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홍차넷
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질문
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- 질문 게시판입니다.
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전체기타게임진로연애가정/육아체육/스포츠교육의료/건강철학/종교IT/컴퓨터여행과학문화/예술법률홍차넷경제
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| Date |
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| Name | 리틀미 |
| File #1 | 캡처.JPG (48.5 KB), Download : 10 |
| File #2 | 2.JPG (94.7 KB), Download : 9 |
| Subject | 혹시 홍차넷에 의사 선생님들 계신가요? |
  64/M, C/C Abdominal mass, pulsatile, No tenderness 박동성 있는 덩이가 만져지고 CT 상에서 명료하게 abdominal aortic aneurysm 소견. (사진 28-1, 28-2) AAA에서 치료 기준을 묻는 문제. Tenderness 등 증상이 있을 때는 rupture 위험성 매우 높으므로 즉각적으로 repair 필요. 증상이 없을 때는 크기가 5.5cm 이상이거나 6개월 동안 0.5cm 이상 자랐을 경우 수술, 이외의 경우에는 sonography 등으로 추적 관찰. 치료에는 operative repair로 prosthetic graft 삽입(open AAA repair), endovascular aneurysm repair(EVAR) 2가지로 나뉨. Anatomy에 따라 EVAR를 선택할 수 있는데 short-term morbidity는 더 좋지만 long-term mortality는 나쁨. 최근 EVAR가 증가하는 추세로 개선되고 있으며 합병증이 적다. 따라서 ④, ⑤가 다소 애매함. 그러나 EVAR를 시행할 때 renal a.와 최소 1.5cm 이상 간격이 확보되어야 하고, mass의 크기가 6.5cm 이상일 경우 생존율 낮다고 함. (J Korean Med Assoc 2009; 52(10): 1020 – 1029) 출제자가 흉부외과임을 고려하여 가급적 open AAA repair를 우선 선택. // 작년 국가고시 문제이고 아래는 제가 달아놓은 해설입니다. 4번은 open surgery고 5번은 EVAR라고 생각해서 고민했는데 일단 이것부터 맞는지 모르겠고요. 지금 anatomy 상으로 대충 봤을 때 애매함 없이 open surgery의 indication이 되는지 (혹은 EVAR의 contraindication인지) 궁금하고요. 실제 임상에서 open sugery랑 EVAR의 선택은 어떤지 궁금합니다. 선배님들 미리 감사드립니다. (__) 꾸벅 Warning: Use of undefined constant no - assumed 'no' (this will throw an Error in a future version of PHP) in /home/redtea/html/a_skin/bbsd/view.php on line 133 Warning: Use of undefined constant no - assumed 'no' (this will throw an Error in a future version of PHP) in /home/redtea/html/a_skin/bbsd/view.php on line 146 Warning: Use of undefined constant vote - assumed 'vote' (this will throw an Error in a future version of PHP) in /home/redtea/html/a_skin/bbsd/view.php on line 161 0 |
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9862 class="iamcmt" style="display:none;"> Warning: Use of undefined constant no - assumed 'no' (this will throw an Error in a future version of PHP) in /home/redtea/html/a_skin/bbsd/view_comment.php on line 66
9862 class='vcm '>
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9862'> Zel
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16/06/07 01:49
9862>삭제 주소복사
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Renal artery가 native aorta에서 나오는 AAA 아닌가요? 그럼 뒤도 안보고 stent graft같은데요. 1.5cm 갭이라고 해도 이건 케바케입니다. 그리고 답가지도 복부 동맥류 '절제술' 이라고 되어 있어서 그냥 오픈 서저리랑 다른 느낌을 줘서 그냥 오답가지 만들려다 대략 만든 느낌인데.
그리고 AAA 치료 기준이 5.5cm 으로 되어 있나요? 요즘 가이드라인은 모르겠는데 저희 전문의 시험엔 4cm 기준에 더 줄여나가는 추세였는데.. 이런건 오히려 학생들이 잘 알 수도 있겠네요. 치료기준과 수술기준은 다르니
사진 자체가 좀 불명확한 부분이 있긴 있습니다. VR로 renal artery 보여주는 정도가 아니고 MPR 이미지 같은거면 모르겠지만. (애시당초 VR로 수술 결정한다는거 자체가 난센스) 여튼 전반적으로 EVAR쪽을 시사하는 문제 패턴이라고 생각해요.
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그리고 AAA 치료 기준이 5.5cm 으로 되어 있나요? 요즘 가이드라인은 모르겠는데 저희 전문의 시험엔 4cm 기준에 더 줄여나가는 추세였는데.. 이런건 오히려 학생들이 잘 알 수도 있겠네요. 치료기준과 수술기준은 다르니
사진 자체가 좀 불명확한 부분이 있긴 있습니다. VR로 renal artery 보여주는 정도가 아니고 MPR 이미지 같은거면 모르겠지만. (애시당초 VR로 수술 결정한다는거 자체가 난센스) 여튼 전반적으로 EVAR쪽을 시사하는 문제 패턴이라고 생각해요.
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Warning: Use of undefined constant vote - assumed 'vote' (this will throw an Error in a future version of PHP) in /home/redtea/html/a_skin/bbsd/view_comment.php on line 173
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