venous patency, repeated interventions are required. 목적: 혈액투석 환자에서 발생한 중심정맥 협착에 대한 경과적 치료의 유용성에 대하여 알아보고자 한다. 대상과 방법: 중심정맥 협착을 가진 100명 107정맥을 대상으로 하였으며 쇄골하정맥 협착은 56명 (폐쇄:21, 협착:35), 무명정맥 협착은 51명(폐쇄:23, 협착:28)이었고, 총 170회 경피적 확장술을 시행하였다. 풍선확장술을 먼저 시행하였고 충분한 내경을 확보할 수 없는 경우에는 stent를 삽입하였다. 기술적 성공을, 합병증 및 장기 개통을 구하였으며 협착의 위치, 완전 폐쇄 여부, 당뇨 유무, 중심관 삽입력 여부에 따른 개통율에 차이가 있는지를 조사하였다. 결과: 170회 시술 중 52회에서 stent를 삽입하였다. 157회(92.4%)에서 기술적으로 성공하였고 2예에서 stent 이탈, 3예의 풍균 개통을 보였다. 1년, 2년, 3년 누적 개통율은 각각 59.8, 47.5, 35.7%이며 평균 23.5개월의 개통율을 보였다. 중심관 삽입력 (p=0.128)을 제외하고는 개통율에 통계적 의의는 없었다. 결론: 혈액투석환자의 중심정맥 협착에 대한 경피적 치료는 안전하고 유용하지만 장기적인 개통성을 유지하기 위해서는 반복적인 시술에 필요하다.

경내경정맥 간생검의 유용성

구동억 대한영상의학회 1997 대한영상의학회지 Vol.37 No.3

Purpose:To evaluate the usefulness of transjugular liver biopsy(TJLB), and possible complications. Materials and Methods:During a three-year period, TJLB was performed in 21 patients. Through the right internal jugular vein, a 9F sheath was introduced into the right hepatic vein, and using Mansfield forceps, biopsy was then performed. Results:Reasons for TJLB included massive ascites in six patients, coagulopathy in nine, thrombocytopenia in five, and other causes in one. In 20 cases, we obtained liver tissue, and pathologic diagnosis was possible in 17;in three cases, the amount of biopsy tissue obtained was indufficient for pathologic diagnosis. In one patient with Budd-Chiari syndrome, we were unable to catheterize the right hepatic vein and failed to obtain liver tissue. Complications occured in five patients, as follows:hematoma formation at the puncture site in one patient, and pain at the pu cture site, lasting 24 hours, in four. Conclusion:TJLB may be a safe and useful method in patients in whom percutaneous liver biopsy is contraindicated.

공동을 동반한 단일 폐결핵종의 전산화단층촬영 소견

구동억 대한영상의학회 1994 대한영상의학회지 Vol.31 No.3

혈액투석환자의 중심정맥 협착에서 covered stent의 유용성

구동억 순천향대학교 의학연구소 2007 Journal of Soonchunhyang Medical Science Vol.13 No.2

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흰쥐 신장에서 Transglutaminase 1, 2, 3 발현에 관한 면역조직화학적 연구

구동억,김원식,박경란,2이증훈,이웅재,노승무,김수열 대한해부학회 1999 Anatomy & Cell Biology Vol.32 No.2

방사선검사 동영상제작을 통한 고객의 검사 만족도 증진

구동억,권재현,박동웅,이수희,이광희,유지수,박재준,채광수,백용환,김현진,김준배,이상규,이종권,변명숙,황의성,신주철,홍진방 한국의료QA학회 2005 가을학술대회 Vol.2005 No.2

인조혈관 동정맥루 혈전증에서 Desilets-Hoffman Sheath를 이용한 혈전흡입술의 유용성

구동억,김정훈,박성태,장윤우,황정아,권귀향,최득린,문철 대한영상의학회 2004 대한영상의학회지 Vol.51 No.1

Purpose: The purpose of this study was to evaluate the feasibility, efficacy and safety of percutaneous thromboaspiration with a Desilets-Hoffman Sheath compared with the previously established percutaneous mechanical thrombectomy technique in cases of occluded dialysis graft. Materials and Methods: One hundred and sixty eight patients (103 women, 65 men; mean age, 54.7 years; mean graft age, 20.9 months) with 225 episodes of dialysis graft thrombosis underwent percutaneous thromboaspiration with a 7F Desilets-Hoffman sheath using the crossing catheter or single puncture technique. The technical success rate, procedure time, and complication and patency rates were analyzed. Results: Technical success was achieved in 200 of the 225 procedures (88.9%). The average duration of the intervention was 74.3±35 minutes. The primary patency rate was 63.1% at 3 months, 44.2% at 6 months and 26.3% at 1 year. Major complications occurred in 4% of the cases (4 venous ruptures; 4 arterial embolisms; 1 arterial rupture) and minor complications occurred in 13.8% of the cases (26 minor venous ruptures; 4 intragraft ruptures; 1 venous dissection). These results were quite similar to those obtained with the previous mechanical thrombectomy technique. Conclusion: Percutaneous thromboaspiration of occluded dialysis grafts with a Desilets-Hoffman Sheath is an effective and safe method. 목적: 혈전으로 막힌 혈액투석용 인조혈관에서 Desilets-Hoffman Sheath를 이용한 경피적 혈 전흡입술의 유용성과 안전성을 보고된 여러 가지 기구를 이용한 기계적 혈전제거술과 비교하 여 평가하고자 한다. 대상과 방법 : 168명(여자 103명, 남자 65명; 평균나이, 54.7세; 인조혈관 평균 사용기간, 20.9 개월)의 혈액투석용 인조혈관 혈전환자에서 7F Desilets-Hoffman Sheath을 이용하여 교차 도관법이나 첨부 천자법으로 225회 경피적 혈전흡입술을 시행하였다. 기술적 성공률, 시술 시 간, 합병증 및 개통률에 대하여 기존의 기계적 혈전제거술과 비교 분석하였다. 결과: 기술적 성공률은 88.9%(200/225회)이며 평균 시술시간은 74.3±35분이었다. 일차 개 통률은 3개월에 63.1%, 6개월에 44.2%, 1년에 26.3%이었다. 중요 합병증은 4%(정맥파열 4 예, 동맥 색전증 4예, 동맥 파열 1예)이며 경미한 합병증은 13.7%(경미한 정맥파열 26예, 인 조혈관 파열 4예, 정맥 내막박리 1예)이었다. 이러한 결과는 기존의 기계적 혈전제거술과 비 슷하였다. 결론: Desilets-Hoffman Sheath를 이용한 혈액투석용 인조혈관의 경피적 혈전흡입술은 유용 하고 안전한 방법이다.

혈액투석 인조혈관의 인터벤션치료 후 생존율: 협착군과 혈전 군 간에 차이가 있는가?

구동억 순천향대학교 의학연구소 2009 Journal of Soonchunhyang Medical Science Vol.14 No.3

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소아 급성 산재성 뇌척수염의 자기공명영상 소견

구동억 대한영상의학회 1995 대한영상의학회지 Vol.33 No.4

Purpose : To evaluate MR characteristics of acute disseminated encephalomyelitis (ADEM) in children, which wasconfirmed by clinical findings. Materials & Methods : The subjects were six patients, who were diagnosed byclinical findings. One subject had recurrence one year after clinical leading to one additional care with thetotal of seven. The modes of viral infections were as follows ; four cases of non-specific upper respiratory tractinfection, one of E-B virus, one of Japanese-B-encephalitis vaccination, and one of upper respiratory infection inBruton's disease. The Gd-DTPA enhanced scan was performed in all cases. MR findings were evaluated in anatomiclocation of the lesions, presence or absence of contrast enhancement, and the temporal changes were also evaluatedon follow-up MRI. Result : There were multifocal high signal intensity lesions on T2WI in all cases. The locationof lesions were basal ganglia in five, thalamus and brain stem in four, and cerebral gray and white matter andcerebellar white matter in three. Bilaterality was 77%. There were contrast enhancement in two of three cerebralcortical lesions and one of three white matter lesions. The size of lesions decreased on the first follow-up MRIwhich were done after 1 month in 4 cases, but new lesions were developed in two cases. On the second follow-up MRIwhich were done 2 months after, all lesions were decreased in size and there was no newly developed lesion.However, in one case who had recurrent similar symptom after 1 year, several new lesions developed on follow-upMRI, and it was concluded as a recurrence. Conclusion : The characteristic MR findings of ADEM were multifocalbilateral white and gray matter lesions which were high signal intensities on T2WI. The majority of lesionsimproved on follow-up MRI, but occasionally showed multiphasic pattern.

무명정맥에서 상대정맥으로 이탈된 자가팽창형 stent의 경피적 제거

구동억 순천향의학연구소 2004 Journal of Soonchunhyang Medical Science Vol.10 No.2

Self expandable stents are being used increasingly in conjunction with balloon dilatation for trearment of innominate vein stenosis. Stent misplacement or migration is a complication of the procedure, and may be symptomatic and warrant repositioning or removal. We report the case of a patient whose innominate vein stenosis was managed with self expandable stent and was complicated by embolization of stent into the superior vena cava. This report illustrates percutaneous endovascular removal of a migrated stent from the superior vena cava using a Goose neck snare