• Journal of Preventive Medicine and Public Health
• /
• 제27권4호
• /
• pp.711-734
• /
• 1994

Among chemical agents in herbicides, dioxin (2, 3, 7, 8-tetrachloro dibenzo-$\rho$-dioxin : TCDD), a chemical contaminant in herbicides sprayed during the Vietnam War has been known to be the major agent causing toxic effects. Approximately 320,000 korean soldiers participated the Vietnam War from 1964 to 1974. Although the potential hazards of the herbicides among Korean veterans exposed were implicated, the problem had not been a public issue until 1991 when Korean veterans were informed U.S. companies, the herbicides manufacturer payed fund, from which a trust fund for New Zealand and Australian Class members were established in 1985. After a series of appeals and demonstration by the Korean Veterans demanding medical care and compensation for their serious health damages, a bill of medical care and compensation for herbicides victims was promulgated in March 1993 and become effective from May 1993, This study was carried out with two major objectives : the first to understand the health problems caused from the herbicides by reviewing literatures published, and the second to examine the nature and extent of health impacts among Korean veterans exposed and to develop valid study methods for the major study by interviewing and reviewing records on a part of veterans (638 persons) registered and completed medical examination in Seoul Veterans Administration Hospital from June to October 1993. The results obtained are as followings: 1. The literature review of 107 papers revealed that 1) Dioxin is teratogenic, carcinogenic and affects almost all organs including nervous, endocrine, and reproductive systems in animal experiments. 2) The diseases showing evidence of causal association were Hodgkin's disease, non-Hodgkin's disease, lung cancer, lymphoma, soft tissue sarcoma, chloroacne and polyneuropathy when judged on the basis of consistency in study results and biological plausibility. 2. Interview and medical record review study on 638 veterans, though limited validity owing to lack of control group, crude estimates of dioxin exposure levels (no biomarkers measurable), and uncertainty of diagnosis, showed that: 1) Most of the study subject's were in their 40's of age and had been dispatched to Vietnam during the period from $1965{\sim}1970$ around one year. 2) Most frequently complained symptoms in medical examination were motor weakness (32%), sensory abnormalities in extremities (23%), skin diseases (22%), and pain in extremities (20%) whereas in Interview they were more frequent in order of skin problem (44%), motor weakness (38%), sensory abnormalities and pain in extremities(17% and 19% each). Kappa indices on the same category of complaints between two sources of information were variable and relatively low. 3) On medical examination, only a part of the 638 subjects had initial impression (442 pts) and final diagnosis (218 pts) suggesting decision making on diagnosis appeared to be difficult even with all available modern medical technologies: in initial impression disorders from peripheral and central neuropathy were predominant whereas in final diagnosis various types of skin disorder were most frequent 4) When dose-response relationship between several conditions (from questionnaire) and arbitrary exposure scores were examined by CMH linear trend test, spontaneous abortion, sexual problems and health problem of offsprings showed statistically significant linear trends. However, pregnancy, accident and suicidal attempts did not show any relationship in this study capacity. 5) Among complaints, psychosis and neurosis (anxiety, phobia) in interview study, and memory disorder and psychosis in medical record study revealed linear trend. 6) Skin disorder was the only condition showing linear trend in initial impression and none in final diagnosis on medical examination. Even though objective to select out dioxin-related disease or group of diseases from this study was not achieved the research experiences provided firm basis for developing various methodological approaches. 3. From this preliminary study we concluded that a larger scale major epidemiologic study on health impacts of herbicides among Korean veterans exposed is not only Indispensible but also well designed study with more valid exposure information and diagnosis may be able to establish causal relationship between certain groups of diseases and exposure to the herbicides among Korean veterans.

• 유통과학연구
• /
• 제8권3호
• /
• pp.37-47
• /
• 2010

CRM은 고객에 대한 가치를 잘 이해하고 고객정보를 바탕으로 하여 그들의 욕구를 충족시키고 나아가서는 평생가치(Life Time Value)를 극대화시킬 수 있는 전략수립 및 고객관리프로세스를 통합적으로 잘 운영하는 것이다. 또한 이를 고객들과 좋은 관계로 유지 발전시켜서 궁극적으로는 회사의 수익을 최대화하기 위한 경영활동이다. 성공적인 CRM을 위한 전략은 고객접점을 담당하는 조직의 변화와 고객관리 프로세스를 재설계한 후에, 기업이 장기적인 계획으로 고객관계를 유지시키는 마케팅 전략과 시장 환경대응에 적절한 방법으로 통합시스템을 구축하여 전사적인 프로그램으로 전개되어야 한다. 또한 CRM 프로그램을 꾸준히 기업 특성에 맞게 개선과 보완활동을 펴나가야만 한다. 특히 중소규모의 유통업체들의 성공적인 CRM을 위한 전략은 다음과 같다. 첫째, CRM에 대한 인식을 바꾸고 고객에 대한 관심을 깊이 기울여야 한다. 둘째, 선진기업들의 CRM 기법을 벤치마킹하여 성공 포인트를 찾아내어 활용한다. 셋째, 나만의 재주와 장기를 마케팅에 접목하는 아이디어를 통해 자사 여건에 알맞은 방법을 모색한다. 넷째, 작지만 화제성 강한 이벤트 행사 등을 통하여 스위스의 소상공인의 사례처럼 개별고객에 대한 관계증진을 키울 수 있는 CRM 모델을 개발하여야 한다.

• 대한환경공학회지
• /
• 제31권11호
• /
• pp.997-1006
• /
• 2009

본 연구에서는 음폐수를 대상으로 5 톤/일 처리규모의 막결합형 2상 혐기성 소화(TPADUF) 플랜트를 운영하며 유기물 제거효율 및 메탄 발생량을 파악하고, 소화가스를 이용한 발전 가능성 및 분리막 적정 운영방안을 검토하였다. 고온 산발효조, 중온 메탄조 및 UF 막으로 구성된 처리 시스템에서 평균 TCOD가 150 g/L인 음폐수를 유기물 부하 11.1 g COD/L/d까지 증가시키며 처리한 결과 최종 유출수의 TCOD는 6 g/L 이하이었으며, TCOD 및 SCOD 제거효율은 모두 95% 이상이었다. 소화 가스의 메탄 구성비는 65%이었으며, 회수된 메탄량은 시스템에서 일부 가스가 누출되었음에도 39 $m^3/m^3$ 음폐수 주입량, 260 $m^3$/톤 COD유입량, 또는 270 $m^3$/톤 COD제거량 이었다. 소모된 가스량 당 발전량은 0.96 kWh/$m^3$ 가스, 또는 1.49 kWh/$m^3$ 메탄으로 다소 낮았으나 이는 소용량 발전기(15 kW급)의 저효율에 기인한 것이다. 분리막은 평균 flux 10 L/$m^2$/hr에서 운전하였으며, 운전 중 flux가 감소하였을 때는 물 또는 화학적(NaOCl)세정을 실시하여 회복시킬 수 있었다. TPADUF 플랜트에서는 메탄조 내액 또는 분리막 농축액을 산발효조로 반송함으로써 산발효조의 pH를 별도의 약품 주입 없이 적정 수준을 유지할 수 있었으며, 산발효조에서 부분적인 메탄생성을 통해 메탄조의 유기물 부하를 낮추는 효과도 있었다.

• Strategy21
• /
• 통권30호
• /
• pp.99-142
• /
• 2012

Withe increased North Korea's security threats, the South Korean navy has been faced with deteriorating security environment. While North Korea has increased asymmetric forces in the maritime and underwater with the development of nuclear weapons, and China and Japan have made a large investment in the buildup of naval forces, the power of the Pacific fleet of the US, a key ally is expected to be weakened. The biggest threat comes from China's intervention in case of full-scale war with North Korea, but low-density conflict issues are also serious problems. North Korea has violated the Armistice Agreement 2,660 times since the end of Korean War, among which the number of marine provocations reaches 1,430 times, and the tension over the NLL issue has been intensifying. With tension mounting between Korea and Japan over the Dokdo issue and conflict escalating with China over Ieo do Islet, the US Navy has confronted situation where it cannot fully concentrate on the security of the Korean peninsula, which leads to need for strengthening of South Korea's naval forces. Let's look at naval forces of neighboring countries. North Korea is threatening South Korean navy with its increased asymmetric forces, including submarines. China has achieved the remarkable development of naval forces since the promotion of 3-step plan to strengthen naval power from 1989, and it now retains highly modernized naval forces. Japan makes an investment in the construction of stat of the art warship every year. Since Japan's warship boasts of its advanced performance, Japan's Maritime Self Defense Force is evaluated the second most powerful behind the US Navy on the assumption that submarine power is not included in the naval forces. In this situation, naval power construction of South Korean navy should be done in phases, focusing on the followings; First, military strength to repel the energy warship quickly without any damage in case of battle with North Korea needs to be secured. Second, it is necessary to develop abilities to discourage the use of nuclear weapons of North Korea and attack its nuclear facilities in case of emergency. Third, construction of military power to suppress armed provocations from China and Japan is required. Based on the above naval power construction methods, the direction of power construction is suggested as follows. The sea fleet needs to build up its war potential to defeat the naval forces of North Korea quickly and participate in anti-submarine operations in response to North Korea's provocations. The task fleet should be composed of 3 task flotilla and retain the power to support the sea fleet and suppress the occurrence of maritime disputes with neighboring countries. In addition, it is necessary to expand submarine power, a high value power asset in preparation for establishment of submarine headquarters in 2015, develop anti-submarine helicopter and load SLAM-ER missile onto P-3C patrol aircraft. In case of maine corps, division class military force should be able to conduct landing operations. It takes more than 10 years to construct a new warship. Accordingly, it is necessary to establish plans for naval power construction carefully in consideration of reality and future. For the naval forces to safeguard maritime sovereignty and contribute to national security, the acquisition of a huge budget and buildup of military power is required. In this regard, enhancement of naval power can be achieved only through national, political and military understanding and agreement. It is necessary to let the nation know that modern naval forces with improved weapon system can serve as comprehensive armed forces to secure the command of the sea, perform defense of territory and territorial sky and attack the enemy's strategic facilities and budget inputted in the naval forces is the essential source for early end of the war and minimization of damage to the people. If the naval power construction is not realized, we can be faced with a national disgrace of usurpation of national sovereignty of 100 years ago. Accordingly, the strengthening of naval forces must be realized.

• 시큐리티연구
• /
• 제58호
• /
• pp.81-106
• /
• 2019

재난안전의 가장 중요한 주체 중 하나인 지방자치단체의 관리 및 대응역량은 지역주민의 삶과 직결될 수 있는 중요성을 갖는다. 따라서 이 연구는 충청북도를 중심으로 실증연구를 통해 지역주민들이 인식하고 있는 지방자치단체의 재난안전 관리체계와 대응역량을 평가하고 이를 통해 향후 자치단체들이 주민들의 안전도 향상과 효과적인 재난안전 관리 체계 구축을 위해 검토해야 할 정책 추진방향 등에 대하여 살펴보았다. 연구결과, 첫째, 재난안전에 대한 위험 인식에 있어 자연재난의 발생 가능성에 대한 위험 인식이 사회재난이나 안전사고 보다 높게 나타나고 있다. 둘째, 재난안전 관리 영역의 중요도에 있어서도 자연재난의 영역을 더욱 크게 인식하고 있는 것으로 나타났다. 셋째, 지방자치단체의 재난안전 관리 업무 중 기본적 업무 수행에 대해서는 평균 이상의 만족도를 보였지만 각 단계별 업무 수행 중 위험요소의 점검 및 전달, 단기적 복구체계는 상대적으로 낮게 나타났다. 넷째, 재난안전 관리를 위한 지방자치단체의 역량에 대해서는 담당부서의 역량과 전문성에 대해서는 긍정적으로 평가하고 있지만, 안전 관련 조직의 규모나 예산에 대해서는 상대적으로 낮게 평가하고 있었다. 다섯째, 재난안전을 위해 지방자치단체가 추진해야 할 정책방향으로는 교육 및 체험 등의 정규교육 강화, 지역주민 대상 교육 확대, 시설 및 재원의 지원 강화, 주민참여 운동의 활성화, 소방 및 치안 분야 장비 및 처우개선, 수시 순찰 관리 및 감시, 재난 대비 훈련을 확대해야 한다는 의견이 많은 것으로 나타났다. 따라서 지방자치단체의 재난안전 관리체계를 강화하여 효과적인 대응체계를 구축하기 위해서는 재난안전 취약계층에 대한 지원 프로그램 확대, 지역친화형 재난안전체계 구축, 주민 참여형 협력체계 확대, 경찰이나 소방 등 안전 관련 기관과의 협력 및 지원체계 강화가 필요할 것이다.

• 한국학교ㆍ지역보건교육학회지
• /
• 제5권
• /
• pp.25-42
• /
• 2004

This study set out to investigate the relations between middle school students' perception of body image and their allowance for plastic surgery, to understand their perception of body image and desire for plastic surgery, and provide some data needed to warn against reckless plastic surgery and guide the students effectively. For those purposes, an examination was conducted of the relationships between the individual characteristics and perception levels of body image, the individual characteristics and allowance for plastic surgery, and perception levels of body image and allowance for plastic surgery. The subjects were drawn from sour middle schools located in two regions of Gyeonggi Province. Total 922 boys and girls were surveyed on a questionnaire, which was developed based on the pretest of previous literature, reviewed for appropriateness, and tested for reliability and reasonableness. The body image on the five scale was greater as the perception level was higher. The allowance for plastic surgery was also greater as the scores were more. The findings were as follows: First, the relationships between individual characteristics and perception levels of body image were examined. The third graders showed the highest perception level, being followed by the first and second graders. The girls were more perceptive than the boys, and those who were extrovert were more perceptive than those who were introvert. Those students whose parents earned 2 million won or more a month and who adapted themselves to the environmental changes had a higher perception level. In a word, the girls from the middle class that were well adapted, felt happy, and were extrovert had a higher perception level of body image. Second, the connections between individual characteristics and allowance for plastic surgery were investigated. The third graders were the most admissive of plastic surgery, followed by the second and first graders. That is, the upper graders were more admissive of plastic surgery. In addition, the girls were more admissive than the boys, and those who were extrovert were more than those who were introvert. There were no significant differences according to the monthly income of the parents, grades, adaptability to surroundings, and happiness, which results almost resembled the findings of a study conducted on adults. Third, there were negative correlations found between the perception levels of body image and the allowance for plastic surgery. To elaborate, the higher the perception levels were, the lower the allowance was, and vice versa. As for the items, the subjects showed more allowance for plastic surgery when they scored less in the item of caring about appearance, importance of looking pretty to others, and efforts to improve appearance. When they had a low value of body and easily felt tired, they were highly acceptive of plastic surgery. The allowance for plastic surgery was also great when their perception was much of how healthy they felt, how important they felt about their bodies, how they were satisfied with their current appearances, how they evaluated the appearance of others, how much they were satisfied physically, and how much demanding they were for physical changes. Meanwhile, there were no correlations between the allowance and physical attraction, the degree for one's activities to be hindered, and sickness. In short, the demand for plastic surgery was 41% for the girls and 20.2% for the boys. Just as the study on adults reported, those who had a low or negative perception of body image were more acceptive of plastic surgery. The middle school students were generally positive about their bodies with the lowest perception level at 2.91 and the highest at 3.21. Their individual allowance for plastic surgery was related to their individual body images, which were in turn affected by the mass communication, surrounding environments, and social values. Thus it's necessary for the entire society to try to improve or change the overall perception. Helping measures should be taken so that the students can form right sense of values about their bodies, avoid the obsession with appearance and appearance-based evaluation, and exercise righteous criteria against humans beings and things. In conclusions, the following suggestions were made: they need to develop such questionnaires or tools as can measure the body image of teens and fit the reality. Moreover, body image improvement programs should be more diverse and more applicable to teens. Despite the consistent reports that prove the correlations between body image and plastic surgery, there has been little effort to apply such factors as experience of the life of the disabled, volunteer activities for the disabled and at the hospitals, and others that can induce changes to body image to the body image improvement programs. In the future, comparative research should be carried out on body image and plastic surgery.

• Journal of Chest Surgery
• /
• 제38권5호
• /
• pp.357-365
• /
• 2005

배경: 관상동맥 질환에 동반된 허혈성 승모판막 폐쇄부전증을 가진 환자들은 장기 생존율이 좋지 않다. 게다가 중등도의 승모판막 폐쇄부전에 대한 치료방법은 아직 확립되어 있지 않은 상태이다. 따라서 본 저자들은 후향적 연구를 통하여 중등도의 허혈성 승모판막 폐쇄부전 환자에서 관상동맥 우회술만을 시행한 군과 승모판막 수술을 함께 시행한 군을 비교하여 승모판막 수술의 유용성을 알아보고자 하였다. 대상 및 방법: 1997년 1월부터 2003년 12월까지 중등도의 허혈성 승모판막 폐쇄부전증으로 진단받은 34명을 대상으로 관상동맥 우회술만을 시행한 군을 I군(n=23), 승모판막 수술을 동시에 시행한 군을 II군(n=11)으로 하였다. 각 군의 평균 추적관찰 기간은 $69.3\pm4.3$개월과 $53.1\pm4.9$개월이었다. 결과: 양 군에서 수술 사망은 없었고, 만기 사망은 I군에서 1명 있었다. II군에서 모든 환자들은 고리(Ring)를 이용한 승모판륜 성형술을 시행받았다. 수술 직후 승모판막 폐쇄부전의 정도는 II군에서 더 만이 감소하였고, 마지막 추적 관찰한 심초음파 검사 상 승모판막 폐쇄부전의 정도를 제외한 나머지 인자들은 양 군간 차이를 보이지 않았다. 양 군의 5년 생존율 또한 차이가 없었다($95.5\%\;vs\;100\%$, p=0.48). 결론: 본 연구 결과에 의하면 중등도의 허혈성 승모판막 폐쇄부전을 가진 선택된 환자에서는 관상동맥 우회술만으로 만족할 만한 결과를 얻을 수 있었으나 수술 전 심박출계수가 낮거나 NYHA class가 낮은 환자들에서는 수술 후 승모판막 폐쇄부전이 지속적으로 남아있는 것을 볼 수 있었다. 따라서 이러한 환자들에서는 승모판막 수술을 시행하는 것이 좋다고 생각된다. 또한, 승모판막 수술을 시행한 환자들에서 좌심실용적과 승모판막 폐쇄부전의 정도가 많이 감소하였는데 심실기능과 장기 생존율에 대한 이러한 인자들의 영향을 알아보기 위해서는 더 많은 환자를 대상으로 한 연구가 필요하다고 생각된다.

• 한국임상보건과학회지
• /
• 제2권1호
• /
• pp.1-16
• /
• 2014

Purpose. For a more efficient hospital management, this study aims to provide basic data so that the hospital management and staff in charge of hospital administration may systematically classify and collect hospital information, by analyzing the ordinary characters of an upper-level general hospital system and its common-type balance sheet, common-type profit and loss statement and financial ratio. Methods. By using information about an upper-level general hospital in C Province, provided by Alio(www.alio.go.kr), a public organization information provision site, Health Insurance Review & Assessment Service(www.hira.or.kr) and Ministry of Health and Welfare(www.mw.go.kr), this study analyzed 3 year's data from 2010 to 2012 and provided basic data by analyzing the ordinary characters of an upper-level general hospital system, and its common-type balance sheet, common-type profit and loss statement and financial ratio. Results. After analyzing the ordinary characters, common-type balance sheet, common-type proft and loss statement and financial ration of this general hospital, based on the 2010 to 2012 data, this study came to the following conclusions. Firstly, out of all the 1,069 hospital staff, there were 272 doctors working for 24 medical departments, out of whom the majority was 33 physicians. Most of the nurses were third-class ones, and about 2,000 outpatients and 600 inpatients on average were treated per day. Secondly, as a result of analyzing the common-type balance sheet, this study discovered that intangible assets out of fixed assets accounted for 41%, the majority, out of which usable and profitable donation asset buildings were of great importance, and the liquid assets increased more in 2012 than 2011. In the financial structure, the ratio of liquid liabilities was over 50% out of all the liabilities in 2012, and the ratio of purchase payables was high as well. The ratio of fixed liabilities reached up to 40%, out of which the retirement benefit appropriation fund was quite high. The capital was over 80%, but the surplus was in a deficit state. Compared to the capital, the ratio of total liabilities was about 90%, which indicates the financial structure of this general hospital was vulnerable. Thirdly, as a result of analyzing the common-type profit and loss statement, this study found out that the medical profits from inpatients were higher than profits from outpatients. The material cost was related to the medical quality of this general hospital, and it was as high as 30% out of the total costs and was about 45% of the labor cost. This general hospital showed 10% in the ratio of non-medical profits, and it seemed because of government subsidies. The ratios of medical profits and current net income were gradually changing for the better in 2012, compared to 2011. Lastly, as a result of analyzing the financial ratio, it was found that the liquidity ratio kept decreasing, from 110.7% in 2010 and 102.0% in 2011 to 77.2% in 2012. Besides, it was analyzed that the liquidity ratio and the net working capital ratio greatly decreased, while the quick ratio and the liquid ratio kept decreasing. Conclusions. 1. It is necessary to take the risk management into more consideration, and particularly, it is needed to differentiate and manage the levels of risk in detail. 2. By considering the fact that investments into hospital infrastructures were mostly based on liabilities, it is needed to deal with the scale of losses when evaluating risks. 3. By reflecting the character that investments into hospital infrastructures were based on liabilities, it is necessary to consider the ratio of ordinary profits as well as the ratio of operating profits to sales, and it is also important to consider sales productivity factors, such as the sales amount per a sickbed, by comparing them with other hospitals. As for limitations of this study, there may be some problems in terms of data interpretation because of the lack of information about the number of inpatients and the number of outpatients per year, which are needed for the break-even point analysis. Besides, to suggest a direction for the improvement of hospital management through analyses, non-financial factors should be reflected, such as the trend of economy, medical policies, and politic backgrounds. However, this study only focused on the common-type balance sheet, common-type profit and loss statement and financial ratio, so this study is actually limited to generalizing all the factors by analyzing public data only.

• 수산해양기술연구
• /
• 제39권1호
• /
• pp.33-43
• /
• 2003

본 연구는 현재 국내에서 사용되는 쌍끌이 중층망 어구어법에서 문제점으로 지적되고 있는 고속예망에서 망고의 제어가 어렵다는 점, 망목에 뜸이 걸려서 파망이 자주 일어나는 점, 네트드럼에 감기는 어구부피가 너무 크다는 점 등의 해결방법으로 무부자 쌍끌이 중층망의 모형실험을 통하여 우리 나라 쌍끌이 중층망에 대한 적용 가능성을 검토하는데 있다. 이를 위하여 850ps급 쌍끌이 기선저인망어선에서 현재 사용되는 실물망을 1/100로 축소 제작한 모형망에서 뜸을 모두 제거하고 끌줄을 양쪽으로 각각 두가닥으로 분리한 후 추를 부착하여 아래끌줄의 길이를 조절함으로써 망고를 제어할 수 있는 무부자 쌍끌이 중층망의 모형어구를 제작하여 회류수조에서 유속에 대한 아래끌줄의 길이에 따른 어구의 전개성능 등을 규명하고 기준형과 비교 분석한 결과를 요약하면 다음과 같다. 1. 유체저항은 무부자망이 기준형보다 약 10∼20%정도 작았으며, 무부자망의 유체저항은 동일유속에서 아래끌줄이 길어짐에 따라 약 1ton씩 증가하였다. 또, 동일유속에서 dL이 10m씩 증가함에 따라 아래끌줄에 작용하는 저항은 약 5%씩 감소하고, 그 반면에 윗 끌줄에 작용하는 저항이 증가하였다. 2. 망고는 직선에 가까운 지수함수적으로 감소하는 경향을 보였으며, 동일유속에서 아래끌줄이 길어짐에 따라 증가하여 로그함수적인 경향을 보였다. 또한, 망고감소율은 무부자망의 경우가 기준형보다 작게 나타났으며, 그 차이는 유속이 증가함에 따라 더욱 커져 dL이 30m인 무부자망을 기준으로 3.0knot일 때 12%, 4.0knot일 때 25%로 나타났다. 3. 망폭은 유속이 증가함에 따라 약 2m 내외로 거의 일정하였으며 무부자망이 기준형보다 크게 나타났다. 4. 망구면적은 유속이 증가함에 따라 지수함수적으로 감소하는 경향을 보였으며, 망구면적의 감소율은 기준형보다 무부자망이 더 작게 나타났다. 여과량은 유속이 증가함에 따라 로그함수적인 경향을 보였으며 기준형이 3.0knot 이상에서 급격히 감소하였지만, 무부자망은 4.0knot까지 증가하였다가 완만하게 감소하였다. 5. dL의 최대적정길이는 망구면적 및 여과량이 최대인 30m일 때이며, 추의 최적위치는 4개의 그물목줄이 연결되는 지점이었다.

• Radiation Oncology Journal
• /
• 제16권2호
• /
• pp.159-165
• /
• 1998

목적 : 간암의 최적치료는 수술적 절제로 알려져 있으나 진행성 병변 또는 동반된 간질환 등으로 인해 실제적인 절제는 매우 제한되고 있다. 이에 본 연구에서는 절제탁가능 원말성 간암에서 경간동맥 항암 색전술과 국소 방사선의 병용요법을 시행하여 그 결과를 보고하는 바이다. 대상 및 방법 1992년 3월부터 1994년 8월까지 진행성 병변 및 간경변증 동반 등으로 절제 불가능으로 판정된 30명의 간암 환자가 본 연구에 포함되었다 간외 전이가 있거나 간경변증의 정도가 Child's C군으로 악화된 경우, 종양이 전체 간 용전의 2/3 이상을 차지하는 경우, 수행 능력이 ECOG 3기 이상인 경우 들은 제외되었다. 환자들의 특성은; 종양의 평균 직경이 $8.95{\pm}3.4cm$, UICC 병기 III, IVA가 각각 10명, 20명, 간경변증 동반이 22명, 간문맥혈전증 동반이 11명, 혈중 alpha fetoproteln(AFP)은 모든 예에서 양성이었다 TACE는 리피오돌 5 ml와 항암제(Adriamycin 50mg)을 혼합하여 도관을 통하여 간동맥내 주입하고 이어서 교질 스폰지 입자(Gelfoam)로 색전술을 시행하였다. 방사선 치료는 TACE 후 7-10일 이내에 시작하였고 평균 조사량은 $44.0{\pm}9.3Gy$로 전통적인 분할 방식으로 조사하였다. 결과 : 30명중 19명에서 종괴의 부분관해를 보여서, 관해율은 $63.3\%$를 보였다 생존율은 1, 2, 3년에 각각 67, 33.3, $22.2\%$를 나타내었고, 중앙 생존기간은 17개월이었다. 부분관해를 보인 19명의 환자중 6명은 3년이상은 생존하였다. 치료로 인한 독성은 경미하였다. 일시적인 간기능 검사의 변화나 열감은 회복되었고 혈소판 감소증과 심한 오심 및 구토가 각각 4명, 1명에서 나타났으나 1-2 주의 치료 중단과 약물로써 회복되었다. 치료로 인한 독성과 관계되는 사망은 없었다. 결론 : 절제불가능 원발성 간암에서 경간동맥 항암 색전술과 국소 방사선의 병용요법은 실질적으로 생존율 향상을 유도하면서 독성이 낮은 안전한 치료인 것으로 나타나, 향후 적극적인 임상적 적용으로 치료율의 향상이 기대된다.