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검색결과 82건 처리시간 0.018초

복강경 보조 위절제술과 개복 위절제술의 비교 분석 (Comparative Analysis of Laparoscopy-assisted Gastrectomy versus Open Gastrectomy)

  • 임정택;김병식;정오;김지훈;육정환;오성태;박건춘
    • Journal of Gastric Cancer
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    • 제7권1호
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    • pp.1-8
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    • 2007
  • 목적: 정기 검진을 통한 위암의 조기 발견으로 조기위암은 늘어나는 추세이며 환자의 삶의 질 향상을 위한 맞춤 수술로서 국내에서도 복강경 보조 위절제술이 점차 늘어나고 있는 추세이다. 본 교실에서도 2004년 4월부터 복강경 보조 위절제술을 시작하였으며, 2005년 1년간 122예의 복강경보조 위절제술을 시행하여 임상병리적 특징과 수술결과에 대하여 개복술과 비교하여 분석하고자 한다. 대상 및 방법: 본 교실에서 조기위암으로 2005년도에 복강경 보조 위절제술을 시행한 119예와 2005년도 1~3월까지 개복 위절제술을 받은 126예를 대상으로 임상병리학적 특징, 수술 후 경과, 합병증을 후향적으로 비교 분석하였다. 결과: 양 군 간에 환자들의 연령은 유의한 차이를 보이지 않았으나, 복강경군에서 여성의 비율이 더 많았고 신체비만지수가 더 높았다. 수술에 소요된 평균시간은 복강경군이 더 오래 걸렸으며(239.2 vs 123.3분, P<0.001), 첫 번째 가스배출은 복강경군에서 빨랐고(3.05 vs 3.70일, P<0.001), 식이의 진행도 복강경군에서 빨랐다(물: 2.86 vs 3.22일, 미음: 3.87 vs 4.19일, 죽: 4.84 vs 5.26일, P<0.001). 합병증 발생은 복강경군에서 4.9%로 개복군의 9.5%보다 적은 경향을 보였으나 통계적인 의미는 없었고(P=0.179), 퇴원도 복강경군에서 빨랐으나(7.73 vs 8.25일) 유의한 차이는 보이지 않았다(P=0.229). 절제된 림프절의 수는 복강경군에서 평균 23.9개, 개복군에서는 23.1개로 유의한 차이는 없었다(P=0.563). 복강경 수술 중 개복술로 전환 한 예와 양 군 모두 합병증으로 재수술 한 경우와 사망한 경우는 없었다. 결론: 복강경보조 위절제술이 개복술에 비해 수술 시간이 길지만, 기타 식이의 진행이나 획득한 림프절의 수나 합병증의 발생 등에서 우세하거나 차이가 없었다. 따라서 복강경보조 위절제술도 안전하게 시행될 수 있는 술식이며, 종양학적으로 용인될 수 있다고 생각되나, 표준수술로 인정받기 위해서는 무작위 전향적인 연구가 필요할 것이다.

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漢江 水質保全 行政에 관한 硏究 (A Study on the Administration for the Han River Water Quality Control)

  • Kim, Kwang Hyop
    • 한국환경보건학회지
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    • 제10권2호
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    • pp.9-40
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    • 1984
  • This thesis purports to overview the diverse administrative and organizational factors and plannings developed by the government organizations, municipal or otherwise, to tackle the Han River water pollution issues in the past years. This thesis also looks into the ever-worsening Han River water pollution problems, in particular, in terms of the various government plans ostensibly designed to reduce the pollution level but with little success. Also dealt with are the efficiencies with which the laws and decrees on water pollution the administrative organizations put to use in the prosecution of the diverse antiwater pollution projects involving the Han River basin. From the early 1960's up to the 1970's the government had concentrated on the growth-oriented economic policy with the result that little attention had been paid to the water pollution and other environmental issues that are bound to arise from the massive economic growth. Belatedly, the five-year Hah River Development Project was initiated in 1982 with emphasis on reducing the water pollution level at Hah River to the minimum. The following are the gists of the thesis and recommendations for the future antiwater pollution plans by the administrative organizations: 1. Documents to date indicate that the irrigation projects along the Han River area had been the main focus of attention during the Yi Dynasty and under the Japanese rule of the country. 2. Despite that the water pollution issue became the subject of many debates among the academic and research institutions in the 1960's and in the 1970's, the administrative organizations in charge of the Han River water quality control failed to come up with a concrete plan for the river's water quality control. 3. Nevertheless, the water pollution of the Han River area in fact began in the 1950's, with the unprecedented concentration into Seoul of population and the industrial facilities on a larger scale, in particular, enforced by the government's strong growthoriented policy in its Economic Development plans in the 1960's. 4. Starting in the 1960's, the Han River water pollution level dramatically increased, but the government was reluctant to promulgate or put into effect strong measures to curb the many factors contributing to the river water pollution, thus worsening the environmental issues along the Han River basin. 5. The environmental protection law and other laws and decrees relating to the antiwater and air pollution issues that were subsequently put into effect underwent so many changes that efficient anti-water pollution policies could not be effected for the Han River basin. The frequent organizational reshuffle within the administrative units concerned with environmental problems has resulted in the undue waste in personnel management and finance. 6. The administration on the environmental protection could not be efficiently carried out due to the organizational overlapping. Under the existing law, frequent organizational frictions and inefficiency are bound to occur among the central government offices themselves, as well as between the central government and the Seoul city administration, and among the city's administrative offices over the conservation of the Han River basin and over the river's anti-water pollution issue. 7. In the planning and prosecution of the Han River project, political influences from the president down to the lower-level politicious appear to have been involved. These political influences in the past had certainly had negative influence on the project, nevertheless, it appears that in the recent years, these political influences are not all that negative in view of the fact that they serve as a positive contributing factor in developing a better water quality control project along the Han River basin. The following are a few recommendations based on the data from the thesis: First, officials in charge of the Han River water quality control should pay attention to a careful screening of the opinions and recommendations from the academic circles and from the public should be made so that the government could better grasp the core issues in the environmental problems that require preventive and other necessary measures. Second, vigorous redistribution policies of population and industrial facilities away from the Seoul area should be pursued. Third, the government should refrain from revising or revamping too frequently the laws and decrees on the anti-water pollution, which is feared to cause undue inconveniences in the environmental administration. Fourth, a large-scale streamlining should be made to the existing administrative organization in an effort to do away with the inter- and intra-organizational friction. It is recommended that a secretariat for the Hah River basis conservation be established. Fifth, High-level administrative officials, with a thorough knowledge and vision on the Han River water quality control, should be prepared to better deal with the budgeting and personnel management for the Han River water pollution control not only at the control government, but also at the Seoul city municipal government levels. Environmental issues should be kept distinct from political issues. Environmental issues should not serve as a window-dressing for sheer political purposes. Sixth, the Hah River proiect should also include, along with the main Han River basin, those areas covering North Han River, South Han River, and the tributaries to the main river basin. The 'Han River Basin Water Quality Control Board' should be established immediately as a means of strengthening the current Han River basin water quality control policy. Seventh, in drawing up the Han River proiect, the administrative officials should be aware that Han River basin is a life line for those people in the region, providing them with not only a sheer physical space, but with a psychological living space for their everyday life.

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