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소화성 궤양 천공의 복강경하 일차 봉합술과 개복 일차 봉합술의 비교
최건무,곽진호,장혁재,한명식,김지훈 대한내시경복강경외과학회 2009 Journal of Minimally Invasive Surgery Vol.12 No.2
Purpose: Simple closure, regardless of using an omental patch, continues to be the preferred option for many surgeons. It is a easy, quick and safe operation, and it can be applied to all situations by every surgeon. The purpose of this study was to investigate the feasibility of routinely using laparoscopic repair for treating perforated peptic ulcer. Methods: A retrospective review was carried out on 68 consecutive patients who underwent patch repair for a perforated peptic ulcer; 11 underwent laparoscopic repair and 57 underwent open repair. Laparoscopic repair was performed by one surgeon at the same hospital between March, 2006 and February, 2009. Both groups were compared according to the Mann-Whitney U-test. A p value<0.05 was considered to be significant. Results: Statistical significance (p<0.05) between two groups (laparoscopic vs. open) was present regarding to the postoperative morbidity (0 vs. 16 cases, respectively), the hospital stay (4.8 vs. 12.7 days, respectively), the postoperative day of resuming an oral diet (3 vs. 5.7 days, respectively). The mean operative time of laparoscopic repair (78 minutes) was shorter than that of open repair (82 minutes) but this was not statistically significant (p=0.81). We excluded using a pain scale or assessing the use of analgesics in this study because of the popularity of IV PCA (intravenous patient-controlled analgesia). Conclusion: Laparoscopic primary repair is a safe emergency procedure for treating perforated peptic ulcer patients.
최건무,곽재영 대한응급의학회 2014 大韓應急醫學會誌 Vol.25 No.3
Purpose: The main purpose of this study was to achieve abroad perspective of the clinical problem with regard to itsoverall presentation and relation to anticoagulant andantiplatelet therapy, and to describe common managementstrategies and clinical outcomes. Methods: We initially screened 262 patients who wereadmitted from the Emergency Department between June,1996 and June, 2013, with International Classification ofDiseases code of K66.1 (hemoperitoneum), R58 (retroperitonealhemorrhage) and D68.3 (hemorrhagic disorder dueto anticoagulants). We excluded patients with retroperitonealhemorrhage (RH) associated with trauma, vascularlesions, tumors, liver cirrhosis, renal failure, and surgicalcomplications. A total of 24 adult patients were found tohave retroperitoneal hematoma due to spontaneous lumbarartery rupture and were included in the study for furtheranalysis. Results: Male to female ratio was 14:10 and the mean agewas 75.3±10.4 years old. Overall, 19 patients (79.1%)were taking warfarin, 20 patients (83.3%) were takingaspirin and/or clopidogrel, and 15 patients (62.5%) weretaking both anticoagulant and antiplatelet medications. Themost common presenting symptom was acute back pain. CT scan showed extravasation of contrast in 20 patients. The mean hematoma size was 12.5±6.4 cm. Elevenpatients (55%) underwent arterial embolization and 22patients (91.6%) received blood transfusion. No surgicalintervention was performed. Conclusion: Retroperitoneal hematomas caused by spontaneousrupture of the lumbar artery showed a strong associationwith use of anticoagulant and/or antiplatelet therapy. For patients, particularly elderly patients, who present withacute back pain or hemodynamic instability and who are onanticoagulant and/or antiplatelet therapy, ER physiciansshould consider retroperitoneal hematoma as a differentialdiagnosis and to rule it out vigilantly.