원발성 담낭암의 치료결과의 분석

채권묵 한국간담췌외과학회 2000 한국간담췌외과학회지 Vol.4 No.1

Primary gallbladder carcinoma is relatively uncommon, but not a very rare disease. It accounts for 3- 4% of all gastrointestinal tract tumors, and is the most common malignant disease of the biliary tract. It occurs more frequently in women than in men at a ratio of 3:1. The etiology of gallbladder carcinoma is unknown, but the association of gallstones with it is well known. The diagnosis often is not made before laparotomy because its symptoms and signs are very nonspecific and are similar to those of cholecystitis. Commonly, it is encountered in the later stages and has very unfavorable courses. Recently, the operative treatments of gallbladder carcinoma have advanced significantly, and many studies revealed that more aggressive surgery gives rise to better prognosis in comparison with previous surgical treatment modalities. We reviewed 60 cases of this disease experienced in our hospital from October, 1988 to February, 1998. We evaluated whether the aggressive surgical treatment and the adjuvant therpy of gallbladder cancer had influence on prognosis. And additionally, we examined the clinical situations of primary gallbladder carcinoma. Only 33 patients of 60 were followed up until a recent date, and so all survival data were calculated within 33 cases. The results are as follows : 1) The incidence of gallbladder carcinoma in females outnumbered in males at a ratio of 1.2:1, and sixty per cent of all patients were 7th and 8th decades of age. 2) Almost all patients had varying degrees of upper abdominal pain, and the duration of symptoms was less than 4 weeks in half of the patients. 3) Forty-five per cent of all patients had gallstones. 4) Preoperative diagnoses were made in 28 cases(46.7%). 5) At the time of diagnosis, many patients(about 70%) were on the TNM stage III and IV. 6) The curative resectability rate of the cancer was merely 53.3%(32/60), and in the remainder of patients(n=28), palliative surgery and only laparotomy were carried out. The operative methods performed on purpose of a curative resection of the cancer were simple cholecystectomy in 14 patients(23.3%), cholecystectomy plus liver wedge resection plus LN dissection(radical cholecystectomy) in 15 patients(25%), radical cholecystectomy plus Roux-en-Y hepaticojejunostomy in 1(1.7%), and radical cholecystectomy plus right hepatic lobectomy in 2(3.3%). Korean Journal of HBP Surgery Vol. 4. No. 1. 2000 7) The cumulative 5-year-survival rates of gallbladder carcinoma were 80% in stage I, 75% in stage II, 33% in stage III, and 0% in stage IV(p=0.002). In advanced cases(that is, in stage III and IV), the survival data was analized according to the operation methods. The mean survival times were 25.9 months in curative operation group and 3.3 months in palliative operation or explo-laparotomy group(p=0.003). 8) In a small number of patients of stage III and IV, chemotherapy and radiation therapy were carried out. But we could not find the statistical significances on the differences of survival rates. Primary gallbladder carcinoma is relatively uncommon, but not a very rare disease. It accounts for 3- 4% of all gastrointestinal tract tumors, and is the most common malignant disease of the biliary tract. It occurs more frequently in women than in men at a ratio of 3:1. The etiology of gallbladder carcinoma is unknown, but the association of gallstones with it is well known. The diagnosis often is not made before laparotomy because its symptoms and signs are very nonspecific and are similar to those of cholecystitis. Commonly, it is encountered in the later stages and has very unfavorable courses. Recently, the operative treatments of gallbladder carcinoma have advanced significantly, and many studies revealed that more aggressive surgery gives rise to better prognosis in comparison with previous surgical treatment modalities. We reviewed 60 cases of this disease experienced in our hospital from October, 1988 to February, 1998. We evaluated whether the aggressive surgical treatment and the adjuvant therpy of gallbladder cancer had influence on prognosis. And additionally, we examined the clinical situations of primary gallbladder carcinoma. Only 33 patients of 60 were followed up until a recent date, and so all survival data were calculated within 33 cases. The results are as follows : 1) The incidence of gallbladder carcinoma in females outnumbered in males at a ratio of 1.2:1, and sixty per cent of all patients were 7th and 8th decades of age. 2) Almost all patients had varying degrees of upper abdominal pain, and the duration of symptoms was less than 4 weeks in half of the patients. 3) Forty-five per cent of all patients had gallstones. 4) Preoperative diagnoses were made in 28 cases(46.7%). 5) At the time of diagnosis, many patients(about 70%) were on the TNM stage III and IV. 6) The curative resectability rate of the cancer was merely 53.3%(32/60), and in the remainder of patients(n=28), palliative surgery and only laparotomy were carried out. The operative methods performed on purpose of a curative resection of the cancer were simple cholecystectomy in 14 patients(23.3%), cholecystectomy plus liver wedge resection plus LN dissection(radical cholecystectomy) in 15 patients(25%), radical cholecystectomy plus Roux-en-Y hepaticojejunostomy in 1(1.7%), and radical cholecystectomy plus right hepatic lobectomy in 2(3.3%). Korean Journal of HBP Surgery Vol. 4. No. 1. 2000 7) The cumulative 5-year-survival rates of gallbladder carcinoma were 80% in stage I, 75% in stage II, 33% in stage III, and 0% in stage IV(p=0.002). In advanced cases(that is, in stage III and IV), the survival data was analized according to the operation methods. The mean survival times were 25.9 months in curative operation group and 3.3 months in palliative operation or explo-laparotomy group(p=0.003). 8) In a small number of patients of stage III and IV, chemotherapy and radiation therapy were carried out. But we could not find the statistical significances on the differences of survival rates.

122. 담도절개 : 일차봉합과 T-tube 배관의 비교연구

채권묵,정용철,이정균,이광만,안해선 대한외과학회 1988 대한외과학회 학술대회 초록집 Vol.1988 No.11

췌십이지장 절제술후 잔여췌장의 위축에 관한 연구

채권묵 한국간담췌외과학회 2000 한국간담췌외과학회지 Vol.4 No.1

Background : The pacreaticoduodenectomy is the procedure of choice for neoplasm of periampullary region. However, some complications such as glucose intolerance and maldigestion are developed on postoperative long-term follow-up. The aim of this study is to evaluate the volume change of remnant pancreas and difference of thickness change between PPPD and Whipples’operation. Material and Methods : From November, 1988 to June, 1998, 110 patients with periampullary neoplasms had undergone pancreaticoduodenectomy in our hospital(Whipple procedure 67, pylorus-preserving pancreaticoduodenectomy 43). We selected 19 patients who had regular interval follow-up during at least 1 year and didn’t have operation related complications and recurrence(Whipple procedure 8, PPPD 11). We examined the size of body and tail of pancreas on preoperative CT and postoperative CT. Medical records were reviewed to find body weight changes, occurrence of glucose intolerance and steatorrhea. Results : The size of body and tail of pancreas were 16.2±3.9mm and 12.1±5.0mm preoperatively, 10.8±3.9mm and 8.3±3.5mm postoperatively(p〈0.001). However, there was no significant difference between Whipple and PPPD group. The body weight reduced to 95% of preoperative body weight, but it didn’t show statistic sigificance. The occurrence of glucose intolerance and steatorrhea were insignificant. Conclusion : We conclude that pancreatic atrophy develop in patients underwent pancreticoduodenectomy. But, the difference of thickness change between PPPD and Whipples’group is no significance. We suggest that further study is need to find out the cause of pancreatic atrophy and correlation between atrophy and resection method such as duodenum preserving pancreatic head resection versus pancreaticoduodenectomy. Also we recommend that long-term follow-up study is necessary to find out correlation between pancreatic atrophy and pancreatic endocrine , exocrine insufficiency. Background : The pacreaticoduodenectomy is the procedure of choice for neoplasm of periampullary region. However, some complications such as glucose intolerance and maldigestion are developed on postoperative long-term follow-up. The aim of this study is to evaluate the volume change of remnant pancreas and difference of thickness change between PPPD and Whipples’operation. Material and Methods : From November, 1988 to June, 1998, 110 patients with periampullary neoplasms had undergone pancreaticoduodenectomy in our hospital(Whipple procedure 67, pylorus-preserving pancreaticoduodenectomy 43). We selected 19 patients who had regular interval follow-up during at least 1 year and didn’t have operation related complications and recurrence(Whipple procedure 8, PPPD 11). We examined the size of body and tail of pancreas on preoperative CT and postoperative CT. Medical records were reviewed to find body weight changes, occurrence of glucose intolerance and steatorrhea. Results : The size of body and tail of pancreas were 16.2±3.9mm and 12.1±5.0mm preoperatively, 10.8±3.9mm and 8.3±3.5mm postoperatively(p〈0.001). However, there was no significant difference between Whipple and PPPD group. The body weight reduced to 95% of preoperative body weight, but it didn’t show statistic sigificance. The occurrence of glucose intolerance and steatorrhea were insignificant. Conclusion : We conclude that pancreatic atrophy develop in patients underwent pancreticoduodenectomy. But, the difference of thickness change between PPPD and Whipples’group is no significance. We suggest that further study is need to find out the cause of pancreatic atrophy and correlation between atrophy and resection method such as duodenum preserving pancreatic head resection versus pancreaticoduodenectomy. Also we recommend that long-term follow-up study is necessary to find out correlation between pancreatic atrophy and pancreatic endocrine , exocrine insufficiency.

1978년도 춘계 학술대회 : 46. 교액성 장폐쇄시 장의 생존성 판정에 관한 실험적 연구

채권묵,조영국 () 대한외과학회 1978 대한외과학회 학술대회자료집 Vol.- No.-

신성 고혈압을 동반한 Takayasu씨 질환 1예

채권묵,노병석,소병준,김호찬 대한혈관외과학회 1993 Vascular Specialist International Vol.9 No.1

Takayasu's arteritis is a chronic nonspecific arteritis of unknown cause that is relatively prevalent in young female subjects. It has been well known that the pathologic features of the disease consist predominantly of occlusive changes in the aorta and the origins of its major branches. Segmental stenosis or aneurysm formation may occur and may produce symptoms of cerebral, visceral, or extremity ischemia. The clinical course of Takayasu's arteritis has been described as includings two stages: an initial inflammatory process with systemic manifestation and a later pulseless phase with multiple arterial occlusion. Surgical treatment is indicated for cerebral ischemia, severe hypertension, and aneurysm with impending rupture. This article presents a case of Takayasu's arteritis with renovascular hypertension and brief review of literature.

백서의 총담관 결찰 후 간에서 BCl-2 및 Bax의 면역조직화학적 발현 양상

채권묵,윤기중 대한소화기학회 2001 대한소화기학회지 Vol.37 No.4

Background/Aims: The cell homeostasis is regulated by a balance between apoptosis, proliferation and growth arrest. Bcl-2 and Bax belong to a family of cytoplasmic proteins that regulate apoptosis. The aim of this study was to verify blood biochemistry, histologic findings and expression pattern of Bcl-2 and Bax during the bile duct proliferation. Methods: We induced bile duct proliferation by the bile duct ligation in Sprague-Dawley rats. The expression of Bcl-2 and Bax was visualized by immunohistochemical staining. The rats were sacrified 2, 4, 6, 8 weeks after bile duct ligation. Results: Bcl-2 was expressed in the bile duct of control rats (n=10) and bile duct- ligated rats (n=40). Bcl-2 expression in hepatocytes was noted in the bile duct-ligated rats but not in control rats. Bax was expressed in the bile duct and hepatocytes of the control and bile duct-ligated rats. Histologically, bile duct proliferation became infiltrative and accompanied periductal inflammatory cells in the bile duct-ligated rats. However, serum levels of AST, ALT, and bilirubin were not increased according to duration of bile duct ligation. Conclusions: From these results, we suggest that hepatocellular expression of Bcl-2 after ligation is an adaptive phenomenon to resist apoptosis and expression of Bax in bile duct is due to inflammatory process.

Complications of Laparoscopic Hepatobiliary Surgery

채권묵 대한외과학회 2001 대한외과학회 학술대회 초록집 Vol.2001 No.11

Familial polyposis 一例 報告 : 多發性 家族性 大腸 폴립症

채권묵 全南大醫大 1982 전남의대학술지 Vol.19 No.1

췌두부 절제후 췌장외분비에 대한 Octreotide의 효과

채권묵,소병준,양기영,채규헌 대한외과학회 1997 대한외과학회 학술대회 초록집 Vol.1997 No.11

Follow up of the Hepatobiliary Cancer

채권묵 대한외과학회 1998 대한외과학회 학술대회 초록집 Vol.1998 No.5