Clinical and Experimental Pediatrics

대한소아청소년과학회 (The Korean Pediatric Society)
권호 표지

세균성 복막염이 동반된 천공성 괴사성 장염을 일차적 복강 배액술로 완치한 초극소 저출생 체중아 1례

Primary peritoneal drainage as a treatment for perforated necrotizing enterocolitis with bacterial peritonitis in an extremely low birth weight infant:a case report

  • 최욱선 (고려대학교 의과대학 소아과학교실) ;
  • 문일홍 (고려대학교 의과대학 소아과학교실) ;
  • 이장훈 (고려대학교 의과대학 소아과학교실) ;
  • 이승화 (고려대학교 의과대학 영상의학과교실) ;
  • 최병민 (고려대학교 의과대학 소아과학교실) ;
  • 은백린 (고려대학교 의과대학 소아과학교실) ;
  • 홍영숙 (고려대학교 의과대학 소아과학교실) ;
  • 이주원 (고려대학교 의과대학 소아과학교실)
  • Choi, Wook Sun (Department of Pediatrics, Korea University College of Medicine) ;
  • Moon, Il Hong (Department of Pediatrics, Korea University College of Medicine) ;
  • Lee, Jang Hoon (Department of Pediatrics, Korea University College of Medicine) ;
  • Lee, Seung Hwa (Diagnostic Radiology, Korea University College of Medicine) ;
  • Choi, Byung Min (Department of Pediatrics, Korea University College of Medicine) ;
  • Eun, Baik-Lin (Department of Pediatrics, Korea University College of Medicine) ;
  • Hong, Young Sook (Department of Pediatrics, Korea University College of Medicine) ;
  • Lee, Joo Won (Department of Pediatrics, Korea University College of Medicine)
  • 투고 : 2006.01.25
  • 심사 : 2006.03.20
  • 발행 : 2006.07.15
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초록

괴사성 장염은 미숙아에서 외과적 응급 수술을 요하는 가장 흔한 질환이며 여전히 높은 이환율과 사망률을 차지하고 있다. 괴사성 장염의 치료로는 전통적으로 천공성 괴사성 장염인 경우 개복술이 시행되어 왔으나 미숙아에서 일차적 복강 배액술이 시도된 이후 초극소 저출생 체중아에서도 양호한 결과를 보인 사례들이 보고되고 있다. 저출생 체중아에서 천공성 괴사성 장염치료시 일차적 복강 배액술과 개복술 중 어느 시술이 더 우수한 결과를 보이는지에 대한 연구는 아직 진행 중에 있으나 일차적 복강 배액술은 전신 마취나 수술을 시행하기에는 불안정한 환자상태인 경우에 시행을 고려할 수 있다. 저자들은 초극소 저출생 체중아에서 천공성 괴사성 장염으로 인한 세균성 복막염 치료로 환아 상태상 전신 마취 및 수술을 바로 시행하기에는 어려워 일차적 복강 배액술을 시행 후 호전된 1례를 경험하였기에 문헌고찰과 함께 보고하는 바이다.

Necrotizing enterocolitis(NEC) is the most common life-threatening surgical emergency in neonates, and remains a major cause of morbidity and mortality. In addition to conventional laparotomy, intraperitoneal drains have been used for the treatment of perforated NEC, especially in extremely low birth weight(ELBW) infants. We report a case of perforated NEC with bacterial peritonitis in an ELBW infant managed with primary peritoneal drainage(PD) without further need for surgery. To our knowledge, this is the first documented Korean case of an ELBW infant where PD was used as primary treatment for perforated NEC. Primary PD is effective and safe in ELBW infants with perforated NEC; although it is not considered a definitive procedure, it should be considered in all cases where infants are too unstable to tolerate anesthesia and surgery.

키워드

참고문헌

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