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재발성 부갑상선암: 경부 재발의 검사 소견과 수술 소견의 불일치
성태연,윤종호,홍석준,Tae-Yon Sung,M.D.,Jong Ho Yoon,M.D. and Suck Joon Hong,M.D. 대한갑상선-내분비외과학회 2011 The Koreran journal of Endocrine Surgery Vol.11 No.1
Parathyroid carcinoma is a rare malignancy presenting hyperparathyroidism. At times, diagnosis and localization are difficult. The optimum treatment for parathyroid carcinoma is en bloc resection when malignancy is highly suspicious or diagnosed. However, even after the adequate surgical treatment, persistent or recurrent disease is well encountered. Here we report a case with recurred parathyroid carcinoma presenting discrepancy between image findings and operative findings. (Korean J Endocrine Surg 2011;11:35-37)
측경부 림프절 청소술을 요하는 갑상선암 환자에서 척수부신경 상측 림프절 청소술이 필요한가?
성태연,윤지섭,정종주,이용상,남기현,정웅윤,장항석,박정수,Tae Yon Sung,M,D,Ji-Sup Yun,M,D,Jong Ju Jeong,M,D,Yong Sang Lee,M,D,Kee-Hyun Nam,M,D,Woong Youn Chung,M,D,Hang Seok Chang,M,D,and Cheong Soo Park,M,D 대한갑상선-내분비외과학회 2007 The Koreran journal of Endocrine Surgery Vol.7 No.2
Purpose: Controversy still exists concerning the extent of neck nodedissection in thyroid carcinoma patients. A modified neck dissection is usually performed for the treatment of thyroid carcinoma patients with positive lateral neck nodes. When performing a neck dissection, removal of the nodes superior to the spinal accessory nerve (level IIB) is difficult and time consuming. This study was performed to determine whether level IIB node dissection is always necessary in therapeutic neck dissection for metastatic papillary thyroid carcinoma. Methods: A total of 200 neck dissections were performed in 175 papillary thyroid carcinoma patients with positive lateral neck nodes between September 2005 and June 2007. The patterns of lateral neck metastasis were analyzed with respect to neck level, but the level IIB nodes were studied as separate specimens. Potential factors predicting level IIB node metastasis were also evaluated. Results: The most common site of metastasis was level III, showing 95.0% (190/200), followed by level IV 66.0% (132/200), level IIA 54.0% (108/200), and level V 15.5% (31/200). Level IIB metastases were seen in 12 necks (6.0%) and seen only in the necks with positive level IIA nodes. In 11 of the 12 necks, the primary tumors were located in the upper pole of the thyroid. Conclusion: Level IIB node dissection is not necessary when there is no level IIA metastasis. Even when there is level IIA metastasis, level IIB node dissection is not always necessary, unlessthe primary tumors are located in the upper pole of the thyroid. (Korean J Endocrine Surg 2007;7:88-93)
원발성 유두 갑상선암의 수술적 치료 후 측경부 전이 림프절에서 발생한 미분화 갑상선암 3예
성태연,홍순원<SUP>1<.SUP>,강상욱,이승철,정종주,이용상,남기현,장항석,정웅윤,박정수,Tae-Yon Sung,Soon-Won Hong<SUP>1<.SUP>,Sang- Wook Kang,Seung Chul Lee,Jong Ju Jeong,Yong Sang Lee,Kee-Hyun Nam,Hang-Seok Chang,Woong Youn Chung,M.D. 대한갑상선-내분비외과학회 2008 The Koreran journal of Endocrine Surgery Vol.8 No.3
Anaplastic thyroid carcinoma (ATC) is a rare disease that shows very aggressive behavior. Most ATCs arise from pre-existing thyroid carcinomas. However, anaplastic transformation occurring in metastatic cervical nodes is extremely rare. We report herein on 3 cases of anaplastic transformation of metastatic lateral cervical lymph nodes from primary papillary thyroid carcinoma (PTC), which happened long after the initial surgical treatment. All the patients died of disease within 4 months in spite of aggressive treatment for the lesions. Our experience supports that appropriate lymph node dissection is mandatory at the time of initial surgery even for differentiated thyroid carcinomas. <B>(Ko</B><B></B><B>rean J Endocrine Surg 2008;8:210-214)</B>
성태연(Tae-Yon Sung),김연선(Yon Seon Kim),이숙현(Sook Hyun Lee),윤종호(Jong Ho Yoon),홍석준(Suk-Joon Hong) 대한외과학회 2009 Annals of Surgical Treatment and Research(ASRT) Vol.77 No.2
Purpose: Subtotal thyroidectomy has been the standard operation for Graves’ disease in achieving a favorable outcome in recovery of euthyroid state. However, the postoperative outcomes following subtotal thyroidectomy differ by surgeon and postoperative thyroid dysfunctions develop as time passes. Here, we have studied the validity of total thyroidectomy for Graves’ disease patients, with a comparison to subtotal thyroidectomy. Methods: A total of 299 patients with Graves’ disease underwent thyroid operation consecutively in Asan Medical Center, Seoul, Korea from December 1995 to December 2005. Among them, 241 cases had subtotal thyroidectomy and 43 had total thyroidectomy. The subtotal thyroidectomy cases were divided into 3 groups according to estimated remnant thyroid; <4 g, 4≤∼<6 g and ≥6 g. Also, according to postoperative thyroid function, the patients were divided into euthyroid, hypothyroidism and hyperthyroidism groups. The postoperative changes of thyroid function, postoperative complications and hospital days were analyzed. Results: In subtotal thyroidectomy, postoperative thyroid function showed euthyroid in 25 (10.4%), hypothyroidism 206 (85.5%) and hyperthyroidism 10 (4.1%). However, total thyroidectomy showed no persistent hyperthyroidism or recurrence. The postoperative thyroid function state changed in 24 patients out of 148 who had more than 2 years postoperative follow-up. Hyper-functional changes developed with higher rates (Hypo-6 vs. hyper-18). The postoperative complication rate was higher in subtotal thyroidectomy including bleeding, hoarseness and hypocalcemia. Conclusion: In our study, the patients showing normal thyroid function after subtotal thyroidectomy were very limited and thyroid dysfunction developed continuously with time lapse, especially towards hyperthyroid state. Therefore, we suggest that total thyroidectomy should be considered as a treatment option in Graves’ disease.
갑상선암에 대한 로봇 보조 내시경적 갑상선 절제술; 100예에 대한 초기 경험
강상욱 ( Sang-wook Kang ),정종주 ( Jong Ju Jeong ),윤지섭 ( Ji-sup Yun ),성태연 ( Tae Yon Sung ),이승철 ( Seung Chul Lee ),이용상 ( Yong Sang Lee ),남기현 ( Kee-hyun Nam ),장항석 ( Hang Seok Chang ),정웅윤 ( Woong Youn Chung ) 대한갑상선학회 2008 International Journal of Thyroidology Vol.1 No.2
Background and Objectives: Various surgical procedures have been performed using surgical robot in recent years and most reports proved that application of robotic technology for surgery is technically feasible and safe. The aim of this study is to introduce our technique of robot-assisted endoscopic thyroid surgery and demonstrate its utility in the surgical management of thyroid cancer. Materials and Methods: From October 4<sup>th</sup> 2007 through March 14<sup>th</sup> 2008, 100 patients with papillary thyroid cancer underwent robot-assisted endoscopic surgeries using a gasless trans-axillary approach. This novel robotic surgical approach allowed adequate endoscopic access for thyroid surgeries. All the procedures were completed successfully using the da Vinci surgical system (Intuitive Surgical, Sunnyvale, California, USA). We used four robotic arms with this system; a 12 mm telescope and three 5 mm instruments. The 3-dimensional magnified visualization obtained by the dual-channel endoscope and tremor-free instruments controlled by robot system helped surgeon do sharp and precise endoscopic dissection. Results: We performed 84 less-than total and 16 total thyroidectomies with ipsilateral central compartment node dissection. Mean operation times was 136.5 min. (range 79∼267 min.) in which the actual time for thyroidectomy with lymphadenectomy (console time) was 60.0 min. (range 25∼157 min). The average number of lymph nodes resected was 5.3 (range 1 to 28). There was no serious complication. Most patients could go home within 3 days after surgery. Conclusion: Our technique of robotic-assisted endoscopic thyroid surgery using a gasless trans-axillary approach is feasible, safe and promising for the selected patients with thyroid cancer. We suggest application of robotic technology for endsocopic thyroid surgeries could overcome the limitations of conventional endoscopic surgeries in the surgical management of thyroid cancer.
종격동 전이를 보이는 갑상선암 환자에서 Robot-assisted Lymph Node Dissection을 병행한 1예
정종주,이용상,강상욱,성태연,이승철,남기현,장항석,정웅윤,백효채<SUP>1<,SUP>,박정수,Jong Ju Jeong,Yong Sang Lee,Sang- Wook Kang,Tae-Yon Sung,Seung Chul Lee,Kee-Hyun Nam,Hang-Seok Chang,Woong Youn Chung,Hyo Chae Paik,<SUP>1<,SUP> and 대한갑상선-내분비외과학회 2008 The Koreran journal of Endocrine Surgery Vol.8 No.2