복벽 출혈에서 색전술의 유용성

Abstract

요 약 복벽 출혈에 대한 색전술은 비교적 효과적이고 안전한 시술이다. 시술 전 복부 CT를 시행하여 출 혈의 위치와 정도를 파악하는 것이 효과적인 색전술에 도움이 되며 조영제의 유출이 있는 경우 경도 자 색전술을 시행하고 거짓동맥류일 경우에는 일차 적으로 초음파 유도 하에 피부 경유 트롬빈 주입술 을 시행한다. 또한 이러한 복벽 동맥의 손상을 방지 하기 위해 복벽 동맥의 주행 경로를 숙지하고 있어야 하며 복벽을 통한 시술이나 기구 삽입 시 먼저 환자의 지혈기전의 문제, 항혈전제 복용 여부 등을 인지하고 있어야 한다.

Abdominal wall hemorrhage is rare. It can occur spontaneously or as results of surgical trauma, paracentesis, catheter removal, and drainage procedure. Although most patients can be treated with supportive care, abdominal wall hemorrhage often requires embolization of the bleeding vessel or surgery for cases that do not respond to conservative treatment. Herein, we retrospectively analyzed all consecutive patients who underwent embolotherapy for treatment of abdominal wall hemorrhage between May 2004 and July 2009. Thirteen women and two men were included and mean age was 53 years (range, 30-77 years). The injured vessels were treated with transcatheter embolization in thirteen and with percutaneous thrombin injection in two. The causes of abdominal wall hemorrhage were surgical trauma, paracentesis, percutaneous catheterization, and spontaneous hemorrhage, in 7, 4, 3, and 1 patient, respectively. The hemorrhage was manifested as contrast leakage and pseudoaneurysm in 12 and 3 patients, respectively. The technical and clinical success rates of the embolotherapy were 100% and 93%, respectively. In conclusion, the embolotherapy for the treatment of abdominal wall hemorrhage is highly effective and safe.