간이식에 있어서 간동맥 재건을 위한 특수 미세혈관수술교육의 효과 : 미세수술교육부터 임상적용까지
 = Effect of Microsurgery Training Program for Hepatic Artery Reconstruction in Liver Transplantation / 허위광

 
저자 허위광
형태사항 iv, 19 p. : 삽도 ; 26 cm.
일반주기 참고문헌 : p. 15-17
학위논문사항 학위논문(석사)-- 아주대학교 일반대학원 : 의학과 2010. 2
DDC 610 22
발행국 경기도
언어 한국어
출판년 2010
소장기관 아주대학교 도서관

 
초록
(배경 및 목적) 생체부분간이식 시 간동맥 재건에 미세수술수기가 도입되면서 간동맥 합병증이 3.8%까지 줄었다는 보고들이 있다. 그러나 대부분의 센터에서 간이식 프로그램의 시작 단계에서 성형외과나 정형외과 등 일반외과 이외의 미세수술담당의의 도움을 받게 되는 것이 보편적인 경향이다. 본원에서도 성인생체간이식을 시작한 2005 년 2 월부터 2008 년 6 월까지 성형외과 미세수술의의 도움을 받아 간동맥재건을 하였고, 점차 간이식 예가 증가함에 따라 간외과 자체 미세수술의의 필요성이 대두되어 미세수술에 경험이 없는 일반외과의를 미세수술수기 단기교육 후 간동맥 재건 미세수술에 투입하는 시도를 하여 그 결과를 보고하는 바이다. (대상 및 방법) 2005 년 2 월부터 2009년 7 월까지 본원에서 진행한 176 명의 간이식 환자를 연구대상으로 진행하였다. 그 중 2005 년 2 월부터 2008 년 6 월까지 총 148 예의 간동맥 재건을 3 명의 성형외과 미세수술의가 시술하였고(Group A), 2008 년 7 월부터 2009 년 7 월까지 총 28 예의 간동맥 재건을 미세수술교육을 받은 일반외과의가 시행하였다(Group B).일반외과의는 간동맥 재건에 투입되기 전 3 개월간 수술실과 같은 현미경을 갖춘 본원 간이식센터 동물실험실에서 미세수술 기본교육을 받으면서 백서의 복부대동맥문합실험을 최소 주 3 회 지속적으로 반복 숙달하였다. 이와 동시에 간이식 수술시에 성형외과 미세수술의의 간동맥 재건시술에 제 1 조수로 투입되었다. 2008 년 7 월부터 일반외과수술의는 독자적으로 간이식술시에 간동맥 재건을 담당하기 시작하여 현재에 이르렀다. 두군 모두에서 간동맥 재건은 수술현미경(OP MICS-1 on floor stand S4) 시야 하에서 시행되었다. 봉합사는 8-0 혹은 9-0 나일론사를 이용하여 비연속 단-단문합을 시행하였다. 간동맥 재건 후 술중 도플러 초음파검사로 동맥혈류를 확인하였으며, 수술 후 7 일간 매일 간기능 검사와 더불어 도플러 초음파를 시행하여 간동맥상태를 확인하였다.(결과) Group A 의 경우에 33 예에서 좌간 이식편을, 73 예에서 우간 이식편을,그리고, 6 예에서 dual grafts 를 이용한 생체간이식이 시행되었고, 36 예는 뇌사자 전간이식을 시행하였다. Group B 의 경우에는 1 예에서 좌간 이식편을, 21 예에서 우간 이식편을 이용하여 생체간이식을 시행하였고, 6 예는 뇌사자 전간이식을 시행하였다. Group A 에서는 5 예에서 간동맥 합병증이 발생하였고(3.3%), Group B 에서는 간동맥 관련 합병증이 없었다(0%). 이는 통계적으로는 유의한 차이는 없었다(p=0.312). (결론) 간이식수술에서 간동맥 재건을 위한 단기간의 미세수술수기 훈련을 받은 일반외과의를 투입한 시도는 매우 성공적이었다고 생각된다.

 
목차
국문요약 ················································································ ⅰ
차례 ·························································································· ⅲ
표차례 ······················································································ ⅳ
Ⅰ. 서론 ···················································································· 1
Ⅱ. 연구대상 및 방법 ······························································ 3
A. 연구대상 ·············································································· 3
B. 연구방법 ·············································································· 3
1. 수술 전 검사 ········································································ 3
2. 수술 환경 및 수술 소견 ····················································· 4
3. 수술 후 수여자 관리 ··························································· 4
Ⅲ. 결과 ····················································································· 6
Ⅳ. 고찰 ····················································································· 11
Ⅴ. 결론 ····················································································· 14
참고문헌 ···················································································· 15
ABSTRACT ·············································································· 18

표 차례
Table 1.환자의 특성 ································································· 7
Table 2.간동맥 재건 길이 및 종류 ········································· 8
Table 3.수술 시간 ····································································· 9
Table 4.수술후 간동맥 합병증 ··············································· 10

주제어
간이식, 간동맥재건, 미세수술