Omental Infarction Following Laparoscopy-assisted Gastrectomy (LAG) for Gastric Cancer

위암 환자의 복강경 위절제술 후 발생한 그물막 경색의 임상적 의의

  • Kim, Min-Chan (Department of Surgery, Dong-A University College of Medicine) ;
  • Jung, Ghap-Joon (Department of Surgery, Dong-A University College of Medicine) ;
  • Oh, Jong-Young (Department of Diagnostic Radiology, Dong-A University College of Medicine)
  • 김민찬 (동아대학교 의과대학 외과학교실) ;
  • 정갑중 (동아대학교 의과대학 외과학교실) ;
  • 오종영 (동아대학교 의과대학 영상의학교실)
  • Received : 2010.02.17
  • Accepted : 2010.03.30
  • Published : 2010.03.30

Abstract

Purpose: Omental infarction (OI) following laparoscopy-assisted gastrectomy (LAG) for gastric cancer could become more common in the future because the indications for LAG are expected to expand. The aim of this study was to determine the clinical characteristics of OI following LAG. Materials and Methods: Three hundred ninety patients who underwent LAG for T1 or T2 gastric cancer from April 2003 to November 2007 were enrolled. OI was diagnosed by two radiologists using the patients' abdominal 16 row-detector CT scans. The clinicopathologic characteristics were retrospectively evaluated in the omental infarction (OI) group and the non-omental infarction (non-OI) group using the gastric cancer database of Dong-A University Medical Center and the medical record. Results: Nine omental infarctions (2.3%) of 390 LAGs were diagnosed. All the OIs could be discriminated from omental metastasis on the initial or follow up CT images. The location of the omental infarctions was on the epigastrium in 3 patients and in the left upper quadrant in 3 patients. The mean size of the OIs was 4.1 cm. Most patients with OI had no signs or symptoms. The body mass index of the OI group was higher than that of the non-OI group (P=0230), and OI was more common in patients who underwent total gastrectomy than in the patients who underwent subtotal gastrectomy (P=0.0011). Conclusion: Laparoscopy-assisted gastrectomy (LAG) with partial omentectomy for gastric cancer can be a cause of secondary OI. Omental infarction after LAG has different clinical characteristics and CT findings that those of other omental infarctions or postoperative omental metastases. Further multicenter study will be needed to evaluate in detail the clinical features of omental infarction after LAG.

목적: 조기위암 환자에서 널리 시행되고 있는 복강경 위 절제술은 큰그물막을 부분 절제함으로 그물막 경색의 가능성을 가지고 있다. 이에 저자들은 위암 환자의 복강경 위절제술 시행 후 발생한 그물막 경색의 임상적 고찰을 시행하였다. 대상 및 방법: 2003년 4월부터 2007년 11월까지 동아대학교 의료원 외과에서 병리조직검사에서 T2 이하의 환자로복강경 위절제술이 시행된 390명의 환자를 대상으로 술 후 복부 단층 촬영 사진을 이용하여 그물막 경색을 진단하였다. 위암 데이터 베이스와 환자들의 차트를 이용하여 그물막 경색의 빈도, 발생 위치와 크기 및 증상 여부를 조사하였으며 그물막 경색이 발생하지 않은 환자들의 임상 병리적 특징들과 비교하였다. 결과: 전체 390명 환자 중 그물막 경색은 9명에서 발생(2.3%)하였으며 평균 나이는 57.2세였고 9명 중 남자가 6명 여자가 3명이었다. 발생 부위는 상복부 정중과 좌 상복부가 각각 3명이었다. 임상 증상은 배꼽 주위와 좌 상복부에 비특이적인 복통이 각 1명에서 나타났으며 9명 모두 술 후 복막 전이와 감별이 가능하였다. 그물막 경색군의 환자는 비경색군에 비해 수술 전 높은 비만도를 나타내었고(P=0.0230) 위절제 범위에서 위전절제술이 많이 시행된 것으로 나타났다(P=0.0011). 결론: 위암 환자의 복강경 위절제술 후 발생하는 그물막경색은 일차성 그물막 경색들과는 상이한 임상적 특징을 가지며 복막 재발과는 복부 재발과는 복부 단층 촬영으로 구별될 수 있다. 향후 다기관 공동 연구를 통하여 보다 더 정확한 임상 양상이 규명될 수 있을 것으로 기대된다.

Keywords

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