• Journal of Gastric Cancer
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• v.8 no.1
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• pp.20-26
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• 2008

Purpose: Pylorus-preserving gastrectomy (PPG), which retains pyloric ring and gastric function, has been accepted as a function-preserving procedure for early gastric cancer for the prevention of postgastrectomy syndrome. This study was compared laparoscopy-assisted pylorus-preerving gastrectomy (LAPPG) with laparoscopy-assisted distal gastrectomy with Billroth-I reconstruction (LADGB I). Materials and Methods: Between November 2006 and September 2007, 39 patients with early gastric cancer underwent laparoscopy-assisted gastrectomy in the Department of Surgery at Korea Cancer Center Hospital. 9 of these patients underwent LAPPG and 18 underwent LADGBI. When LAPPG was underwent, we preserved the pyloric branch, hepatic branch, and celiac branch of the vagus nerve, the infrapyloric artery, and the right gastric artery and performed D1+$\beta$ lymphadenectomy to the exclusion of suprapyloric lymph node dissection. The distal stomach was resected while retaining a $2.5{\sim}3.0\;cm$ pyloric cuff and maintaining a $3.0{\sim}4.0\;cm$ distal margin for the resection. Results: The mean age for patients who underwent LAPPG and LADGBI were $59.9{\pm}9.4$ year-old and $64.1{\pm}10.0$ year-old, respectively. The sex ratio was 1.3 : 1.0 (male 5, female 4) in the LAPPG group and 2.6 : 1.0 (male 13, female 5) in the LADGBI group. Mean total number of dissected lymph nodes ($28.3{\pm}11.9$ versus $28.1{\pm}8.9$), operation time ($269.0{\pm}34.4$ versus $236.3{\pm}39.6$ minutes), estimated blood loss ($191.1{\pm}85.7$ versus $218.3{\pm}150.6\;ml$), time to first flatus ($3.6{\pm}0.9$ versus $3.5{\pm}0.8$ days), time to start of diet ($5.1{\pm}0.9$ versus $5.1{\pm}1.7$ days), and postoperative hospital stay ($10.1{\pm}4.0$ versus $9.2{\pm}3.0$ days) were not found significant differences (P>0.05). The postoperative complications were 1 patient with gastric stasis and 1 patient with wound seroma in LAPPG group and 1 patient with left lateral segment infarct of liver in the LADGB I group. Conclusion: Patients treated by LAPPG showed a comparable quality of surgical operation compared with those treated by LADGBI. LAPPG has an important role in the surgical management of early gastric cancer in terms of quality of postoperative life. Randomized controlled studies should be undertaken to analyze the optimal survival and long-term outcomes of this operative procedure.

• Journal of Chest Surgery
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• v.34 no.2
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• pp.156-161
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• 2001

배경: 식도암의 절제술에 있어 식도 위 문합술은 중대한 합병증, 즉 문합부 누출, 양성협착, 종양의 재발 등을 유발한다. 수술 후 재원기간동안 환자가 느끼는 주관적인 증상과 합병증이 식도와 위장관의 문합부 위치에 따라 달라질 수 있으므로 서로간에 비교분석할 필요가 있겠다. 대상 및 방법: 1995년 1월부터 1999년 5월까지 식도암 근치술로 식도 위 문합술을 시행 받은 55명의 환자를 대상으로 문합위치에 따라 경부문합한 23명의 환자와 흉부문합을 한 32명의 환자를 비교 분석하였다. 절제술 후 AJCC분류에 따라 I기 5명, II기 27명, III기 23명으로 판정되었으며, 종양이 상흉부에 위치한 경우 3명, 중흉부 34명, 하흉부 18명이었다. 조직학적으로 55명의 환자 2명의 선암을 제외하고 53명이 편평상피세포암이었다. 55명 전원이 남자였으며 평균연령은 경부문합의 경우 59세였고, 흉부문합은 55세였다. 경부 문합의 경우 1명의 staple봉합을 제외하고 나머지 22명이 수봉합을 하였으며, 흉부문합술의 경우는 9명이 수봉합, 23명이 staple봉합을 하였다. 결과: 수술 후 사망자는 경부문합 1명, 흉부문합 2명이었다. 경부 문합환자의 경우 23명 중 15명에서 호흡기, 소화기등의 합병증 46례가 발생하였고, 흉부 문합환자의 경우 32명중 13명에서 합병증 37례가 발생하였다. 경부문합환자는 중등도 혹은 심한 연하곤란을 나타내는 경우가 11명에서 있었으며, 흉부문합환자는 2명에서 나타났다. 또한 수술 후 20일 이후까지 재원한 경우는 경부문합환자 18명, 흉부문합환자는 13명이었다. 결론: 식도암에서 식도 위 문합술의 경우 호흡기, 소화기, 감염등의 합병증이 발생하였으며, 특히 호흡기 합병증에 의한 사망률이 높았다. 문합부 누출은 staple봉합보다 수봉합에서, 흉부문합보다 경부문합에서 빈도가 높았다. 경부문합의 경우 문합부 누출률이 높고, 연하곤란을 많이 호소하며 재원기간이 의미있게 길었다.

• Transactions of the Korean Society of Mechanical Engineers B
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• v.36 no.7
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• pp.697-703
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• 2012

In this study, duodenogastric reflux has been investigated according to pyloroplasty and the path of the gastric tube in esophageal reconstruction. The paths of the gastric graft (front and rear paths) were determined from the CT images of ten patients, and the gastric tube model was constructed using an RP technique. The gastric tubes were connected to the pylorus models with and without pyloroplasty. Various distal pressures and pulse widths were applied, and the volume and maximum height of the refluxate were measured. The results show that the volume and height of the refluxate increase with the distal pressure, and the front path leads to a smaller volume and lesser height of the refluxate than the rear path if pyloroplasty is conduced. The volume of the refluxate is markedly increased by a larger pulse width, but its effect on the maximum height depends on whether pyloroplasty is conducted.

• Journal of the Korean Arthroscopy Society
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• v.15 no.2
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• pp.99-107
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• 2011

Purpose: The purpose of this study was to investigate the clinical results after a anatomical double bundle ACL reconstruction using a longitudinally split tibialis anterior allograft. Materials and Methods: We evaluated 24 patients with a minimum follow-up of 12 months who had undergone anatomical double bundle ACL reconstructions. The grafts utilized in all cases were tibialis anterior allografts which were longitudinally split into two strands. A standard rehabilitation protocol was applied in all patients. The pre- and post-operative data including Lysholm scores, International Knee Documentation Committee (IKDC) scores, Lachman test, pivot shift test and the side-to-side differences of anterior laxity measured by KT-2000 arthrometer were analyzed by use of a statistical method Results: The mean side-to-side instrumented laxity measured by the KT-2000 arthrometer significantly improved to a mean of $1.04{\pm}0.80\;mm$ (P < 0.001). The Lysholm knee scores also improved from $58.34{\pm}15.32$ to $86.25{\pm}6.48$ after surgery (P < 0.001). The patients exhibited improved IKDC scores (A: 15 cases, B; 9 cases) at the final follow-up, compared to preoperative scores (B: 5, C: 10, D: 9). Conclusion: Our data demonstrated that clinical results of anatomical double bundle ACL reconstruction with a split tibialis anterior allograft are encouraging with excellent side-to side laxity, significantly improved Lysholm knee score, IKDC score, Lachman and pivot shift data.

• Journal of Chest Surgery
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• v.35 no.1
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• pp.77-81
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• 2002

We report a case of colobronchial fistula, which is an extremely rare complication of esophagocologastrostomy A 53-year-old man developed recurrent respiratory symptoms 30 months after colon interposition for corrosive esophageal and gastric strictures. Chest radiographs and computed tomography showed an aspiration pneumonia and total atelectasis of the left lower lobe(LLL). Esophagoscopy and barium esophagogram revealed fistula between the colon just below the esophagocolostomy and superior segment of the LLL. The colobronchial fistulectomy and left lower lobe lobectomy were performed. This rare complication should be considered in patients who develop recurrent productive cough whenever they drink or eat something after esophagocologastrostomy.

• Journal of Chest Surgery
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• v.29 no.10
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• pp.1123-1128
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• 1996

A clinical study was performed on 152 cases of surgical esophageal disease treated by the Department of Thoracic & Cardiovascular Surgery of Korea University Hospital from Jan. 1989 through July 1994. The most common esophageal disease was cancer which was seen in 73 cases (48%) among 152 cases. All were treated surgically' 52 patients (71%) were managed by curative or palliative resection with reconstruction and feeding gastrostomy or jejunostomy, otherwise Celestine tube insertion was performed on the remaining 21 patients for palliatio'n. Esophageal leiomyoma occurred in 6 cases(3.9%), among them 1 case was performed with trio recoscopic enucleation . Achalasia were in 7 cases (4.6%) and was treated with modified Heller's m otomy and with Belsey Mark IV operation. Diverticulum were in 11 cases (7.2%). Esophageal stricture occurred in 20 cases (14.1 %) and 17 of 20 cases were managed with bypass surgery. Esophageal perforation was seen in 20 cases, its cause was instrumental trauma in 7 cases, stab wound in 4 cases, foreign body in 4 cases, spontaneous perforation in 3 cases, and others 1 case Other disease including congenital lesion was seen In 1 Scases.

• Proceedings of the KOR-BRONCHOESO Conference
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• 2003.09a
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• pp.109-109
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• 2003

성문 하방으로 진행된 후두암이나 하인두암, 기관의 침범이 있는 갑상선암 혹은 기공주변 재발암 등의 경우에 적절한 절제연을 얻기 위하여 상부기관륜 일부의 절제가 불가피하며 이때 만들어지는 영구 기관개구창은 일반적인 기관개구창에 비하여 하부에 위치하게 되며 보다 하부로의 기관 절제가 필요한 경우 기관과 주위 피부와의 봉합이 힘들고 경우에 따라서는 종격동 기관개구창을 만들어야 할 경우도 있다. 그리고 기관주위의 림프절이나 상부종격동 림프절 청소술을 병행한 경우나 후두전절제술 후 인두피부누공에 의한 창상감염이 생긴 경우, 기관주위 조직의 제거 후에 노출된 중요혈관의 보호와 광범위하게 제거된 결손부위를 덮기 위해 재건이 필요하게 된다. 대흉근피판은 혈관경이 일정하고 혈액 공급이 풍부하여 감염이 있거나 재건 후 감염을 방지하는데 사용될 수 있으며 피판 경의 길이가 대부분의 두경부 부위에 도달할수 있을 정도로 길고 근육의 부피가 충분하여 결손부위가 넓은 경우에 유용한 장점이 있다. 특히 종격동 림프절 청소술 후에나 하부 기관공의 재건을 위하여서는 한 수술시야에서 시행할 수 있는 인접한 부위 근피판 이라는 장점이 있고 필요시에는 이중도서(double-island) 형태로 접어서 이중피판으로 사용할 수도 있으며 피부이식과 병용하면 경부 피부의 재건도 동시에 시행할 수 있다. 저자들은 광범위한 기관륜의 제거 후 영구 기관개구창이 경부 하방이나 흥부 상부에 위치하게 되어 안쪽으로 말려들어가는 기관개구창 주변부위와 기관주위 결손 부위의 재건, 그리고 무명 동맥 등의 중요 구조물의 보호를 위해 사용된 대흉근 피판의 여러 작도법(design)과 응용, 결과를 종합하여 하부 기관개구창 재건에 있어 대흉근피판의 유용성을 살펴보고자 하였다. 한다. 본 연구의 결과를 이용하여 향후 전개될 홈 네트워크 서비스 및 관련시장의 발전 방향을 전망해 보고 이에 따른 기업이나 정부차원의 대응전략을 파악하고자 한다.육구에서는 큰 변화를 나타내고 있지 않았다(p<0.05). 운동과 비운동시킨 참돔의 지질 함량의 변화는 운동시킨 참돔은 운동으로 인한 에너지 소비로 인하여 함량이 유의적으로 감소했으며(r=-0.35), 비운동사육구에서는 절식으로 인하여 지질함량이 감소하였다(r=-0.38). 파괴강도와 가장 밀접한 영향을 가지는 콜라겐은 운동과 비운동 모두 사육기간동안 큰 변화는 보이지 않았다. 초기의 파괴강도값은 1.45±0.02kg(운동사육구), 1.36±0.18kg(비운동사육구)이였으며 사육기간동안 운동사육구는 파괴강도값이 증가한 반면, 비운동수조에서는 참돔의 파괴강도는 사육기간동안 큰 유의차가 없었다. 각 성분간의 상관도를 살펴보면, 수분함량과 파괴강도는 상관성을 가졌으며, 지질함량과 파괴강도도 같은 경향은 나타내었다. 운동기간동안의 파괴강도와 콜라겐 사이에는 상관성의 거의 없었다. 이는 운동기간에 따른 파괴강도의 증가가 콜라겐의 함량의 증가보다는 지질함량의 감소와 수분함량의 증가와 같은 성분과의 상관성이 크다고 판단된다. 다음으로는, 운동횟수에 의한 영향으로써 운동시간을 1일 6시간으로 설정하여, 운동횟수를 결정하기 위하여 오전, 오후에 각 3시간씩 운동시키는 방법과 오전부터 6시간동안 운동시키는 두 방법을 이용하여 품질을 비교하였다. 각 조건에 따라 운동시킨 참돔의 수분함량을 나타낸 것으로, 2회(오전 3시간, 오후 3시간)에 나누어서 운동시키기 위한 육의 수분함량은 73.37±2.02%를 나타냈으며, 1회(6시간 운동)운동시키기 위한 육은 71.74±1.66%을 나타내

• Journal of Chest Surgery
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• v.36 no.1
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• pp.51-54
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• 2003

This patient was an 53-year-old man who had undergone Sengstaken-Blackmore tube insertion for esophageal varix bleeding. Two days after Sengstaken-Blackmore tube insertion, he developed severe left hemothorax and was transferred to our hospital. The esophagoscopic findings revealed a large perforation lengthening 8-cm in the intrathoracic esophagus. A left thoracotomy was performed 33 days after the injury due to repeated varix bleedings and poor conditions. An 8-cm longitudinal perforation of the intrathoracic esophagus with gross suppurative empyema was found. Primary repair and esophageal exclusion was performed 2cm proximal and distal to the perforation, using rows of nonabsorbable staplers(TA stapler 60 $\times$ 4.8) and large bore thoracostomy tubes were placed for local drainage. Six days after intrathoracic esophageal exclusion, an esophagogram revealed a leakage at just above the proximal stapling site. A cervical esophageal exclusion was performed using the same method. One hundred thirty seven days after exclusion operation for the intra-thoracic esophageal perforation, the patient was able to eat per orally without any secondary esophageal reconstructive surgery.

• Journal of Gastric Cancer
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• v.6 no.1
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• pp.1-5
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• 2006

Purpose: A proximal gastrectomy is performed for gastric cancer in the upper part of the stomach to preserve the function of the stomach after surgery. An esophagogastrostomy is one of the common reconstruction methods for a proximal gastrectomy, but this method results in a high incidence of reflux esophagitis. This study was undertaken to compare subjective and functional results between esophagogastrostomy and jejunal interposition reconstructions. Materials and Methods: From June 1998 to December 2002, proximal gastrectomies were performed in 33 patients with tumors in the upper third of the stomach; 8 had reconstruction using jejunal interposition between the esophagus and the remnant stomach (JI group) while 25 had reconstruction using esophagogastrostomy (EG group). The postroperative courses of the patients were reviewed in terms of symptoms, weight changes, and endoscopic findings. Results: The mean age of the patients was 59 years; 26 were men and 7 were women. There were no significant differences in general complications, operating times, or histologic features between the two groups. Fifty-two percent (52%) of the EG group complained of dysphagia, and 16% them experienced heartburn and acid belching. Twelve percent (12%) of the JI group complained of dysphagia, but heartburn and acid belching did not occur. Incidences of reflux esphagitis (36%) and balloon dilatation for anastomotic stricture (16%) were more common in the EG group than in the JI group (0% and 12%). Conclusion: To prevent or minimize complications, such as reflux esophagitis and postoperative symptoms, a proximal gastrectomy with a jejunal interposition is an alternative method as an organ-preserving surgical strategy to improve quality of life for patients. (J Korean Gastric Cancer Assoc 2006;6:1-5)

• Journal of Chest Surgery
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• v.39 no.3 s.260
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• pp.214-219
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• 2006

Background: Perforation of esophagus is relatively uncommon. but it is associated with high morbidity and mortality. Treatment and outcome are largely determined by the time of presentation. We performed a retrospective review of patients with esophageal perforation to assess the outcome of current management techniques. Material and Method: A retrospective chart review was performed on all patients treated for perforation of esophagus from March 1990 to March 2005. There were 28 patients (22 men and 6 women: mean age 51 years, range 17 to 82 years) The causes of the perforations were as follows: foreign body retention (9 patients), trauma (7 patients), spontaneous rupture (7 patients), and iatrogenic (5 pati-ients). 18 patients were presented within 24 hours and 10 patients were presented after 24 hours., Esophageal repair was performed in 21 ($75\%$) of them, 4 patients were treated with esophagectomy, 3 patients were treated with feeding gastrostomy and drainage. Result: Hospital mortality was $18\%$ and iatrogenic was increase the mortality rate (p < 0.05). Site of perforation, time from perforation, and treatment method had no influence on mortality. Postoprative leaks occurred in 4 patients after primary repair and were treated conservatively. Conclusion: Esophageal perforation remains a devastating event which is difficult to diagnose and manage. Primary repair can be performed in most patients with esophageal perforation regardless of time to presentation with a low mortality. Accurate diagnosis and early treatment are essential to the successful management of patients.