폐쇄성 결직장암에서 스텐트 삽입 후 시행한 복강경 결직장 절제술의 경험

이정임,이인규,강원경,조현민,박종경,오승택,김준기,김병욱,이보인,이윤석 대한대장항문학회 2009 Annals of Coloproctolgy Vol.25 No.3

Purpose: Laparoscopic surgery has been considered to be contraindicated for obstructive colorectal cancer. However, endoscopic stent insertion for obstructive colorectal cancer has recently allowed elective laparoscopic surgery. The aim of this study is to evaluate the feasibility and the short-term clinical outcomes of laparoscopic surgery following endoscopic stent insertion for management of malignant colorectal obstruction at a single center. Methods: The medical records of patients who had undergone endoscopic stent insertion for colorectal cancer obstruction, followed by laparoscopic colorectal resections, from August 2004 to August 2008 were reviewed. To evaluate the surgical and clinical outcomes, we analyzed the clinical and pathologic data. Results: Thirty-six endoscopic stent insertions were successfully performed during the study period. Of those 36, the 28 treated by laparoscopic surgery were enrolled in this study. The mean interval between stent insertion and surgery was 7.4 ±2.3 days. Two cases were converted to open surgery. The mean operative time was 185.5±53.1 min, and the mean blood loss was 77.0±72.9 mL. Flatus was passed on the mean 2nd postoperative day, and patients started to eat on the mean 4th postoperative day. The mean postoperative hospital stay was 11.2±4.4 days. Anastomosis leakages occurred in two cases and were treated by a secondary operation with a transient ileostomy. There were morbidities in five cases, but no mortalities. Conclusion: A combined endoscopic stent insertion and laparoscopic surgery is an effective and safe, minimally invasive operation for malignant colorectal obstruction. Purpose: Laparoscopic surgery has been considered to be contraindicated for obstructive colorectal cancer. However, endoscopic stent insertion for obstructive colorectal cancer has recently allowed elective laparoscopic surgery. The aim of this study is to evaluate the feasibility and the short-term clinical outcomes of laparoscopic surgery following endoscopic stent insertion for management of malignant colorectal obstruction at a single center. Methods: The medical records of patients who had undergone endoscopic stent insertion for colorectal cancer obstruction, followed by laparoscopic colorectal resections, from August 2004 to August 2008 were reviewed. To evaluate the surgical and clinical outcomes, we analyzed the clinical and pathologic data. Results: Thirty-six endoscopic stent insertions were successfully performed during the study period. Of those 36, the 28 treated by laparoscopic surgery were enrolled in this study. The mean interval between stent insertion and surgery was 7.4 ±2.3 days. Two cases were converted to open surgery. The mean operative time was 185.5±53.1 min, and the mean blood loss was 77.0±72.9 mL. Flatus was passed on the mean 2nd postoperative day, and patients started to eat on the mean 4th postoperative day. The mean postoperative hospital stay was 11.2±4.4 days. Anastomosis leakages occurred in two cases and were treated by a secondary operation with a transient ileostomy. There were morbidities in five cases, but no mortalities. Conclusion: A combined endoscopic stent insertion and laparoscopic surgery is an effective and safe, minimally invasive operation for malignant colorectal obstruction.

폐쇄성 수면 무호흡 환자의 후두개 폐쇄 양상

지영훈,우주영,고태경,구수권 대한이비인후과학회 부산,울산,경남 지부회 2023 임상이비인후과 Vol.34 No.4

Background and Objectives: We evaluated the pattern of epiglottic obstruction in obstructive sleep apnea (OSA) patients, focusing on the results of drug induced sleep endoscopy (DISE), along with a literature review. Materials and Methods: The subjects were 270 Koreans who underwent DISE. Each patient underwent a thorough history taking, physical examination, polysomnography and DISE image evaluated by one otolaryngologist. Results: The prevalence of epiglottic obstruction was 39% (105/270), anterior-posterior complete obstruction was 26% (70/270), and partial obstruction was 13% (35/270). There was no significant correlation between gender, age, body mass index and epiglottis obstruction. The more severe the epiglottic obstruction, the more severe the sleep apnea. The more severe the anterior-posterior obstruction of the tongue base, the more severe the obstruction of the epiglottis (p<0.001). Conclusion: The epiglottis is not well understood compared to other anatomical sites, and it can OSA either alone or simultaneously with other obstructive sites, so researches are needed from a therapeutic point of view.

폐쇄성 황달을 동반한 간세포암 환자에서 담관조영소견의 분석

송일한(Il Han Song),고문수(Moon Soo Koh),최호순(Ho Soon Choi),이성구(Sung Koo Lee),정영화(Young Hwa Chung),김명환(Myung Hwan Kim),이영상(Yung Sang Lee),서동진(Dong Jin Suh),민영일(Young Il Min) 대한소화기학회 1996 대한소화기학회지 Vol.28 No.1

N/A Background/Aims: Jaundice is present in 19-44% of patients with hepatocellular carcinoma(HCC) at the time of diagnosis. The mechanisms of jaundice are associated with cirrhosis, tumor infiltration into the hepatic parenchyma, and bile duct obstruction. Causes of obstructive jaundice secondary to bile duct obstruction in HCC are bile duct invasion of tumor, tumor thrombi, blood clot of hemobilia, and direct bile duct compression of tumor or metastatic lymph n3e. Methods: To evaluate levels and causes of bile duct obstruction in HCC patients with obstructive jaundice and to assess its survival according to causes of obstructive jaundice, we performed retrospective study, from March 1992 to June 1994, with HCC patients with obstnictive jaundice who under- went endoscopic retrograde cholangogiraphy and/or percutaneous transhepatic cholangiography. Results: The commonest level of bile duct obstruction was common hepatic duct(35.3%), followed by common bile duct(23.5%). The causes of obstruction type were tumor invasion(58.8%), tumor thromhi(29.4%), blood clot with hemobilia(5.97o), and bile duct compression hy tumor (5.9%), in order. The level of bile duct obstruction in most cases of tumor invasion was common hepatic duct while in cases of tumor thrombi, common bile duct was the frequent site. There v:as no difference in levels and types of bile duct obstruction according to tumor types of HCC. The su.rvival period of patients with tumor thrombi was significantly longer than that of patients with bile duct invasion(p0.05). Conclusions; HCC involving bile duct will be found frequently with increased use of direct cholangiograpy. The commonest type of bile duct obstruction in HC'C was duct invasion, so aggressive and adequate treatment for HCC may be useful in management of bile duct obstruction. (Korean J Gastroenterol 1996;28: 101 - 110)

구개수구개인두성형술 후 호전되지 못한 폐쇄성 수면무호흡증 환자에서 약물유도수면내시경을 이용한 결과 분석

김동규,이정우,이준호,이중섭,나윤성,김명진,이민주,박찬흠 대한이비인후과학회 2014 대한이비인후과학회지 두경부외과학 Vol.57 No.2

Background and Objectives The purpose of this study is to evaluate drug-induced sleep endoscopy (DISE) findings in patients with persistent obstructive sleep apnea (OSA) after uvulopalatopharyngoplasty (UPPP) surgery. Subjects and Method Patients were included in this study if they had a postoperative DISE evaluation as well as pre- and postoperative polysomnography. DISE findings included the obstructive sites (velum, oropharyngeal lateral walls, tongue base, and epiglottis), and the obstructive patterns of velopharynx (anteroposterior, lateral, and concentric). Results A total of 77 patients were included in this study. Poor-responder patients to UPPP (n=50) and well-responder patients to UPPP (n=27) were similar with regard to age, gender, body mass index, preoperative AHI, and minimal O2 saturation. In our analysis of DISE findings on poor-responder, velopharynx was the most common obstruction site (100%), followed by oropharynx (88%), tongue base (70%), and epiglottis (44%). Results showed that most patients (n=49) had multiple obstructive sites. No significant differences according to position dependency and REM dependency were found in obstructive sites. However, severe OSA patients had tongue base obstruction more frequently than the moderate OSA patients did. The obstructive pattern of velopharynx usually showed concentric configuration (70%, 35 of 50). Conclusion Our results suggest that the preoperative DISE may be a useful method for determination of the personalized surgery to OSA patients because of its more precise information to upper airway obstruction. Korean J Otorhinolaryngol-Head Neck Surg 2014;57:96-102

Contemporary Surgery for Obstructive Sleep Apnea Syndrome

Nelson B. Powell 대한이비인후과학회 2009 Clinical and Experimental Otorhinolaryngology Vol.2 No.3

Surgical treatment of obstructive sleep apnea syndrome (OSAS) has been available in some form for greater than three decades. Early management for airway obstruction during sleep relied on tracheotomy which although life saving was not well accepted by patients. In the early eighties two new forms of treatment for OSAS were developed. Surgically a technique described as a uvulopalatopharyngoplasty (UPPP) was used to treat the retropalatal region for snoring and sleep apnea. Concurrently sleep medicine developed a nasal continuous positive airway pressure (CPAP) device to manage nocturnal airway obstruction. Both of these measures were used to expand and stabilize the pharyngeal airway space during sleep. The goal for each technique was to limit or alleviate OSAS. Almost 30 yr later these two treatment modalities continue to be the mainstay of contemporary treatment. As expected, CPAP device technology improved over time along with durable goods. Surgery followed suit and additional techniques were developed to treat soft and bony structures of the entire upper airway (nose, palate and tongue base). This review will only focus on the contemporary surgical methods that have demonstrated relatively consistent positive clinical outcomes. Not all surgical and medical treatment modalities are successful or even partially successful for every patient. Advances in the treatment of OSAS are hindered by the fact that the primary etiology is still unknown. However, both medicine and surgery continue to improve diagnostic and treatment methods. Methods of diagnosis as well as treatment regimens should always include both medical and surgical collaborations so the health and quality of life of our patients can best be served. Surgical treatment of obstructive sleep apnea syndrome (OSAS) has been available in some form for greater than three decades. Early management for airway obstruction during sleep relied on tracheotomy which although life saving was not well accepted by patients. In the early eighties two new forms of treatment for OSAS were developed. Surgically a technique described as a uvulopalatopharyngoplasty (UPPP) was used to treat the retropalatal region for snoring and sleep apnea. Concurrently sleep medicine developed a nasal continuous positive airway pressure (CPAP) device to manage nocturnal airway obstruction. Both of these measures were used to expand and stabilize the pharyngeal airway space during sleep. The goal for each technique was to limit or alleviate OSAS. Almost 30 yr later these two treatment modalities continue to be the mainstay of contemporary treatment. As expected, CPAP device technology improved over time along with durable goods. Surgery followed suit and additional techniques were developed to treat soft and bony structures of the entire upper airway (nose, palate and tongue base). This review will only focus on the contemporary surgical methods that have demonstrated relatively consistent positive clinical outcomes. Not all surgical and medical treatment modalities are successful or even partially successful for every patient. Advances in the treatment of OSAS are hindered by the fact that the primary etiology is still unknown. However, both medicine and surgery continue to improve diagnostic and treatment methods. Methods of diagnosis as well as treatment regimens should always include both medical and surgical collaborations so the health and quality of life of our patients can best be served.

한국 성인 남성 폐쇄성 수면무호흡증 환자에서의 수면내시경 소견

홍성룡,이종길,이정훈,조규섭,노환중 대한이비인후과학회 부산,울산,경남 지부회 2012 임상이비인후과 Vol.23 No.2

Drug-induced sleep endoscopy (DISE) is one of the common techniques that visualize the upper airway dynamics during sleep in patients with obstructive sleep apnea (OSA). Authors tried to present the DISE results and to investigate the their relationship with polysomnography (PSG) findings. Materials and methods: Authors enrolled 31 male adults who were diagnosed with OSA between March 2011 and February 2012 at Pusan National University Yangsan Hospital. The data including age, body-mass index (BMI), Friedman staging, DISE findings and PSG results such as apnea-hypopnea index (AHI) and positional dependency were collected by retrospective chart reviews. Results:In DISE, 87.0% (27/31) showed the retropalatal airway obstruction and 48.4% (15/31) showed the retroglossal airway obstruction. Among them, 35.5% (11/31) showed obstructions in both the retropalatal and retroglossal airway. The retroglossal airway obstruction was not related with age, BMI or AHI but with Friedman’s palatal position and positional dependency (p=0.020 and 0.029, respectively). Conclusions:Freidman’s palatal position may be a good predictor of the retroglossal airway obstruction. This study suggests that a palatal airway surgery plus a positional therapy or a mandibular advancement device can be tried even in severe OSA patients with the retroglossal airway obstruction.

Palatine Tonsil Size Predicts Upper Airway Obstruction in Adults with Obstructive Sleep Apnea

지창록,구수권,고태경,우주영 대한이비인후과학회 부산,울산,경남 지부회 2022 임상이비인후과 Vol.33 No.2

Background and Objectives: Drug-induced sleep endoscopy (DISE) is widely used to diagnose obstructive sleep apnea syndrome (OSAS). Palatine tonsil hypertrophy is a frequently encountered potential source of upper airway obstruction. Here, we determined whether the pre-surgery size of the palatine tonsil could be used to predict the extent and pattern of upper airway obstruction during DISE of adults with OSA. Materials and Methods: We retrospectively evaluated 268 patients (mean age 42.80±12.34 years, range 17–73 years) who underwent polysomnography and were diagnosed with OSAS in a single medical center from 2013 to 2020. The Brodsky tonsil scores of all subjects were obtained via physical examination. DISE proceeded with each patient supine. The extent of obstruction was evaluated by dividing the upper airway into retropalatal and retrolingual levels (the Koo's DISE classification system). Data were analyzed via simple linear regression. A p<0.05 was considered statistically significant. Results: We found relationships between the Brodsky tonsil score and the extents of obstruction at the retropalatal level. A significantly negative relationship between the score and retropalatal anteroposterior collapse was apparent (slope coefficient –0.115, p<0.05), as well as a significantly positive relationship between the score and retropalatal lateral collapse (slope coefficient 0.274, p<0.05). However, at the retrolingual level, no significant relationship was apparent between the Brodsky score and the extent of obstruction (p>0.05). Conclusion: In adult patients with OSA, as the palatine tonsil size increased, lateral pharyngeal wall obstruction at the retropalatal level became more severe, and the pattern of upper airway collapse at that level tended to be lateral rather than anteroposterior or concentric.

Pharmacodynamic Estimate of Propofol-Induced Sedation and Airway Obstruction Effects in Obstructive Sleep Apnea-Hypopnea Syndrome

구본녀,한동우,신서경,김소연,강영란,정규희 연세대학교의과대학 2015 Yonsei medical journal Vol.56 No.5

Purpose: Sedatives must be carefully titrated for patients with obstructive sleep apnea-hypopnea syndrome (OSAHS) as oversedationmay lead to disastrous respiratory outcomes. This study aimed to investigate the relations between the effect-site concentration(Ce) of propofol and sedation and airway obstruction levels in patients with OSAHS. Materials and Methods: In 25 patients with OSAHS, sedation was induced by 2% propofol using target-controlled infusion. Sedationand airway obstruction levels were assessed using the Observer’s Assessment of Alertness/Sedation Scale and a four-category scale, respectively. The relationships between propofol Ce and sedation and airway obstruction were evaluated using a sigmoid Emax model. Pharmacodynamic modeling incorporating covariates was performed using the Nonlinear Mixed Effects Modeling VII software. Results: Increased propofol Ce correlated with the depth of sedation and the severity of airway obstruction. Predicted Ce50(m) (Ce associated with 50% probability of an effect≥m) for sedation scores (m≥2, 3, 4, and 5) and airway-obstruction scores (m≥2, 3, and 4) were 1.61, 1.78, 1.91, and 2.17 μg/mL and 1.53, 1.64, and 2.09 μg/mL, respectively. Including the apnea-hypopnea index (AHI) as a covariate in the analysis of Ce50(4) for airway obstruction significantly improved the performance of the basic model (p<0.05). Conclusion: The probability of each sedation and airway obstruction score was properly described using a sigmoid Emax model with a narrow therapeutic range of propofol Ce in OSAHS patients. Patients with high AHI values need close monitoring to ensure that airway patency is maintained during propofol sedation.

Determinants of Nicotine Dependence in Chronic Obstructive Pulmonary Disease

( Yun Su Sim ),( Jin Hwa Lee ),( Ki Uk Kim ),( Seung Won Ra ),( Hye Yun Park ),( Chang-hoon Lee ),( Deog Kyeom Kim ),( Kyeong-cheol Shin ),( Sang Haak Lee ),( Hun Gyu Hwang ),( Joong Hyun Ahn ),( Yong 대한결핵 및 호흡기학회 2017 Tuberculosis and Respiratory Diseases Vol.80 No.3

Background: Smoking cessation is the most powerful intervention to modify progress of chronic obstructive pulmonary disease (COPD), and nicotine dependence is one of the most important determinants of success or failure in smoking cessation. We evaluated nicotine dependence status and investigated factors associated with moderate to high nicotine dependence in patients with COPD. Methods: We included 53 current smokers with COPD in the Korean Obstructive Lung Disease II cohort enrolled between January 2014 and March 2016. Nicotine dependence was measured by using Fagerstrom test for nicotine dependence (FTND). Cognitive function was assessed by Korean version of Montreal Cognitive Assessment. Results: The median FTND score was 3, and 32 patients (60%) had moderate to high nicotine dependence. The median smoking amount was 44 pack-years, which was not related to nicotine dependence. Multiple logistic regression analysis revealed that high education status (odds ratio, 1.286; 95% confidence interval, 1.036-1.596; p=0.023), age <70 (odds ratio, 6.407; 95% confidence interval, 1.376-29.830; p=0.018), and mild to moderate airflow obstruction (odds ratio, 6.969; 95% confidence interval, 1.388-34.998; p=0.018) were related to moderate to high nicotine dependence. Conclusion: Nicotine dependence does not correlate with smoking amount, but with education level, age, and severity of airflow obstruction. Physicians should provide different strategies of smoking cessation intervention for current smokers with COPD according to their education levels, age, and severity of airflow obstruction.

간외담관의 폐쇄소견을 보인 원발성 간세포암 - 담관조영술 소견을 중심으로 -

박승우(Seung Woo Park),송시영(Si Young Song),정재복(Jae Bock Chung),강진경(Jin Kyung Kang),박인서(In Suh Park),이우정(Woo Jung Lee),김병로(Byong Ro Kim) 대한소화기학회 1995 대한소화기학회지 Vol.27 No.1

N/A Rackground/Aims: Mechanisms of hepatomo-in(luced biliary obstruction include pedunculated tumor extension, obturating bemorrhagic clot and tumor debris, direct invasion of the biliary system by a tumor nodule, and metastatic lymph node compression of the major ducts in the porta hepatis. Usually, the diagnosis has been an unexpected finding at surgery or postmortem and preoperative diagnosis is seldom made, it is very meaning to find out thc characteristics to predict the hepatoma-induced biliary obstruction. This study I, conducted to elucidnte the findings in patients with hepatoma-induced obstructive jaundice. Methods: We reviewed clinical, radiological and surgical findings in six cases of hepatocellular carcinoma who showed jaundice due to obstruction of the extrahepatic bile duct and confirmed histologically from 1990 to 1993, and analyznl the cholangiographic fingdings. Results: The mean age of the patients was 54.2 years and 4 were males, 2 females. The common cholan-giographic tmdings of a11 case. Wvre bulky intraluminal tilling defects, which expand the biliary trce by tumor itself. Thesc defects somewhat resemble a wine- g1ass appearance. The margins of defects were slightly lobulated and somewhat irregular. Defects occurred at various level from the intrahepatic raclicle to the <lista1 common hile duct, however most frequently located in the common hepotic duct. Total obstruction was demonstrated in 2 cases, however stenosis wa.I not noticed in all of our ca.ies. Tissue diagnosis was madc preoperatively by cytologic examination of hile ohtained during ERCP in 2 cases and remaining 4 cases diagnosed by operatively. Conclusions: We may suspect this disease on the findings of bulky filling defects expanding the extrahepatic bile duct especially in common hepatic duct level resembling wine-gIass, and which has lobulated and somewhat irregular surface on cholangiogram. Additionally even though the preoperative histologic diagnosis is difficult, patho1ogic examination of the extracted materials or bile, transpapillary biopsy during ERCP or peroral choledochoscopic examinations are mandatory for the confirmative diagnosis. (Korean J Gastroenterol 1994; 27: 83-95)