복회음절제술후의 장폐색증에 관한 고찰

노재형,박재갑,최국진,김진복 대한대장항문학회 1992 Annals of Coloproctolgy Vol.8 No.2

소아의 소장폐색: 진단과 위치 파악에 있어 CT의 유용성

이영철,김영통,배원경,김일영 대한영상의학회 2007 대한영상의학회지 Vol.57 No.6

Purpose: To evaluate the usefulness of CT for the diagnosis of the cause and localization of small bowel obstruction. Materials and Methods: Out of a group of children who underwent a CT examination for a suspected small bowel obstruction, 19 patients with confirmed underlying disorders were identified and included in the study. Neonates and patients with duodenal obstruction were excluded from the study. The CT findings were analyzed for the location of obstruction site, abnormalities of the mesentery and mesenteric vessels, bowel wall thickening, closed loop obstruction, and strangulation. The obstruction site was divided into five parts. The preoperative CT diagnosis was compared with the final diagnosis. Results: Causes of small bowel obstruction were intussusception (n = 6), appendiceal perforation (n = 4), transmesenteric internal hernia (n = 2), postoperative bands (n = 1), idiopathic multiple bands (n = 1), a foreign body (n = 1), a small bowel adenocarcinoma (n = 1), Meckel's diverticulitis (n = 1), tuberculous peritonitis (n= 1) and Salmonella enteritis with bowel perforation (n = 1). The CT findings showed mesenteric vascular prominence (n = 13), omental or mesenteric infiltration (n = 10), localized bowel wall thickening (n = 7), closed loops obstruction (n = 3) and strangulation (n = 1). The obstruction site was identified in all cases. The causes of obstruction could be diagnosed preoperatively in 14 cases, but a preoperative diagnosis was difficult in 5 cases. Conclusion: The causes of small bowel obstruction in children are variable, and CT is useful for evaluating the cause and localization of small bowel obstruction. 목적: 소장폐색의 원인 질환 진단과 폐색 위치 확인에 CT의 진단적 유용성을 알아보고자 하였다. 대상과 방법: 소장폐색이 의심되어 CT검사를 시행한 환아 중 원인질환이 규명된 19명의 소아 환자를 대상으로 하였다. 신생아와 십이지장 폐색은 제외했다. CT 소견은 장간막과 장간막 혈관의 병변, 소장벽 비후, 막힌 장폐색, 감돈 등을 분석하여 원인질환을 진단하고 소장 폐색의 위치를 알아보았다. 폐색의 위치는 다섯 부위로 나누었다. 수술 전 진단명과 확진이 된 후의 진단명과 비교하였다. 결과: 본 연구에서 소장폐색 원인 질환은 장중첩증(n=6), 충수돌기천공(n=4), 경장간막 내 헤르니아(n=2), 수술 후 유착(n=1), 원인불명의 다발성 띠형성(n=1), 이물질(자두씨) (n=1), 소장선암(n=1), 메켈씨 게실염(n=1), 결핵성 복막염(n=1), 살모넬라장염에 의한 장천공(n=1)이었다. CT 소견은 장간막울혈(n=13), 대망 또는 장간막 침윤(n=10), 국소적 소장벽 비후(n=7)와 막힌 장폐색(n=3), 감돈(n=1)등 이었다. 소장 폐색의 위치는 CT 소견으로 모든 예(n=19)에서 알 수 있었다. 장폐색의 원인 파악은 14예(74%)에서 CT로 진단 가능 하였으며 5예에서는 진단이 어려웠다. 결론: 소아의 소장폐색의 원인은 다양하며, CT는 소장 폐색의 원인과 위치를 평가하는데 도움을 된다.

Intraoperatively Observed Lacrimal Obstructive Features and Surgical Outcomes in External Dacryocystorhinostomy

이민정,곽상인,김인혁,최정훈,최연주,김남주,정호경 대한안과학회 2017 Korean Journal of Ophthalmology Vol.31 No.5

Purpose: To analyze the features of lacrimal drainage system obstruction confirmed during external dacryocystorhinostomysurgeries and report the surgical outcomes. Methods: We reviewed the medical records of a total of 769 cases who underwent external dacryocystorhinostomyfor primary lacrimal drainage obstruction between 2005 and 2014. Data about detailed location andextent of obstruction were collected intraoperatively. The sites of obstruction were classified into nasolacrimalduct obstruction (NLDO), common canalicular obstruction (CCO), and canalicular obstruction. Lacrimalsac mucosa and lumen were grossly inspected, and the frequency of lacrimal sac changes, such as significantinflammation or fibrosis, was analyzed in cases of CCO or canalicular obstruction. The surgical successrate was also evaluated including effect of lacrimal sac status in the CCO and canalicular obstruction groups. Results: Of 769 cases, primary NLDO with patent canaliculi was diagnosed intraoperatively in 432 cases(56.2%), CCO in 253 (32.9%), and canalicular obstruction in 84 (10.9%). Of 253 cases with CCO, 122 (48.2%)showed clear lacrimal sac lumen, and the other 131 (51.8%) showed significant inflammation or fibrosis ofthe lacrimal sac. In cases with canalicular obstruction, 35 of 84 (41.7%) showed a clear lacrimal sac, and theother 49 cases (58.3%) cases revealed mucosal changes of the lacrimal sac. The functional success ratewas 87.5% for primary NLDO, 75.5% for CCO, and 72.6% for canalicular obstruction. In the CCO group, thefunctional success rate was lower in cases with significant lacrimal sac change (p = 0.044). Conclusions: Even in patients with CCO or canalicular obstruction, a large number of cases have lacrimal sacchanges, and those changes were associated with lower functional success rate.

Intraoperatively Observed Lacrimal Obstructive Features and Surgical Outcomes in External Dacryocystorhinostomy

Min Joung Lee,Sang In Khwarg,In Hyuk Kim,Jeong Hoon Choi,Youn Joo Choi,Namju Kim,Ho-Kyung Choung 대한안과학회 2017 Korean Journal of Ophthalmology Vol.31 No.5

Purpose: To analyze the features of lacrimal drainage system obstruction confirmed during external dacryocystorhinostomy surgeries and report the surgical outcomes. Methods: We reviewed the medical records of a total of 769 cases who underwent external dacryocystorhinostomy for primary lacrimal drainage obstruction between 2005 and 2014. Data about detailed location and extent of obstruction were collected intraoperatively. The sites of obstruction were classified into nasolacrimal duct obstruction (NLDO), common canalicular obstruction (CCO), and canalicular obstruction. Lacrimal sac mucosa and lumen were grossly inspected, and the frequency of lacrimal sac changes, such as significant inflammation or fibrosis, was analyzed in cases of CCO or canalicular obstruction. The surgical success rate was also evaluated including effect of lacrimal sac status in the CCO and canalicular obstruction groups. Results: Of 769 cases, primary NLDO with patent canaliculi was diagnosed intraoperatively in 432 cases (56.2%), CCO in 253 (32.9%), and canalicular obstruction in 84 (10.9%). Of 253 cases with CCO, 122 (48.2%) showed clear lacrimal sac lumen, and the other 131 (51.8%) showed significant inflammation or fibrosis of the lacrimal sac. In cases with canalicular obstruction, 35 of 84 (41.7%) showed a clear lacrimal sac, and the other 49 cases (58.3%) cases revealed mucosal changes of the lacrimal sac. The functional success rate was 87.5% for primary NLDO, 75.5% for CCO, and 72.6% for canalicular obstruction. In the CCO group, the functional success rate was lower in cases with significant lacrimal sac change (p = 0.044). Conclusions: Even in patients with CCO or canalicular obstruction, a large number of cases have lacrimal sac changes, and those changes were associated with lower functional success rate.

눈물주머니조영술에서의 눈물길 폐쇄 위치에 따른 코경유눈물주머니코안연결술의 효과

배경화(Kyoung Hwa Bae),조남천(Nam Chun Cho),안 민(Min Ahn) 대한안과학회 2018 대한안과학회지 Vol.59 No.4

Purpose: The success of endonasal dacryocystorhinostomy was assessed according to the level of tear duct obstruction in dacryocystography. Methods: Patients visited our clinic with the chief complaint of epiphora between January 2009 and September 2016 who re-ceived dacryocystography and were diagnosed with a total nasolacrimal obstruction. Among these patients, 128 eyes from 115 patients who received endonasal dacryocystorhinostomy were selected and their medical records from > 6-month follow-ups were analyzed retrospectively. The patients were divided into four groups according to the level of lacrimal passage obstruction in dacryocystography: common canaliculus obstruction as group 1, lacrimal sac obstruction as group 2, lacrimal sac-nasolacri-mal duct junction obstruction as group 3, and nasolacrimal duct obstruction as group 4. Success and failure were determined ac-cording to symptom improvements after surgery. Results: Among the total of 128 eyes, 19 eyes were categorized as group 1 (22.6%), 28 eyes as group 2 (21.9%), 28 eyes as group 3 (21.9%), and 43 eyes as group 4 (33.6%). Nasolacrimal duct obstruction was the most common condition. The success of endonasal dacryocystorhinostomy was 55.2% in group 1, 71.4% in group 2, 85.7% in group 3, and 86.1% in group 4. The surgical success of the patient group with common canaliculus obstruction was significantly lower than the surgical success of the lacrimal sac-nasola-crimal duct junction obstruction and nasolacrimal duct obstruction groups (p = 0.03 and p = 0.01, respectively). Conclusions: Determination of the accurate position of obstruction using preoperative dacryocystography is recommended for patients with epiphora caused by tear duct obstruction because this predicted the effects of endonasal dacryocystorhinostomy. 목적: 눈물주머니조영술은 눈물길 폐쇄 위치와 정도를 한눈에 보기에 편한 검사법으로 이에 따른 눈물길 폐쇄 위치가 코경유눈물주머니코안연결술의 성공률과 관련이 있는지 알아보고자 한다. 대상과 방법: 2009년 1월부터 2016년 9월까지 눈물흘림을 주소로 본원 안과에 내원하여 눈물주머니조영술을 받고, 눈물길 완전폐쇄를 진단받은 환자 중 코경유눈물주머니코안연결술을 받은 115명 128안을 6개월 이상 추적 관찰한 의무기록을 후향적으로 조사하였다. 눈물주머니조영술에서 눈물길 폐쇄 위치에 따라 환자를 네 군으로 분류하였다. 공동눈물소관 폐쇄 1군, 눈물주머니 폐쇄 2군, 눈물주머니-코눈물관 연결부 폐쇄 3군, 코눈물관 폐쇄는 4군으로 하였으며 수술 후 증상 호전 여부에 따라 성공과 실패를 판단하였다. 결과: 전체 128안 중 1군 19안(22.6%), 2군 28안(21.9%), 3군 28안(21.9%), 4군 43안(33.6%)으로 코눈물관 폐쇄를 보인 환자의 비율이 가장 많았다. 폐쇄 부위별 코경유눈물주머니코안연결술 성공률은 1군 55.2%, 2군 71.4%, 3군 85.7%, 4군 86.1%였다. 이 중 공동눈물 소관 폐쇄 환자군의 수술 성공률은 눈물주머니-코눈물관 연결부위 폐쇄 환자군과 코눈물관 폐쇄 환자군의 수술 성공률에 비하여 통 계학적으로 유의하게 낮았다( p =0.03, p =0.01). 결론: 눈물길 폐쇄에 의한 눈물 흘림 환자에서 수술 전 눈물주머니조영술은 눈물길 폐쇄 위치를 파악함으로써, 코경유눈물주머니코안 연결술의 효과를 예측하는 데 도움이 된다.

Palliative Care of Malignant Ureteral Obstruction with Polytetrafluoroethylene Membrane-Covered Self-Expandable Metallic Stents: Initial Experience

김재한,송강현,조문기,박종욱 대한비뇨의학회 2012 Investigative and Clinical Urology Vol.53 No.9

Purpose: We assessed the efficacy and safety of insertion of a polytetrafluoroethylene membrane-covered self-expandable metallic stent (UVENTA stent) for palliation of malignant ureteral obstruction on the basis of our early results. Materials and Methods: Eighteen patients underwent UVENTA stent insertion for extrinsic malignant ureteral obstructions of 20 ureters. The UVENTA stents were deployed retrogradely under cystoscopy and fluoroscopy. Candidates for the procedure had preexisting double-J stents that were nonfunctional or caused excessive bladder irritation. We recorded the success and patency rate in addition to any complications associated with the procedure. Results: The mean length of obstruction was 10.6 cm (range, 2 to 20 cm). Two ureters were obstructed in the upper ureter, 9 in the lower ureter, and 9 in multiple levels of ureter. Simultaneous balloon dilation was performed in 12 ureters. UVENTA stents were successfully inserted in all patients. No obstruction of the UVENTA stents occurred during the mean follow-up period of 7.3 months (patency rate 100%), but de novo ureteral obstruction developed in 4 ureters. There were no instances of stone formation, hyperplastic reaction, encrustation, or migration. Abnormally elevated serum creatinine decreased to normal levels and hydronephrosis gradually resolved during the 4 weeks after UVENTA insertion. No significant complications developed except for transient and self-limiting hematuria and mild lower abdominal pain. Conclusions: UVENTA stents may relieve malignant ureteral obstruction safely and easily. Long-term follow-up is necessary to assess the role of this stent in the treatment of malignant ureteral obstruction. Purpose: We assessed the efficacy and safety of insertion of a polytetrafluoroethylene membrane-covered self-expandable metallic stent (UVENTA stent) for palliation of malignant ureteral obstruction on the basis of our early results. Materials and Methods: Eighteen patients underwent UVENTA stent insertion for extrinsic malignant ureteral obstructions of 20 ureters. The UVENTA stents were deployed retrogradely under cystoscopy and fluoroscopy. Candidates for the procedure had preexisting double-J stents that were nonfunctional or caused excessive bladder irritation. We recorded the success and patency rate in addition to any complications associated with the procedure. Results: The mean length of obstruction was 10.6 cm (range, 2 to 20 cm). Two ureters were obstructed in the upper ureter, 9 in the lower ureter, and 9 in multiple levels of ureter. Simultaneous balloon dilation was performed in 12 ureters. UVENTA stents were successfully inserted in all patients. No obstruction of the UVENTA stents occurred during the mean follow-up period of 7.3 months (patency rate 100%), but de novo ureteral obstruction developed in 4 ureters. There were no instances of stone formation, hyperplastic reaction, encrustation, or migration. Abnormally elevated serum creatinine decreased to normal levels and hydronephrosis gradually resolved during the 4 weeks after UVENTA insertion. No significant complications developed except for transient and self-limiting hematuria and mild lower abdominal pain. Conclusions: UVENTA stents may relieve malignant ureteral obstruction safely and easily. Long-term follow-up is necessary to assess the role of this stent in the treatment of malignant ureteral obstruction.

Prenatal MRI Findings of Fetuses with Congenital High Airway Obstruction Sequence

Carolina V. A. Guimaraes,Leann E. Linam,Beth M. Kline-Fath,Lane F. Donnelly,Maria A. Calvo-Garcia,Eva I. Rubio,Jeffrey C. Livingston,Robert J. Hopkin,Elizabeth Peach,Foong-Yen Lim,Timothy M. Crombleho 대한영상의학회 2009 Korean Journal of Radiology Vol.10 No.2

Objective: To define the MRI findings of congenital high airway obstruction sequence (CHAOS) in a series of fetuses. Materials and Methods: Prenatal fetal MR images were reviewed in seven fetuses with CHAOS at 21 to 27 weeks of gestation. The MRI findings were reviewed. The MRI parameters evaluated included the appearance of the lungs and diaphragm, presence or absence of hydrops, amount of amniotic fluid, airway appearance, predicted level of airway obstruction, and any additional findings or suspected genetic syndromes. Results: All the fetuses viewed (7 of 7) demonstrated the following MRI findings: dilated airway below the level of obstruction, increased lung signal, markedly increased lung volumes with flattened or inverted hemidiaphragms, massive ascites, centrally positioned and compressed heart, as well as placentomegaly. Other frequent findings were anasarca (6 of 7) and polyhydramnios (3 of 7). MRI identified the level of obstruction as laryngeal in five cases and tracheal in two cases. In four of the patients, surgery or autopsy confirmed the MRI predicted level of obstruction. Associated abnormalities were found in 4 of 7 (genetic syndromes in 2). Postnatal radiography (n = 3) showed markedly hyperinflated lungs with inverted or flattened hemidiaphragms, strandy perihilar opacities, pneumothoraces and tracheotomy. Two fetuses were terminated and one fetus demised in utero. Four fetuses were delivered via ex utero intrapartum treatment procedure. Conclusion: MRI shows a consistent pattern of abnormalities in fetuses with CHAOS, accurately identifies the level of airway obstruction, and helps differentiate from other lung abnormalities such as bilateral congenital pulmonary airway malformation by demonstrating an abnormally dilated airway distal to the obstruction. Objective: To define the MRI findings of congenital high airway obstruction sequence (CHAOS) in a series of fetuses. Materials and Methods: Prenatal fetal MR images were reviewed in seven fetuses with CHAOS at 21 to 27 weeks of gestation. The MRI findings were reviewed. The MRI parameters evaluated included the appearance of the lungs and diaphragm, presence or absence of hydrops, amount of amniotic fluid, airway appearance, predicted level of airway obstruction, and any additional findings or suspected genetic syndromes. Results: All the fetuses viewed (7 of 7) demonstrated the following MRI findings: dilated airway below the level of obstruction, increased lung signal, markedly increased lung volumes with flattened or inverted hemidiaphragms, massive ascites, centrally positioned and compressed heart, as well as placentomegaly. Other frequent findings were anasarca (6 of 7) and polyhydramnios (3 of 7). MRI identified the level of obstruction as laryngeal in five cases and tracheal in two cases. In four of the patients, surgery or autopsy confirmed the MRI predicted level of obstruction. Associated abnormalities were found in 4 of 7 (genetic syndromes in 2). Postnatal radiography (n = 3) showed markedly hyperinflated lungs with inverted or flattened hemidiaphragms, strandy perihilar opacities, pneumothoraces and tracheotomy. Two fetuses were terminated and one fetus demised in utero. Four fetuses were delivered via ex utero intrapartum treatment procedure. Conclusion: MRI shows a consistent pattern of abnormalities in fetuses with CHAOS, accurately identifies the level of airway obstruction, and helps differentiate from other lung abnormalities such as bilateral congenital pulmonary airway malformation by demonstrating an abnormally dilated airway distal to the obstruction.

대장암 환자의 수술 전 내시경적 폐색이 수술 후 예후에 미치는 영향

나영현(Young Hyun Na),이선일(Sun Il Lee),강상희(Sang Hee Kang),홍광대(Kwang Dae Hong),문홍영(Hong Young Moon) 대한종양외과학회 2012 Korean Journal of Clinical Oncology Vol.8 No.2

목적 : 대장암의 재발 고위험인들 중 장폐색 여부는 수술 전 예측 가능하여 환자 선별과 수술전 치료의 도입에 중요한 선택인자가 되리라 여겨지나, 그 동안 임상적 기계적 장폐색에 비해 부분적 폐색 혹은 내시경적 폐색에 대한 연구가 많지 않아. 연구자들은 내시경적 장폐색 유무가 미치는 영향을 연구하였다. 대상 및 방법 : 2003년 1월 1일부터 2006년 12월 31일까지 단일 병원에서 근치적 절제수술을 받은 대장암 환자 들 중 2기 및 3기 환자 315명을 대상으로 후향적 연구를 시행하였으며 폐색의 임상소견이 없으나 대장 내시경이 종양의 근위부로 통과하지 못하는 경우를 내시경적 폐색으로 정의하였다. 결과 : 남녀비는 1.4:1이었으며 평균연령은 62.0세였다. 폐색 여부에 따라 비교하였을 때, 종양의 크기와 위치, 침윤도, 수술전 CEA(carcinoembryogenic antigen)는 유의한 차이를 보였으나 림프절 전이 여부는 유의하지 않았다. 또한, 폐색성 결장암의 41.1%가 침윤형 혹은 윤형이었으며 이는 비폐색성 결장암의 23.4%에서만 관찰되었다 (p<0.05). 5년 무병생존율은 85.8%(2기)와 70.7%(3기)였으며 2기 및 3기 결장암과 3기 직장암에서는 폐색여부에 따른 차이가 없었으나, 2기 직장암에서는 유의한 차이를 보였다. 결론 : 내시경적 폐색은 2기 직장암에서 유의한 재발 위험 인자로 추정되는 바, 이러한 환자들에 대해 수술전 방사선 치료 등의 추가적 요법을 고려해야 하겠다. Purpose : The colorectal cancer has better prognosis rather than other gastrointestinal malignancy by the development of operation procedure and adjuvant therapy. But the high-risk patients have a high recurrence rate and a poor prognosis, so more interest and the development of new treatment modality for high-risk patients is needed. Now some high-risk factors of the colorectal cancer ? lymph node metastasis and lymphatic/vascular invasion ? were difficult to estimate preoperatively. The colon obstruction is considered to be a factor which is predictable preoperatively and helpful for patient. There were fewer studies about oncologic outcome of partial or endoscopic colon obstruction than complete colon obstruction, so we investigate the prognostic impact of endoscopic obstruction on colorectal cancer. Materials and Methods : Retrospective analysis of 317 patients with surgically resected stage Ⅱ and Ⅲ colorectal cancer in Korea University Guro Hospital from 1st January 2003 to 31st December 2006 was performed for preoperative colon obstruction and postoperative prognosis. Statistical analysis was performed using SPSS® 12.0 Chi-square test and t-test were used for comparing each variables. OS analysis was performed using Kaplan-Meier curves with long-rank testing. P<0.05 was considered statistically significant. Result : Gender (Male : Female) of whole patients was 1.4:1. Mean age was 62.0(year). Comparison of clinical features and pathologic findings according to the presence of obstruction demonstrated a significant difference in size, location, infiltration, and preoperative CEA (carcinoembryogenic antigen), yet showed no major difference in age, sex, the timing of surgery, and lymph node metastasis. When the left colon was compared with the right colon while excluding the rectum, difference was found between the sizes of the tumor, but no difference was found in the presence of obstruction. According to the comparison based on the shape of the tumor, 41.1% of the obstructive colon cancer was infiltrating or encircling, and these findings were observed in 23.4% of nonobstructive colon cancer (p<0.05). There were 69 recurrences during the monitoring, and the 5-year disease-free survival rate for stage Ⅱ and stage Ⅲ were 85.5% and 70.7% respectively. Comparing the disease-free survival rate according to the location of the lesion and presence of obstruction, it showed no difference in stage Ⅲ colon and rectal cancer, but a significant difference was found in stage Ⅱ rectal cancer. When compared according to the types of obstruction, the 5-year disease-free survival rates for no obstruction, endoscopic obstruction, and complete obstruction were 77.2%, 70.9%, and 67.1%, respectively. There were no differences between them. Conclusion : Endoscopic obstruction is a significant risk factor for recurrence in stage Ⅱ rectal cancer compared to colon cancer and for those patients, adjuvant treatment such as pre-operative radiotherapy is needed.

중심 정맥 폐쇄에서의 나선식 CT 정맥조영술

정진욱 대한영상의학회 1998 대한영상의학회지 Vol.39 No.5

Purpose : To determine the clinical usefulness of spiral computed tomographic (CT) venography for the evaluation of central venous obstruction. Materials and Methods : The authors prospectively performed a total of29 spiral CT venography procedures in 25 consecutive patients with suspected central venous obstruction. Diluted contrast media were directly injected into the peripheral veins of the hand or the foot. Scan parameters were 3mmX-ray beam collimation, table speed of 4-6 cm/sec, scan time of 32-40 sec, and injection delay of 20 sec. Axial images were reconstructed at 2-mm intervals, and using shaded surface display (SSD), maximum intensity projection(MIP), and multiplanar reformation (MPR), 3-D reconstruction was performed. In all cases, ascending venograp-hy(n=13) and/or direct catheter venography (n=21) was performed within 2 days of CT venography. With regard to site, extent, extent, severity, and cause of obstruction and collateral circulation, we compared the results of CT and contrast venography. Results : In 24 patients, a total of 56 sites of central venous obstruction or stenosis (>50%) were demonstrated. The causes of obstruction were venous thrombosis(n=6), malignant tumors (n=4),arteriovenous fistula for hemodialysis(n=5), extrinsic compression(n=2), coincidence of extrinsic compression and arteriovenous fistula (n=1), pacemaker (n=1), mediastinal inflammatory pseudotumor (n=1), spinal tuberculosis(n=1), membranous obstruction of the hepatic inferior vena cava (n=1), Behcet's disease (n=1), or unknown cause(n=1). When compared with ascending venography (n=13), CT venography was superior for evaluation of the extent and cause of obstruction and collateral circulation in two, four and one case(s), respectively. For the evaluation of site and severity of obstruction, CT venography was equal to ascending venography. In two cases, direct catheter venography (n=21) was superior to CT venography for evaluating the obstruction site, but in three, five and one case(s) respectively, CT venography was superior to direct catheter venograp-hy for evaluating the extent and cause of obstruction and collateral circulation. For the evaluation of severity of obstruction, CT and direct catheter venography were equal. Conclusion : In patients with suspected central venous obstruction, spiral CT venography can be an alternative to replace not only conventional CT but also direct contrast venography.

수술후 장폐쇄 환자에서 감압목적의 Miller-Abbott 관을 통한 소장관장법의 유용성

이명환 대한영상의학회 1996 대한영상의학회지 Vol.34 No.2

Purpose : The purpose of this study is to assess the efficacy of enteroclysis through the previously insertedMiller-Abbott (M-A) tube for decompression in the postoperative intestinal obstruction. Materials & Methods : Thisstudy includes twenty patients who had intestinal obstruction symptoms after operation for benign(12) ormalignant(8) abdominal lesions. Small amount of barium was introduced to M-A tube for enteroclysis. We evaluatedthe presence, level, degree, and causes of obstruction on enteroclysis, compared with surgical(11) and clinical(9)findings. Results : Obstruction was seen in 18 cases including the two cases in which the level of obstruction wasnot clear. There was no obstruction in two cases. Obstruction on enteroclysis was demonstrated in all 11 operatedcases(100% accuracy, 11\11). The level of obstruction on enteroclysis were jejunum in three cases, ileum in seven,and colon in one case. The levels of obstruction on enteroclysis were matched with those in operation field in 10cases. There were two cases of nonobstruction, nine cases of low-grade partial obstruction, and nine cases ofhigh-grade partial obstruction. We analyzed the findings on enteroclysis regarding causes of obstruction in 16patients with the findings of adhesive bands of extrinsic cause(9), cancer recurrence of intrinsic cause(6), andbezoar of intraluminal cause(1). Misinterpreted cases were two cases(87.7% accuracy, 14/16). The cause, fornonvisualization of obstruction site on enteroclysis in four patients included technical failure such asinadequate location of tube(1) and bowel overlapping(1), minimal obstruction(1), and nonexistent obstruction(1),in spite of diffuse edematous mucosa. Conclusion : Enteroclysis through the M-A tube for decompression in patientswith postoperative intestinal obstruction is an useful method for evaluation of intestinal obstruction.