• Journal of Gastric Cancer
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• 제7권1호
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• pp.31-37
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• 2007

목적: 위 전절제술 시 췌장의 합병 절제로 인한 술 후 합병증의 감소를 위해 췌장보존 비장적출술이 소개되었으나, 이 술식을 적용했던 몇몇 보고에서 여전히 합병증에 대한 문제점이 제기되었고 이에 따른 보완술식의 필요성과 해부학적 검토가 요구되어 본원에서 시행한 술식의 결과를 통해 그 보완점을 제시하고자 하였다. 대상 및 방법: 1997년 1월부터 2004년 12월까지 위암으로 위 전절제술 시 췌장보존 비장적출술을 시행 받은 환자 141명을 대상으로 하였으며, 기존의 전통적인 술식을 시행한 38예(A군)와 췌장 미부의 괴사에 대해 보완 개발된 술식을 시행한 103예(B군)를 각각 두 군으로 구분하여 술 후 합병증을 비교 분석하였다. 결과: A군과 B군 두 군 간 술 후 합병증 비교에서는 췌장루가 각각 4예와 0예, 복강내 농양이 1예와 0예였고 췌미부 괴사는 2예와 0예에서 수술 중 발생되었으며 2예 모두 췌미부 절제술을 시행하였다. 그 외로 경미한 췌즙누출이 각각 2예씩 발생하였으나, 보존적 치료로 호전되었다. 두 군 간 합병증 발생률은 통계적으로 유의한 차이를 보였다(P=0.0001). 결론: 위 전절제술에서 췌장보존 비장적출술의 합병증에 대한 보완을 위해 혈관 겸자를 이용해 임시적으로 비동맥의 혈류를 차단하여 췌 미부의 허혈성 변화를 관찰한 후 비동맥을 절단하는 술식을 적용한 보완된 췌장 보존 비장 적출술은 간편하면서도 술후 합병증을 예방할 수 있는 유용한 술식으로 생각된다.

• Clinical and Experimental Pediatrics
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• 제58권2호
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• pp.69-72
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• 2015

Insulinoma, which arises from insulin-producing pancreatic beta cells, is a rare tumor in children. Only 5%-10% of insulinomas are malignant and undergo metastasis. We report a case of an 11-year-old girl who experienced hypoglycemia-related seizures induced by an insulinoma; after resection of the primary tumor, she developed hepatic focal nodular hyperplasia (FNH). Laboratory test results indicated marked hypoglycemia with hyperinsulinemia. Abdominal ultrasonography (US) and computed tomography results were normal; however, magnetic resonance imaging (MRI) showed a solid mass in the pancreatic tail. Therefore, laparoscopic distal pancreatectomy was performed. Two months after the surgery, an abdominal MRI revealed multiple nodular lesions in the liver. An US-guided liver biopsy was then performed, and histological examination revealed FNH without necrosis or mitotic activity. The patient has been free of hypoglycemia for 2 years, and recent MRI studies showed a decrease in the size of FNH lesions, without any evidence of metastasis. Even though no metastatic lesions are noted on imaging, close observation and follow-up imaging studies are required in a child with insulinoma that has malignant potential on histopathologic findings.

• Journal of Trauma and Injury
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• 제24권2호
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• pp.68-74
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• 2011

Purpose: Although pancreas injury is rare in abdominal trauma, it poses a challenge to the surgeon because its clinical features are not prominent and the presence of main duct injury cannot be easily identified by imaging studies. Furthermore, severe pancreas injuries require a distal pancreatectomy or a pancreaticoduodnectomy which are associated considerable morbidity and mortality. We reviewed the clinical features of and outcomes for patients with pancreas injury. Methods: For 10 years from Jan. 2001 to Dec. 2010, thirty-four patients were diagnosed as having pancreas injury by using an explo-laparotomy. Patients successfully treated by non-operative management were excluded. Patients were divided into early (n=18) and delayed surgery groups (n=11) based on an interval of 24hours between injury and surgery. The clinical features of and the outcomes for the patients in both groups were compared. Results: Males were more commonly injured (82.4% vs.17.6%). The mean age was 37.2 years. The injury mechanisms included vehicle accidents (62.9%, 22/34), assaults (20%, 7/34), and falls (11.4%, 3/34). The head and neck of the pancreas was most commonly injured, followed by the body and the tail (16, 12, and 6 cases).Of the 34 patients, 26 (76.5%) patients had accompanying injuries. Grade 1 and 2 occurred in 14 (5 and 9) patients, and grade 3, 4, and 5 occurred in 20 (16, 3, and 1) patients. The early and delayed surgery groups showed no difference in surgical outcomes. Two patients with grade 3 in the early surgery group died after surgery,one due to massive hemorrhage and the other due to septic shock. Of the five patients initially managed non-operatively, three developed peripancreatic necrosis and two developed pseudocyst. All five patients were successfully cured by surgery. Conclusion: All cases of pancreas injury in this study involved blunt injury, and accompanying injury to major vessels or the bowel was the major cause of mortality. Surgery delayed for longer than 24 hours after was not associated with adverse outcomes.