심장이식후에 발생한 외과적 합병증 − 단일 센터 경험 − = Surgical Complications in Heart Transplant Recipients − A Single Center Experience −

다국어 초록 (Multilingual Abstract)

Background: As the patients who undergo heart transplantation have achieved better survival in recent years, a growing number of recipients are at a risk for experiencing surgical complications in addition to rejection and infection. In this paper, we report on our experience with the surgical complications that occurred in heart transplant recipients. Material and Method: From April 1994 to September 2003, 37 heart transplantations were performed at our center by a single surgeon. The indications for transplantation were dilated cardiomyopathy, ischemic cardiomyopathy, valvular cardiomyopathy and familial hypertrophic cardiomyopathy. Result: Twenty postoperative complications required surgeries in 15 patients (41%). The types of operations required were; redo-sternotomy for bleeding (5), pericardiostomy for effusion (4), implantation of a permanent pacemaker (1), right lower lobe lobectomy for aspergilloma (1), removal of urinary stone (1), cholecystectomy for gall bladder stone (1), drainage of a perianal abscess (1), paranasal sinus drainage (1), total hip replacement (1), partial gingivectomy due to gingival hypertrophy (1), urethrostomy (1), herniated intervertebral disc operation (1) and total hysterectomy for myoma uteri (1). The locations of the complications were mediastinal in 10 (27%) cases and extramediastinal in 10 (27%) cases. Conclusion: The relatively high incidence of extrathoracic complications associated with heart transplantation emphasizes the importance of a multidisciplinary approach to the improve long-term survival when managing those complex patients.

국문 초록 (Abstract)

배경: 심장이식이 최근 증가하면서 거부반응과 감염외의 외과적합병증도 증가하고 있다. 이 논문에서는 한 외과의에 실시된 심장이식후에 발생한 외과적합병증을 보고하고자 한다. 대상 및 방법: 1994년 4월부터 2003년 9월까지 실시된 37명의 심장이식환자를 대상으로 하였으며 심장이식의 적응은 확장성 심근증, 허혈성심근증, 판막심근증, 가족력심근증 등이었다. 결과: 총 15명의 이식환자에서 20예의 합병증이 발생하였으며 실시된 외과적 수술의 종류는 출혈로 인한 재개흉(5), 심낭액저류배액술(4), 인공박동기거치술(1), 아스페르질루스증에 의한 우하엽절제술(1), 요석제거술(1), 담낭제거술(1), 직장주위절개술(1), 부비동배액술(1), 고관절치환술(1), 치주비대에 의한 치주절개술(1), 뇨도절개술(1), 추간판 탈출증수술(1), 자궁근종으로 인한 자궁적출술(1)이 있었다. 합병증의 위치는 흉곽내가 10예, 흉곽외가 10예였다. 결론: 심장이식 수술후에는 흉곽 뿐만 아니라 다른 부위장기에 많은 합병증을 가져올 수 있기 때문에 장기생존율을 높이기 위해서는 다학제간의 적극적인 치료가 매우 중요하다.

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