• 대한영상의학회지
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• 제81권5호
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• pp.1216-1221
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• 2020

국소진행성 췌장암 환자에서 이차적 근치절제 가능성을 얻기 위해 수술 전 동시항암화학방사선요법이 점차 많이 이용되고 있다. 대부분의 환자들에게 담도의 감압이 필요함에도 불구하고, 담도 스텐트와 동시항암화학방사선요법을 함께 시행하는 안전성에 대한 연구는 많지 않다. 저자들은 동시항암화학방사선요법 후 담도 스텐트에 의해 발생한 지연성 간동맥 출혈의 드문 증례를 보고하는 바이다. 추적 관찰 CT에서 담도 스텐트와 우간동맥과의 거리가 점점 가까워졌고, 결국 스텐트가 간동맥을 압박하여 간동맥에 심한 굴곡이 생겼다. 카테터 혈관조영술에서 우간동맥에 조영제의 혈관 외 유출이 발견되어 혈관 내 색전술을 이용하여 치료하였다. 본 증례 보고는 동시항암화학방사선요법 후 발생하는 해부학적 변형이 심각한 합병증의 원인이 될 수도 있음을 강조하고 있다. 간동맥이 담도 스텐트에 의해 압박되는 소견은 혈관손상의 경고 신호로서 주의가 필요하다.

• Journal of Trauma and Injury
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• 제29권2호
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• pp.47-50
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• 2016

Transcatheter arterial embolization (TAE) for blunt hepatic injury in children is not common and is especially rare after damage control surgery (DCS). We report a successful TAE after DCS on a child for massive bleeding from the left hepatic artery due to a motor vehicle accident. The car (a sport utility vehicle) ran over the chest and abdomen of a 4-year-old boy. On arrival, initial vital signs were as follows: blood pressure, 70/40 mmHg; heart rate, 149/min; temperature, $36.7^{\circ}C$; respiratory rate, 38/min. After resuscitation, computed tomography was done, and a suspicious contrast leakage from a branch of the left hepatic artery and a spleen injury (grade V) were found. TAE was performed successfully after DCS for a liver injury.

• 대한영상의학회지
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• 제83권1호
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• pp.189-193
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• 2022

췌장-담도계 수술 후에 발생하는 합병증 중에 출혈은 드물지만 사망률이 높은 합병증이다. 출혈의 주요 원인은 가성동맥류의 파열이며, 코일색전술 혹은 혈관 내 스텐트 그라프트 삽입술이 효과적인 치료 방법으로 알려져 있다. 저자들은 유문부 보존 췌두부십이지장절제술 이후 발생한 총간동맥의 가성동맥류의 치료를 위해 삽입한 스텐트 그라프트가 공장으로 이동한 후 몸 밖으로 빠져나간 사례를 보고하고자 한다.

• 대한방사선기술학회지:방사선기술과학
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• 제24권2호
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• pp.13-17
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• 2001

When most patients are diagnosed with the quiet progressed hepatoma which often would make the operation impossible, the Interventional Radiology hepatic artery embolization is an extremely useful method for such patients. An existence of the malfunction is evaluated by gaining a portal vein image as a delayed phase image after injecting a contrast media into the superior mesenteric artery. However, it is difficult to make a definite judgement due to the extended exposure time with the peristalsis and the intestine gas obstructing the sharpness of the image when the Patient exposure time increases and due to the increased usage of contrast media and its side effect. The portal vein can be evaluated by obtaining the MIP image after reconstructing a 3-dimensional personal computer setting using the 2-dimensional from an enhancement abdomen CT image that is almost a requisite in operation to a hepatoma patient. Such method nay prevent a decrease in the quality of image based upon the time delay and intestine gas; also, because the patient exposure dose and contrast media usage may be reduced, it is a new, valuable way to decide the operational matter of hepatic artery embolization on a pre-angiography.

• BMB Reports
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• 제36권2호
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• pp.237-242
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• 2003

Hepatic lipase is a key enzyme that is involved in HDL-C metabolism. The goal of this study was to find out the frequency of the hepatic lipase C514T polymorphism, and evaluate its relationship with plasma HDL-C levels and coronary artery disease (CAD) in Koreans. Two hundred and twenty four subjects with no previous history of lipid-lowering therapy, 118 patients with significant CAD, and 106 controls were examined with respect to their genotypes, lipid profiles, and other risk factors for CAD. The frequency of the -514T allele was 0.37 in men and 0.35 in women, which were higher than the frequency that was reported in Caucasians, but lower than the frequency that was reported in African-Americans. The -514T allele was associated with significantly higher HDL-C levels in women. After controlling for age, gender, BMI, DM, and smoking, the non-CC genotype was significantly associated with HDL-C levels, and explained 6% of the HDL-C variation in this study. When the genotypes-distribution was compared between the CAD and non-CAD patients, the hepatic lipase C-514T polymorphism was not associated with the presence of CAD. Koreans have a higher frequency of the hepatic lipase gene 514T allele than Caucasians, and the -514T allele is associated with higher plasma HDL-C levels in Korean women, and perhaps non-smoking men. However, our data does not suggest an association between the polymorphism and an increased risk of CAD.

• 한국산학기술학회논문지
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• 제20권3호
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• pp.188-193
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• 2019

경동맥 화학색전술은 널리 이용되며 빠르게 발전하고 있는 간세포암의 비수술적 치료법이다. 만족할만한 치료결과를 얻기 위해서는 환자의 해부학적 특성을 이해하고 종양 공급 동맥을 찾아내서 올바른 치료 계획을 세워야 한다. 본 연구에서는 간세포암의 경동맥 화학색전술 중에 방해요인으로 작용한 후천성 동정맥 기형의 증례를 보고하고자 한다. 72세 남자가 2일전부터 지속된 복통으로 내원하였다. 만성 B형 간염환자로 10년 전 간세포암에 대한 고식적 경동맥 화학색전술을 시행 받고 완치된 과거력이 있었다. 전산화 단층 촬영상 간우엽의 8분절에 결절성 간세포암이 발견되었으며 우간동맥은 상장간막동맥에서 기시하는 기형을 가지고 있었으며 종양 주변에 과혈관성 종양 구조가 관찰되었다. 1차 경동맥 화학색전술을 실시하였을 때 좌간동맥에서 기시하는 종양 공급동맥을 찾아 이를 약물방출미세구와 Adriamycin 50mg을 이용하여 화학색전하였다. 우간동맥조영술을 시행하였을 때 동정맥 기형이 관찰되었으며 간세포암은 관찰되지 않았다. 1개월 후 시행한 전산화 단층 촬영상 괴사된 종양과 남은 병변이 관찰되어 2차 경동맥 화학색전술을 시행하였다. 우간동맥을 통하여 미세유도철사와 카테터를 이용하여 동정맥 기형을 지나쳐 초선택하였고 시행한 조영술에서 남은 간세포암의 병변이 조영됨을 확인할 수 있었다. 이를 약물방출미세구와 Adriamycin을 이용하여 화학색전하였다. 시술 후 혈관 조영술에서 간세포암이 조영되지 않는 것을 확인하였고, 그 후 환자는 특별한 합병증 없이 퇴원하였다. 저자들은 매우 드물게 발생하는 간세포암 주변의 후천성 동정맥 기형을 발견하였고, 방해요인으로 작용한 동정맥 기형을 넘어 초선택적 경동맥화학색전술을 시행하여 간세포암을 치료하였다.

• Journal of Gastric Cancer
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• 제21권1호
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• pp.74-83
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• 2021

Purpose: No consensus exists on whether to preserve or ligate an aberrant left hepatic artery (ALHA), which is the most commonly encountered hepatic arterial variation during gastric surgery. Therefore, we aimed to evaluate the clinical effects of ALHA ligation by analyzing the perioperative outcomes. Materials and Methods: We retrospectively reviewed the data of 5,310 patients who underwent subtotal/total gastrectomy for gastric cancer. Patients in whom the ALHA was ligated (n=486) were categorized into 2 groups according to peak aspartate aminotransferase (AST) or alanine aminotransferase (ALT) levels: moderate-to-severe (MS) elevation (≥5 times the upper limit of normal [ULN]; MS group, n=42) and no-to-mild (NM) elevation (<5 times the ULN; NM group, n=444). The groups were matched 1:3 using propensity score-matching analysis to minimize confounding factors that can affect the perioperative outcomes. Results: The mean operation time (P=0.646) and blood loss amount (P=0.937) were similar between the 2 groups. The length of hospital stay was longer in the MS group (13.0 vs. 7.8 days, P=0.022). No postoperative mortality occurred. The incidence of grade ≥ IIIa postoperative complications (19.0% vs. 5.1%, P=0.001), especially pulmonary complications (11.9% vs. 2.5%, P=0.003), was significantly higher in the MS group. This group also showed a higher Comprehensive Complication Index (29.0 vs. 13.9, P<0.001). Conclusions: Among patients with a ligated ALHA, those with peak AST/ALT ≥5 times the ULN showed worse perioperative outcomes in terms of hospital stay and severity of complications. More precise perioperative decision-making tools are needed to better determine whether to preserve or ligate an ALHA.

• 대한영상의학회지
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• 제81권6호
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• pp.1448-1452
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• 2020

간동맥 거짓동맥류는 드문 질환이나 잠재적으로 생명을 위협할 수 있는 질환으로 외상 이후에 발생하는 경우가 많다. 때문에 빠른 진단과 적절한 치료가 혈복강과 같은 심각한 결과를 예방하기 위해 필수적이다. 우리는 의인적 손상 없이 Klebsiella oxytoca에 의한 간농양에 생긴 간동맥 거짓동맥류의 드문 증례를 보고하는 바이다. 이 증례의 독특한 특징은 농양 공간이 간동맥과 생긴 누공에 의해 거짓동맥류가 되었다는 점이다. 이 증례로부터 의인성 손상이 없이 환자의 임상 과정이 좋지 않은 경우 혈관 관련 합병증에 주의를 기울여야 함을 알 수 있으며 혈관 내 시술의 효과적이고 안전한 치료 방법이 될 수 있음을 알 수 있다.

• Journal of Digestive Cancer Research
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• 제3권1호
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• pp.26-29
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• 2015

A 73-year-old male visited our hospital with a complaint of general weakness. He underwent pyloric preserving pancreas-toduodenectomy due to ampullary cancer three years ago. Abdominal computed tomography scan at initial visit revealed multiple hepatic masses. A PET-CT scan showed multiple FDG uptakes at whole liver. He underwent hepatic artery infusion chemotherapy (HAIC) for five cycles. During the first cycle of HAIC, he developed gastric ulcer bleeding and endoscopic hemostasis was done successfully. Esophagogastroduodenoscopy after the 5^th cycle of HAIC revealed ulcer scar at gastric angle. PET-CT scan at 12 months showed no FDG uptake at liver, but a focal FDG uptakes at stomach and peri-gastric lymph nodes were newly developed. Esophagogastroduodenoscopy revealed about 3 cm sized mass at gastric angle. He underwent surgery and pathologic examination revealed large cell neuroendocrine carcinoma. We report a case of gastric large cell neuroendocrine carcinoma with liver metastasis treated with HAIC followed by surgery.

• 대한수의학회지
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• 제32권4호
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• pp.511-521
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• 1992

The distribution of the hepatic arteries within the liver in 30 Korean native cattle were observed. Vinylite solution was injected into the hepatic arteries of 10 livers for cast preparation. The angiography was prepared in 20 livers by injected 30% barium sulfate solution into the hepatic arteries and then radiographed on X-ray apparatus. The results were summarized as follow ; 1. The hepatic arteries were divided into the Ramus (R.) sinister, R. dexter and R. intermedius. The intrahepatic arteries were derived from the R. sinister and R. dexter. The R. intermedius divided into the Arteria(A.) gastrica dextra, A. gastroduodenalis and A. cystica. 2. The right branch (ramus dexter) of the hepatic artery supplies the right lobe and caudate process. It consisted of the A. dorsalis lobi dextri, A. ventralis lobi dextri and A. lobi caudati. They formed one common trunk with three arteries(6 cases, 20%), and two arteries formed common trunk with the A. ventralis lobi dextri and A. lobi caudati (16 cases, 52.8%), or with A. dorsalis lobi dextri and A. lobi caudati (5 cases, 16.5%). The three arteries arose from the A. hepatia independently(3 cases, 10%). 3. The left branch (ramus sinister), larger than the right and often double (6 cases, 20%), supplies the caudate, quadrate and left lobes, and often gives origin to the A. gastrica dextra. 4. The branches of hepatic artery in the left lobe were derived from A. dorsalis lobi sinistri, A. ventralis lobi sinistri and A. intermedius lobi sinistri. The A. intermedius lobi sinistri were absent in some cases (3 cases, 10%). They almostly originated a single branch and often two branches. 5. The A. cystica arose from the R. intermedius(27 cases, 90%) and A. hepaica(3 cases, 10%). 6. The Rami processus papillarum arose from dorsal border of the Pars transversa of the left branch(19 cases, 62.7%), the left branch and right branch (9 cases, 30%) or A. hepatica(2 cases, 6.6%). 7. The A. lobi quadrata arose from either the Pars transversa of left branch (12 cases, 40%) or A. hepatica(4 cases, 13.2%). It also arose from both Pars transversa of left branch and A. ventralis lobi sinistri (3 cases, 10%). 8. The anastomosis on the branches of A. hepatica was observed in intrahepatic and cystic arteries. The left and right branches ramified several secondary radiating branches within the liver. 9. The hepatic arteries formed a very short common trunk of the right branch ($18.75{\pm}11.89$ : 2.20~44.8mm) and a long Pars transversa of the left branch($72.85{\pm}20.04$ : 28.2~104.1mm). 10. The ramified angles at the A. dorsalis lobi dextri, A. ventralis lobi dextri, A. lobi sinistri, A. ventralis lobi sinistri, A. lobi quadrata, A. cystica and Rami processus papillarum were 50-80, 270-300, 340-20, 120-160, 160-290, 200-230, 250~290, 230~280 and 80~120 degrees, respectively.