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간장 ( 肝臟 ) , 담도 ( 膽道 ) 및 췌장 ( 膵臟 ) : 체외 충격파 쇄석술을 이용한 간내 담관결석의 치료
이성구(Sung Koo Lee),김명환(Myung Hwan Kim),이승규(Sung Kyu Lee),민영일(Yong Il Min),이문규(Moon Kyu Lee),성규보(Kyu Bo Seong),조경식(Kyung Sik Cho),안세현(Se Hyun Ahn),민병철(Byung Chul Min) 대한소화기학회 1991 대한소화기학회지 Vol.23 No.3
N/A Extracorporeal shockwave lithothripsy was performed in the intrahepatic stone patients (n = 18) by Dornier MPL 9,000 with ultrasound guidance. The patients had T-tube (n=9) or percutaneous transhepatic biliary drainge tube (n =9). Average treatment session was four and shock wave numbers were in the range of 3,604 to 12,000 (average 6,288 shocks). Intrahepatic stones were removed completely in 16 patients over a 3 month period by ESWL and combined stone extraction maneuver such as cholangioscopic or interventional radiologic method. Extracorporeal shock wave lithothripsy was very helpful in facilitating extraction of stones in unfavorable location or located above the severe stricture. In summary, extracorporeal shockwave lithotripsy followed by percutaneous stone extraction will provide an improvement in the success rate and duration of treatment required for complete removal of primary hepatolithiasis.
폐색전증 진단에 있어서 Spiral Computed Tomography 의 유용성
이성순(Sung Soon Lee),임채만(Chae Man Lim),송군식(Koun Sik Song),성규보(Kyu Bo Sung),고윤석(Youn Suck Koh),이상도(Sang Do Lee),김우성(Woo Sung Kim),김동순(Dong Soon Kim),김원동(Won Dong Kim) 대한내과학회 1997 대한내과학회지 Vol.53 No.6
Objective: Spiral volumetric computed tomography(spiral CT) has the advantage of direct imaging of intravascular thrombus or its relevant vascular abnormalities, but controversy exists about the value of spiral CT in the diagnosis of pulmonary embolism in the different levels of pulmonary artery. Methods : The authors prospectively evaluated the diagnostic efficacy of spiral CT for pulmonary embolism in 20 patients (M:F=13:7, 57±10.4yrs) who were suspected to have pulmonary embolism from clinical symptoms and/or scintigraphic findings. Both spiral CT and pulmonary angiography were performed in these patients with the interval being 28 ±14.1 hours. The diagnostic efficacy of spiral CT was evaluated in the patients and also in the pulmonary arteries found to have emboli on pulmonary angiogram. Results: Pulmonary embolism was diagnosed in 8 patients and excluded in 12 patients by pulmonary angiography. Spiral CT showed positive findings of pulmonary embolism in 7 of the 8 patients with pulmonary embolism, and was negative in 11 of the 12 patients without pulmonary embolism. The overall diagnostic efficacy of spiral CT for pulmonary embolism was: sensitivity 87%(7/8), specificity 92%(11/ 12), positive predictive value 87%(7/8), negative predictive value 92%(11/12), and accuracy 90%(18/20). For pulmonary embolism at lobar or greater pulmonary arteries, the diagnostic efficacy of spiral CT was: sensitivity 100%(15/15), specificity 98%(201/205), positive predictive value 79%(15/19), negative predictive value 100%(201/201), and accuracy 90% (216/220). For segmental or smaller arteries, how- ever, the diagnostic efficacy was: sensitivity 71%(15/ 21), specificity 98%(549/559), positive predictive value 60% (15/25), negative predictive value 99%(549/555), and accuracy 97%(554/580). Conclusion: Spiral CT can be a useful noninvasive method for the diagnosis of pulmonary embolism, and it may replace pulmonary angiography at the level of central pulmonary artery.
간장 ( 肝臟 ) , 담도 ( 膽道 ) 및 췌장 ( 膵臟 ) : 급성 담낭염의 치료에 있어서 경피적 담낭루 설치술의 이용
민영일(Young Il Min),이성구(Sung Koo Lee),안세현(Sei Hyun Ahn),김명환(Myung Hwan Kim),이승규(Sung Gyu Lee),전용철(Yong Cheol Jeon),성규보(Kyu Bo Seong),조경식(Kyung Sik Cho),이문규(Mun Gyu Lee) 대한소화기학회 1991 대한소화기학회지 Vol.23 No.3
N/A Percutaneous cholecystostomy is a techniue to obviate cholestectomy or surgical cholecystostomy in high risk patients. We evaluated 12 relatively high risk patients who underwent percutaneous cholecystostomy in recent 1 year. Overall success rate of percutaneous cholecystostomy was 92%(12/ 13). Relief of pain and defervescence could be observed promptly in almost all patients. In 4 cases of acalculous cholecytstitis, the catheters were removed successfully after resolution of acute inflammation. 3 cases of calculous cholecystitis were treated with elective cholecystectomy after resolution of septic condition. Percutaneous stone removal was performed via the enlarged tract with stone basket or other mechanical devices in 3 cases of calculous cholecystitis. Two cases of tube dislodge and 1 case of mild bile leakage were the complications of this procedure without significant mortality or morbidity. Percutaneous cholecystostomy is a fast, low risk and effective treatment of acute cholecystitis in poor surgical risk patients.
간장 ( 肝臟 ) , 담도 ( 膽道 ) 및 췌장 ( 膵臟 ) : Expandable Metallic Stent를 이용한 담도 협착의 치료
민영일(Young Il Min),이성구(Sung Koo Lee),김명환(Myung Hwan Kim),이승규(Sung Gyu Lee),전용철(Yong Cheol Jeon),성규보(Kyu Bo Seong),민병철(Pyung Cheol Min) 대한소화기학회 1991 대한소화기학회지 Vol.23 No.3
N/A Expandable metallic stents were implanted in 9 patients with malignant (4 patients) or benign (5 patients) biliary stenoses. Five patients with benign strictures (intrahepatic stones with intrahepatic strictures, n=4; intrahepatic and extrahepatic stones with common bile duct stricture, n= 1) and four with malignant biliary strictures (cholangiocarcinoma, n=4) were treated with expandable metallic stents via percutaneous or transpapillary route. The patients with benign disease had failed treatment with surgical reconstruction and transhepatic balloon dilatation. In the three of the four patients with cholangiocarcinoma, relief of jaundice was observed. Patients with benign strictures have done very well. Our experience shows that expandable metallic stents can be inserted with little discomfort for the patients and with relatively few complications. They will provide good palliation in patients with malignant obstructive jaundice and benign strictures.
원발성 간내 담석 환자에서 간내담도협착의 교정을 위한 팽창성 금속스텐트 ( Expandable Metallic Stent ) 의 이용
민영일(Young Il Min),이성구(Sung Koo Lee),김병식(Byung Sik Kim),김명환(Myung Hwan Kim),이승규(Sung Gyu Lee),성규보(Kyu Bo Seong),이선영(Sun Young Yi),박홍동(Hung Dong Park) 대한소화기학회 1993 대한소화기학회지 Vol.25 No.3
N/A We inserted self-expandable metallic stents in 16 patients with primary intrahepatic stones for the correction of intrahepatic strictures after complete rensoval of intrahepatic stones. All the patients had previous history of abdominal operations for removal of intrahepatic stones. The criteria from insertion of expandable metallic stents was recurrent stenosis after successful balloon dilatation. Inserted metallic stents were Gianturco-Rosch stents (24F) and the stents were inserted via T-tube or percutaneous transhepatic biliary drainage (PTBD) track, In the fallow-up period of average 12 months (9-15 months), 14 patients (88%) out of 16 patients had relief of pruritus and improvement of liver function. But two patients with secondary biliary cirrhosis showed no improvement of clinical symptoms and signs. In conclusion, these findings suggest that expandable metallic stents will be useful in the management of intrahepatic stricutures, which recurred after successful balloon dilatation, in the patients with primary intrahepatic stones.
양성간외담도협착증에서 중재적 방사선치료와 고식적 외과치료의 비교고찰
이종남(Jong Nam Lee),이승규(Sung Gyu Lee),권태원(Tae Won Kwon),최건무(Kun Moo Choi),성규보(Kyu Bo Seong),김명환(Myeong Hwan Kim),이성구(Sung Koo Lee),민병철(Pyung Chul Min) 대한소화기학회 1994 대한소화기학회지 Vol.26 No.4
N/A Benign biliary stricture represents a significant clinical problem, despite of the technological development that has facilitated diagnosis and management. Without proper treatment, it could cause recurrent cholangitis, biliary cirrhosis, liver failure, and death. There are several e- tiologic factors in benign biliary strictures but almost all cases are related to biliary operation, especially cholecystectomy. At Asan Medical Center, from July 1989 through June 1993, nineteen patients were man- aged for post-operative biliary strictures with surgery and radiologic intervention. Nine pa- tients were treated with surgical repair (Roux-en-Y choledocho- or hepaticojejunostomy); ten patients were treated with radiologic and endoscopic intervention (9 endoscopic or tran- shepatic balloon dilatation with stent placement and 1 balloon dilatation only). All patients had the history of previous biliary scrgery, 15 cholecystectomy or CBD explo- ration, 2 choledochoenterostomy, and 2 endoscopic papillostomy. There was no motality after any proce- dure and mean period of follow-up was 10.2 months (3 36 months) for both groups. In sur- gery group, 8 patients (89%) showed successful outcome but in radiologic intervention group, only 4 patients (40%) showed successful outcome. Minor complications after procedure were 4 cases in surgery group and 3 cases in radiologic intervention group but there was no major complication in both groups. Mean period of hospital stay was 6 days (1 16 days) in radiolog- ic intervention group and 23.1 days (19&5 days) in surgery group. Five patients required retreatment because of recurrent strictures after endobiliary stenting. In these patients, 3 Roux-en-Y hepaticojejunostomy was performed, 1 pancreaticduodenectomy was done because of a possibility of malignancy and 1 PTBD was done because the patient refused the surgery. In conclusion, Radiologic intervention for benign biliary strictures provides temporary relief of symptom and might be an alternative treatment, especially in poor risk patients. However, open surgery (mucosa-to-mucosa anastomosis) is superior to radiologic intervention for definite treatrnent of postoperative biliary strictures because of fewer problems that require fur- ther therapy and excellent outcome. (Korean J Gastroenterol 1994; 26: 697 705)