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[조선] 몸속에서 녹는 스텐트, 내년 국내 들어올듯 - 강남세브란스병원 송석원 교수

혈관 질환 치료의 최신 경향은 수술·시술 시 외과적 절제를 최소화하면서 효과는 최대화하는 것과, 인체 친화적인 재료를 사용해 이물 반응과 부작용을 줄인 삽입물을 개발하는 것이다.

◇녹아 없어지는 스텐트 개발 중

▷혈관에서 녹는 스텐트=협심증 환자의 관상동맥을 넓히기 위해 스텐트를 넣으면 망 사이로 혈관벽이 새로 생겨 다시 막히는 비율이 30%에 달한다. 이를 해결하기 위해, 현재 유럽에서 마그네슘으로 만든 녹는 스텐트가 개발돼 임상시험에 들어갔다. 우리나라는 내년쯤 이 스텐트의 임상시험을 시작할 것으로 의료계는 예상한다.

현재 쓰는 최신 제품은 스텐트 안에 항응고제를 발라서 혈관이 막히지 않게 하는 약물 용출 스텐트다. 혈관 재협착률은 5% 정도이다.

▷구불구불한 혈관용 스텐트=길고 가는 무릎 아래 혈관이나 구불구불한 뇌혈관에 안전하게 넣을 수 있는 스텐트를 사용하고 있다. 강남세브란스병원 심장내과 이병권 교수는 "실온에서는 작게 압축돼 있다가 따뜻한 피가 도는 혈관 속에 넣으면 혈관 모양과 굵기에 맞게 펴진다"고 말했다. 당뇨병으로 혈관이 막힌 경우 등에 쓴다.

▷줄기세포 혈관=노화한 혈관에 줄기세포를 주사해 혈관벽을 재생시키는 임상 연구가 국내에서 진행 중이다. 삼성서울병원 혈관외과 김동익 교수는 "하지혈관이 막히면 풍선확장술로 넓힌 뒤 줄기세포로 혈관벽을 재생시키는 치료를 2~3년 안에 환자에게 실제로 적용할 수 있을 것"이라고 말했다.

◇최소절개·한번에 모든 혈관 치료

▷하이브리드 동맥류 수술=혈관이 비정상적으로 부푸는 동맥류는 배를 열고 인조혈관으로 대체하는 수술을 하거나, 영상 장비로 환부를 투시하면서 스텐트를 삽입하는 시술로 치료한다. 두 가지 수술·시술이 모두 필요한 흉부·복부 대동맥류 환자는 우선 스텐트 삽입 시술을 하고 2~3일 뒤에 인조혈관 대체 수술을 한다.

최근에는 이 두 가지를 한 수술대에서 동시에 하는 하이브리드 수술이 도입됐다. 강남세브란스병원 흉부심장혈관외과 송석원 교수는 "기존 수술보다 회복기간이 2분의 1에서 3분의 1로 짧아져 합병증과 부작용의 위험이 줄었다"고 말했다.

▷뇌 절개 않고 뇌동맥류 수술=뇌동맥류의 기존 수술법은 두개골을 10cm 절개하는 방식이다. 최근에는 눈썹 가운데를 3~4cm 절개한 뒤, 미세현미경을 뇌 안으로 밀어 넣고 동맥류를 제거한다. 경북대병원 신경외과 박재찬 교수는 "서너시간 걸리던 수술이 한 시간 반 이내로 짧아졌고, 회복도 빠르다"고 말했다.

▷심장 안 세우고 대동맥판막 교체=대동맥판막이 협착되면 전신마취 후 가슴을 열고 심장을 세운 뒤 인공판막으로 갈아끼우는 대수술을 한다. 전신마취를 하며, 3~4시간 이상 걸리기 때문에 만성질환을 가진 고령층은 이 수술을 받기 어렵다. 세브란스병원 심장내과 최동훈 교수는 “최근에는 조영 장비를 이용해 다리동맥 쪽으로 인공판막을 밀어 넣는 ‘경도관 대동맥판막 거치술’이 도입돼 나이가 많은 사람도 치료받을 수 있다”고 말했다. 시술 중 혈관 확보가 어려우면 곧바로 기존의 개흉수술로 전환해야 하기 때문에, 외과와 함께 하이브리드 수술로 진행한다.

▷피부절개 없이 하지정맥류 치료=하지정맥류는 피부를 째고 정맥류가 생긴 혈관을 모두 끄집어내는 수술을 했다. 통증이 심하고, 수술받은 뒤 하루 정도는 걸어다니지 못했다. 최근에는 피부 절개를 하지 않고 피부 위에서 레이저와 고주파를 쏘아 정맥류가 생긴 혈관을 태워 없애는 치료법이 도입됐다.

◇부작용 줄이고 회복기간 짧게

▷손목동맥·상완동맥 조영술=관상동맥에 스텐트를 시술할 때 허벅지 다리동맥을 뚫고 들어가는 방법은 시술 시간이 길고, 지혈에도 6~8시간 걸린다. 5~6년 전부터는 손목동맥을 통한 스텐트 삽입술이 도입돼 15~20분이면 시술이 끝난다. 최근에는 더 나아가, 팔꿈치나 겨드랑이 동맥을 통해서 스텐트 삽입술을 하는 방법이 도입돼 있다. 손목동맥이 좁아 굵은 스텐트나 큰 장비 등을 넣을 수 없는 사람에게 주로 쓴다. 팔꿈치나 겨드랑이 동맥을 이용하면 회복이 빠르고, 조영제 배출도 잘 된다.

▷망막혈관 항체주사=당뇨망막병증, 망막분지정맥폐쇄증 등은 최근 항체주사로 치료한다. 기존에는 레이저로 손상된 조직을 제거해 증상을 없앴다. 을지병원 안과 김영균 교수는 “레이저를 쓰면 효과를 볼 때까지 2~3주 기다려야 하며, 시야가 좁아지거나 눈부심이 심해지는 부작용이 있었다”며 “항체주사는 효과가 하루 만에 나타나고 부작용이 거의 없다”고 말했다.

☞스텐트란

금속 등으로 만든 그물망 모양의 작은 관이다. 접혀 있는 상태로 좁아진 혈관에 밀어 넣은 뒤 펴
면 혈관이 넓어진다.

강남세브란스병원 흉부외과 홈페이지 바로가기

헬스조선 한희준 기자 기사 보러가기

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2012/05/02 16:46 2012/05/02 16:46

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