342
￭ Sun-069 ￭
Tolvaptan 으로 조절한 유미성 복수 1예
건국대학교 병원
*
김성은, 최원혁
간경변증 환자에서 발생하는 유미성 복수(chylous ascites) 는 드물게 발생하는 합병증이지만,효과적인 치료가 정립되어 있지 않아 예후가 매우 불량하다.
저자들은 이뇨제 치료에도 불구하고 불응성 유미성 복수 (refractory chylous ascites)를 보인 환자에서 tolvaptan (selective, competitive vasopressin receptor 2 antagonist) 으로 치료한 예를 경험하였기에 보고하는 바이다. 38세 남자환자로 만성B형간염에 의한 간경변증과 그로 인한 합병증인 다량의 복수 (ascites) 가 있어 대량복수천자 (large volume paracentesis, 이하 LVP) 를 시행하였다. 천자한 복수에서 유미성 복수가 확인되었다 (ascites/serum triglycerides 535/ 59 mg/dL). 이뇨제 치료 (furosemide 160 mg + aldactone 200 mg) 에도 불구하고 복수가 조절되지 않아 매주 1회 이상의 LVP를 시행하였다.유미성 복수 치료를 위해 octreotide 를 투약하였으나, 역시 복수가 잘 조절되지 않아 매주 1회 이상의 LVP가 필요하였다. 치료약제를 변경하여 복용중인 이뇨제에 Tolvapan을 추가로 복용하였으며, tolvaptan 복용으로 복수천자 횟수가 급격히 줄어들어 월 1회 정도의 LVP 만 시행하게 되었다. Tolvaptan 투약 18개월동안 유미성 복수는 잘 조절되는 상태이다.
￭ Sun-070 ￭
The necessity of Computed Tomography to Hepatic Lesions Detected on Abdominal Sonography
1단국대학교병원 내과학교실, 2단국대학교병원 소화기내과학교실
*
장성욱
1, 김석배
2, 남광우
2, 방기배
2, 신현덕
2, 신정은
2, 김홍자
2, 송일한
2Background/Aims: As abdominal sonography become popular, we encounter more patients with hepatic lesions (cyst, hemangioma, and etc.). As a result, computed tomography (CT) examinations have been performed to evaluate the hepatic lesions more commonly than before, although most of the lesions are benign. We investigated the necessity of CT in patients referred for benign hepatic lesions in sonography. Methods: We enrolled the patients from Jan.
2010 to Apr. 2018 who were referred for further evaluation of the intrahepatic lesion detected on sonography. They took CT for final diagnosis. Sensitivity of both modalities was analyzed. Results: Total 298 patients had taken CT because of liver lesion on sonography. We analyzed 290 patients except for 8 patients who were not finally diagnosed because of follow-up loss, no further examination such as magnetic resonance imaging, biopsy. Their mean age was 56.2±13.8 years old. Most of them were male (72.8%). 36 patients (12.4%) were finally confirmed as malignancy. 24 patients were diagnosed as hep- atocellular carcinoma and all of them had underlying liver diseases such as chronic hepatitis B (11), liver cirrhosis (11), chronic hepatitis C (2). Other 12 patients were diagnosed as cholangiocarcinoma (5), hepatic metastasis (colon cancer 3 patients, malignant GIST 2 patients, pancreatic cancer 1 patient) or undifferentiated carcinoma (1). Malignant group’s mean age was 60.8±13.9 years old and higher than that of all patients. The mean size of the malignant le- sions were 6.4±5.1cm and all of them were suspected as malignancy on sonography. Conclusions: Although sensitivity of hepatic lesions on private clinic sonography is 53.8 ~ 82.1%, specificity for malignant lesions is very high (98.1%). We have to consider carefully CT for benign hepatic lesions suspected on sonography to avoid abuse.
