• Journal of Gastric Cancer
• /
• 제1권3호
• /
• pp.150-154
• /
• 2001

Purpose: Multiple early gastric cancers were found in $6.9\∼11.7\%$ of patients with early gastric cancer. The goal of this study was to clarify the clinicopathologic features of and to investigate treatment strategy for multiple early gastric cancer. Materials and Methods: Of 967 patients with an gastric adenocarcinoma who were treated by surgical resection during the period of $1993\∼1998$ at the Department of Surgery, Korea University College of Medicine, 267 patients had early gastric cancer. A retrospective analysis of the clinicopathologic differences between the main and the accessory lesions in multiple early gastric cancer was carried out. A comparative analysis was also conducted between solitary early gastric cancer and multiple early gastric cancer. Results: Of 267 patients with early gastric cancer, multiple early gastric cancers were found in 12 patients ($4.5\%$), including 10 men and 2 women. Eleven patients with multiple early gastric cancer had one accessory lesion and 1 patient had 2 accessory lesions. Of the 13 accessory lesions, 7 ($53.8\%$) were located in the same region as the main lesion. The most frequent combination of macroscopic types for the main lesion and the accessory lesion were depressed and depressed types (6 cases, $46.1\%$). The most frequent histologic type of main lesion was a well differentiated adenocarcinoma in 7 ($58.3\%$) of the 12 cases; the accessory lesion was also well differentiated in 4 of those 7 cases. Of the 13 accessory lesions, 4 ($30.8\%$) had been overlooked preoperatively; most of them were located in the lower third of the stomach and were IIb or IIc type and measured less than 1 cm in diameter. Lymph node metastasis was detected in 1 patient ($8.3\%$). The clinicopathologic features of multiple early gastric cancer were not different from those of solitary early gastric cancer. Conclusion: In multiple early gastric cancer, the main and the accessory lesions showed similar differentiation, and lymph node metastasis was less frequent than in solitary early gastric cancer. Therefore, limited procedures, including endoscopic mucosal resection, may be indicated if each lesion of the multiple early gastric cancer fits the criteria for treatment strategy.

• Archives of Plastic Surgery
• /
• 제37권1호
• /
• pp.99-103
• /
• 2010

Purpose: Blow-out fractures are reduced through transcutaneous or transconjunctival incisions. But the field of orbital surgery is difficult due to lack of visualization of fracture site, blind dissection of orbital floor, susceptibility of injury of orbital structures. In these situations, the former technique of using an antral balloon catheter has advantages over other methods for reconstruction because of its rapidity, simplicity, and inexpensiveness. Furthermore, the antral balloon catheter allows not only elevation of the orbital bone fragment but also expansion of the maxillary sinus in cases where there is a fracture of its walls. But postoperative follow-up method using computed tomography is expensive. Hence, we report a simple and inexpensive follow-up method using radiopaque dye inflation. Methods: We performed endoscopic transantral approach in 5 cases of blow-out fracture under general anesthesia. To accomplish this technique, a rigid 4 mm, 0 or 30 degree angled endoscopy was inserted into the maxillary sinus. Inflation of the catheter started gradually, with 10 to 15 mL of saline mixed radiopaque dye (saline: dye, 5 : 1) by syringe and while observing the elevation of the fracture site with endoscope until a proper contour was reached. For the maintain of the position of fractured site, 12 French urinary balloon foley catheter were used in fracture site for 7 - 10 days. Results: Postoperative assessment was performed by means of clinical and simple radiographic examination to secure the catheter under the inferior orbital wall and in the maxillary sinus. No specific complications occurred related to this procedure. Results of the surgery and follow-up in all cases were satisfactory. Conclusion: It may be a better alternative to the conventional follow-up method, with less cost and effectiveness of the catheter patency. The advantages of using the urinary balloon foley catheter with the radiopaque dye include the following : it is safe, efficacy, simple, and especially low cost. On drawback of this method is the discomfort to the patient caused by the catheter during the treatment.

• 한국간담췌외과학회지
• /
• 제27권4호
• /
• pp.350-365
• /
• 2023

Backgrounds/Aims: Extra hepatic portal venous obstruction (EHPVO) is the most common cause of portal hypertension in Indian children. While endoscopy is the primary modality of management, a subset of patients require surgery. This study aims to report the short- and long-term outcomes of EHPVO patients managed surgically. Methods: All the patients with EHPVO who underwent surgery between August 2007 and December 2021 were retrospectively reviewed. Postoperative complications were classified after Clavien-Dindo. Binary logistic regression in Wald methodology was used to determine the predictive factors responsible for unfavourable outcome. Results: Total of 202 patients with EHPVO were operated. Mean age of patients was 20.30 ± 9.96 years, and duration of illness, 90.05 ± 75.13 months. Most common indication for surgery was portal biliopathy (n = 59, 29.2%), followed by bleeding (n = 50, 24.8%). Total of 166 patients (82.2%) had shunt procedure. Splenectomy with esophagogastric devascularization was the second most common surgery (n = 20, 9.9%). Nine major postoperative complications (Clavien-Dindo > 3) were observed in 8 patients (4.0%), including 1 (0.5%) operative death. After a median follow-up of 56 months (15-156 months), 166 patients (82.2%) had favourable outcome. In multivariate analysis, associated splenic artery aneurysm (p = 0.007), isolated gastric varices (p = 0.004), preoperative endoscopic retrograde cholangiography and stenting (p = 0.015), and shunt occlusion (p < 0.001) were independent predictors of unfavourable long-term outcome. Conclusions: Surgery in EHPVO is safe, affords excellent short- and long-term outcome in patients with symptomatic EHPVO, and may be considered for secondary prophylaxis.

• Tuberculosis and Respiratory Diseases
• /
• 제40권5호
• /
• pp.468-473
• /
• 1993

연구배경 : 최근의 비디오 영상기술, 내시경 수술기구 및 내시경 수술기법의 눈부신 발달에 힘입어 흉강경의 영역이 단순한 늑막질환 진단에서 여러가지 흉부질환의 치료 방법으로 넓어졌다. 비디오 흉강경 수술(VATS) 방법은 3년전에 개발된 새롭고 가히 매력적이라 할 만한 흉부질환 수술방법으로 서울대학교병원에서도 1992년 7월에 도입하여서 비록 짧은 기간이지만 여러가지 임상경험을 하였기에 그 결과를 분석한다. 방법 : 1992년 7월부터 1993년 4월까지 10개월간 30명 환자에게 31예의 비디오 흉강경 수술을 시행하였다. 폐기포 절제술이 18명(19예), 종격동 종양 절제술이 4예, 폐실질 폐조직 생검 3예, 늑막생검 3예, 늑막종괴제거술 1예 그리고 늑막심낭창형성술 1예였다. 결과 : 사망예는 없으며 8예의 합병증이 발생하였다. 장기간공기누출이 3예, 장기간 늑막액 유출이 2예, 기흉재발 1예, 호너씨 증후군 1예, 애성 1예였다. 31예 모두 비디오흉강경 자체로 수술을 완료하였다. 합병증이 없었던 자연기흉 환자들의 술후 입원기간은 5일정도로 평상적인 개흉술로 수술받은 환자보다 입원기간이 약간 짧았다. 결론 : 비록 비디오 흉강경 수술은 초기단계라서 비교적 술후 합병증 빈도가 높았지만 이러한 술식이 통증감소, 입원기간단축, 빠른 회복, 미용적으로 우수한 작은 수술 상처 등의 여러가지 장점을 갖고 있어 환자들에게 매우 유익하다고 확신한다. 비디오 흉강경수술의 영역은 앞으로 흉곽내 여러가지 질환의 진단과 치료에 사용되고 심지어 심장병질환에도 응용될 것이라 생각된다.

• 대한기관식도과학회지
• /
• 제16권2호
• /
• pp.109-114
• /
• 2010

Background: The aim of this study was to compare a novel mannose receptor-binding agent(Technetium-99m human serum albumin, $^{99m}Tc$-MSA) with $^{99m}Tc$-phytate for sentinel node mapping in patients with esophageal cancer. Material and Method: Twenty patients with clinical stage T1N0m0 or T2N0M0 esophageal cancer that were candidates for esophagectomy were enrolled. Endoscopic injection of $^{99m}Tc$-MSA or $^{99m}Tc$-phytate was administered at the peri-tumor region before surgery in 10 patients. The radioactive lymph nodes were identified with a handheld gamma probe after lymph node dissection. Results: The patient's age and the sex ratio of both groups were similar. The clinical stage, tumor location, and operative technique did not differ. The total number of dissected lymph nodes did not differ ($28.5{\pm}9.12$ in MSA group, $32.2{\pm}11.24$ in phytate group, p=0.430). The sentinel node was identified in all cases in both groups. The number of sentinel nodes per patient was $2.7{\pm}1.57$ in the MSA group, which was significantly greater than the $1.7{\pm}0.88$ in the phytate group (p=0.036). Five out of 20 patients whose sentinel nodes could be identified had metastases; however, neither group had any false-negative results for sentinel node identification. Conclusion: Sentinel nodes were detected more frequently with MSA than with phytate.

• 대한기관식도과학회지
• /
• 제3권1호
• /
• pp.94-100
• /
• 1997

Background and Objectives : In children with tracheal stenosis, operative management remains a challenging problem due to difficulties of operative techniques and postoperative care. The purpose of this study was to determine the effectiveness of tracheal resection with end to end anastomosis as operative management for tracheal stenosis in children. Materials and Methods : 6 children with severe tracheal stenosis underwent tracheal resection with end to end anastomosis. Causes of stenosis were trauma in 1 case and prolonged intubation or tracheotomy in 5 cases. The diagnoses were made by radiologic evaluation (plain X-ray, CT, 3-Dimensional CT) and confirmed by direct laryngoscopy and ventilating bronchoscopy under general anesthesia. Thyroplasty and unilateral arytenoidectomy were performed in 1 case. Suprahyoid release was done in 1 case with severe adhesion. Decanulation was achieved following postoperative endoscopic examination and pulmonary function test. Postoperative physical and radiologic examinations were given at regular intervals. Results : Stenosis were improved from grade III grade I in 4 cases and from grade II to grade I in 2 cases. Decanulation was achieved on average postoperative 6 months in 5 cases, and 10 years in 1 case due to exertional dyspnea. There were 1 each case of immediate postoperative subcutaneous emphysema, pneumothorax and wound infection. Postoperative granulomas at anastomosis site were treated with laser vaporization under suspension laryngoscope and bronchoscope in 3 cases. There was 1 each case of delayed postoperative vocal cord palsy, aspiration pneumonia and loss of cough reflex. Conclusion In tracheal stenosis of children, tracheal resection with end to end anastomosis has good result with preservation of normal airway. Preoperative evaluation of local factors such as swallowing, vocal cord movement and cough reflex and general condition was important for successful treatment. As the cases in adults, authors considered this operation to be a curable operative management for tracheal stenosis.

• Journal of Minimally Invasive Surgery
• /
• 제21권4호
• /
• pp.160-167
• /
• 2018

Purpose: The aim of our study was to present an abdominal wall closure technique using barbed suture $V-Loc^{TM}$ 90 after single incision laparoscopic appendectomy (SILA) and to compare perioperative outcomes with conventional layer by layer abdominal wall closure after SILA. Methods: From March 2014 to July 2016, a retrospective case-control study was conducted for a total of 269 consecutive patients who underwent SILA. According to abdominal wall closure methods, 129 patients were classified into the V-Loc closure group and 140 patients were assigned into the conventional layer by layer closure group. In the V-Loc group, abdominal wall closure was performed from the fascia to the skin with a single thread of unidirectional absorbable barbed suture $V-Loc^{TM}$ 90 2-0 using continuous running suture and reverse overlapping reinforced running technique. Subcutaneous closure and subcuticular suture were performed with the remaining portion of V-Loc. Results: The V-Loc closure group showed shorter total operation time ($40.0{\pm}15.4min$ vs. $44.9{\pm}16.3min$, p=0.013) and abdominal wall cusing continuous running suture and reverse overlapping reinforced running technique. Subcutaneous closure and subcuticular suture were performed with the remaining portion of V-Loc. Results: The V-Loc closure group showed shorter total operation time losure time ($5.5{\pm}0.9min$ vs. $6.5{\pm}0.8min$, p<0.001). Postoperative incision length was significantly shorter in the V-Loc closure group ($1.1{\pm}0.3cm$ vs. $1.8{\pm}0.4cm$, p<0.001). Postoperative wound pain, time to resume diet, postoperative hospital stay, complications including surgical site infection, or mean patient satisfaction score at one month after hospital discharge was not significantly different between the two groups. Conclusion: In conclusion, unidirectional knotless barbed suture is a safe alternative method for abdominal wall closure after SILA. It can save time while providing comparable cosmesis.

• Journal of Gastric Cancer
• /
• 제5권3호
• /
• pp.169-173
• /
• 2005

목적: 위폴립은 위장에 발생하는 흔한 양성 신생물로서, 증식폴립과 샘종폴립으로 크게 나눈다. 대개의 위폴립은 증식폴립이며 아직 정확한 병인은 밝혀져 있지 않다. 샘종폴립의 경우 보통 장화생 현상을 동반한 미성숙 상피세포로 변화할 수 있어, 악성 변화를 나타낼 수 있는 것으로 알려져 있다. 따라서 샘종폴립에 비해 증식폴립에서는 악성으로 잘 이행하지 않는다고 하는, 지금까지 알려진 위폴립의 지식을 바탕으로 하여 저자들은 위절제술 후 생긴 위 폴립 병변의 특성을 알아보고자 하였다. 대상 및 방법: 1995년 1월부터 2004년 1월까지 위암으로 위절제술을 받은 환자 중 6개월 또는 1년을 단위로 하여 내시경 경과관찰을 한 환자의 잔위에서 생긴 위 폴립을 병리조직 학적 분류와 빈도, 내시경적 크기와 Yamada형 소견, 수술 방법에 따른 차이를 보이는지를 비교 관찰하였다. 결과: 전체 대상 환자는 138명, 정상 위에서 발생한 폴립은 115예, 위절제술 후에 발생한 폴립은 23예였다. 정상 위에서의 폴립의 발생 부위를 보면 전정부에서의 발생이 가장 많았으나, 위절제술 후에는 수술 후 문합부위에서 가장 높은 빈도를 보였다. 정상 위에서의 폴립의 조직학적 분류는 증식폴립 86예(75%), 샘종폴립 24예(21%), 염증폴립 4예(3%), 장피 화생 1예(0.8%)의 발생빈도를 보였다. 위절제술 후의 폴립의 조직학적 분류는 위십이지장 문합술 후 증식폴립 3예(18%), 샘종폴립 1예(6%), 염증폴립 13예(76%)였고 위공장 문합술 후 증식폴립 3예(50%), 샘종폴립 1예(17%), 염증폴립 2예(23%)였다. 위절제 수술 후 폴립의 크기는 정상 위의 폴립의 크기보다 작은 양상을 보였다. 정상 위에서 폴립의 Yamada 형태의 분류는 위절제 수술 후에는 I, IV형이 정상 위의 폴립에 비하여 적은 빈도로 생기는 양상을 보였다. 결론: 위절제 수술 후의 폴립은 수술 문합부에서의 발생빈도가 높았고, 주로 염증폴립 이 대부분을 차지하였으며, 자주 내시경 관찰을 하는 이유로 정상 위에서 보다 일찍 발견되어 크기는 작았으며, 육안적으로 폴립의 Yamada 형태의 분류는 II, III의 형태를 띠고 있었다.

• Journal of Chest Surgery
• /
• 제38권5호
• /
• pp.366-370
• /
• 2005

배경: 일반적으로 심장수술은 정중흉골절개를 통해 행해져 오고 있으며, 과거 십 년간 내시경 장비와 수술 수기의 향상은 작은 절개를 이용한 최소 침습적 심장수술의 발전을 이끌었다. 술자의 음성 명령을 인식하여 내시경을 움직이는 로봇 팔(AESOP 3000, Automated Endoscope System for Optimal Positioning)의 등장으로 심장수술은 로봇 시대에 진입하였다. 대상 및 방법: 2004년 4월부터 12월까지 총 78명의 환자들에게 수술로봇을 이용한 심장수술을 시행하였고 그 중 64명의 환자들에게는 음성명령으로 조절되는 로봇 팔과 대퇴 동정맥관 삽관, 경피적 내경정맥관 삽관, 흉곽을 통한 대동맥 겸자를 사용하여 5cm 우외측 최소개흉으로 로봇을 이용한 최소 침습적 심장수술을 시행하였다. 다른 14명의 환자들에게는 AESOP을 이용한 내흉동맥 박리를 통해 최소 침습적 관상동맥 우회술(MIDCAB)을 시행하였다. 결과: 로봇을 이용한 심장수술은 승모판막 성형술이 37예, 승모판막 치환술이 10예, 대동맥판막 치환술이 1예, MIDCAB이 14예, 심방중격결손증 수술이 9예, Maze 수술만 시행한 경우가 1예였다. 승모판 수술의 경우 평균 체외순환시간은 $165.3\pm43.1$분이었고 평균대동맥 차단 시간은 $110.4\pm48.2$분이였다. 재원일수의 중간값은 승모판 수술인 경우 6일($3\~30$일), MIDCAB은 4일($2\~7$일), 심방중격결손증 수술은 4일($2\~6$일)이였다. 합병증으로는 술 후 출혈로 재수술한 경우가 3예이였고 사망환자는 없었다. 결론: 수술로봇을 이용한 심장수술을 시행한 우리의 경험으로 볼 때 많은 심장외과 의사들이 로봇을 이용하여 작은 창상을 통해 최소 침습적 심장수술이 가능하리라 본다. 수술로봇을 이용한 심장수술의 이점을 분석하기 위해서는 잘 계획된 연구와 긴밀한 장기간의 관찰이 필요할 것으로 판단된다.

• Radiation Oncology Journal
• /
• 제34권3호
• /
• pp.177-185
• /
• 2016

Purpose: To investigate whether preoperative chemoradiotherapy (PCRT) followed by local excision (LE) is feasible approach in clinical T2N0 rectal cancer patients. Materials and Methods: Patients who received PCRT and LE because of clinical T2 rectal cancer within 7 cm from anal verge between January 2006 and June 2014 were retrospectively analyzed. LE was performed in case of a good clinical response after PCRT. Patients' characteristics, treatment record, tumor recurrence, and treatment-related complications were reviewed at a median follow-up of 49 months. Results: All patients received transanal excision or transanal minimally invasive surgery. Of 34 patients, 19 patients (55.9%) presented pathologic complete response (pCR). The 3-year local recurrence-free survival and disease free-survival were 100.0% and 97.1%, respectively. There was no recurrence among the patients with pCR. Except for 1 case of grade 4 enterovesical fistula, all other late complications were mild and self-limiting. Conclusion: PCRT followed by an LE might be feasible as an alternative to total mesorectal excision in good responders with clinical T2N0 distal rectal cancer.