자궁내막암 환자에서 복강경하 자궁적출술과 복식 자궁적출술의 비교 연구

김종혁,이상수,김천복,김대연,김용만,김영탁,목정은,남주현 대한부인종양 콜포스코피학회 2003 Journal of Gynecologic Oncology Vol.14 No.4

목적 : 자궁내막암 환자에서 시행된 복강경 수술의 임상적 결과를 평가하고 수술적 지표 및 재발률에 대하여 기존의 개복 수술과 비교하고자 하였다. 연구 방법 : 1997년 8월부터 2003년 11월까지 저자들은 임상적 병기 I기인 79명의 자궁내막암 환자에서 복강경하 자궁적출술과 골반 및 부대동맥 림프절 절제술을 시행하였다. 총 79명의 환자 중, 수술적 병기 I기와 II기로 판명된 74명의 환자를 연구 대상으로 하였다. 대조군으로는 같은 기간 동안에 개복수술을 시행한 환자중 복강경 수술군과 병기가 같은 168예를 선정하였다. 결과 : 평균 수술 기간, 수혈량은 양군에서 비슷하였으며, 평균 재원 기간은 복강경 수술군에서 유의하게 짧았다. 수술전후 및 만성 합병증의 발생은 개복 수술군에서 유의하게 증가되었으며, 획득한 림프절의 수는 복강경 수술군에서 유의하게 더 많았다. 복강경 수술군에서 1예, 개복 수술군에서는 2예에서 재발하였고, 2년 무병 생존률은 복강경 수술군과 개복 수술군에서 각각 97.5%와 98.6%으로 유의한 차이는 관찰되지 않았다. 결론 : 자궁내막암 치료로서 복강경 수술은 기존의 개복술을 대신할 수 있는 안전하고 효과적인 시술 방법이다. 개복 수술과 비교해 볼 때, 재발 및 생존율 면에서 차이가 없었지만, 향후 전향적이고 더 오랜 추적기간을 갖는 연구가 필요하다고 사료된다. Objective : To evaluate the outcomes of laparoscopic surgery and to compare surgical parameters and recurrence rate of these with those of conventional abdominal surgery in patients with endometrial cancer. Methods : From August 1997 to November 2003, we have performed 79 cases of LAVH (laparoscopically assisted vaginal hysterectomy) with or without lymph node dissection. Laparoscopic approach was adapted in patients with FIGO clinical stage I by imaging study. Of the 79 patients, 74 patients who were proved to be surgical stage I and II were enrolled in this comparative study. As a control group, We selected 168 cases for the laparotomy group of the same stages. Results : The mean duration of surgery, the amount of blood transfusion and hemoglobin chamges were similar in both the laparoscory and the convertional alparotomy group. The mean duration of hospital stay was significantly shorter in patients treated by laparoscopic surgery (10.2 vs. 15.5 days). The number of lymph node obtained was significantly higher in the laparoscopy group. Two year recurrence-free survival rates were 97.5% in laparoscopy group and 98.6% in laparotomy group (p=0.763). Conclusion : Laparoscopic surgery for the treatment of early stage endometrial cancer is safe and effective altematives in terms of perioperative complications. Overall and recurrence-free survival did not differ significantly in both groups however long term risk for recurrence and survival has yet to be defined.

자궁경부에 발생한 배아성 횡문근육종 2예

박정열,조준식,김대연,이동헌,김종혁,김용만,김영탁,목정은,남주현 대한부인종양 콜포스코피학회 2002 Journal of Gynecologic Oncology Vol.13 No.3

횡문근육종은 소아와 청소년기에 가장 흔한 연부조직 육종이다. 발생 부위는 일반적으로 두부 및 경부, 그 다음으로 비뇨생식계이다 조직학적으로 배아성 횡문근육종, 국화상 육종, 폐포성 횡문근육종, 다형성 횡문근육종으로 나누어진다. 횡문근육종의 약 20%가 비뇨생식기에서 발생하고, 50% 이상이 배아성 횡문근육종이다. 여성 생식기의 배아성 횡문근육종은 드문 악성 종양으로,주로 유소아의 질에서 발생하며, 자궁경부에서 발생하는 횡문근육종은 청소년기에 흔하고, 질에서 기원하는 횡문근육종이 자궁경부에 기원하는 경우보다 5배 정도 많다. 폐경기여성에서는 자궁체부에서 가장 흔히 발생한다. 비뇨생식기의 횡문근육종의 치료는 과거에는 골반장기 적출술만으로 치료를 시도하였으나. 서서히 다중 항암화학요법, 방사선요법, 근치적 절제술을 포함한 병합요법으로 바뀌어가고 있으며, 이에 따라 생존율이 현저하게 향상되었다. 이에 저자들은 최근 본원 산부인과에서 자궁경부에 발생한 배아성 횡문근육종 2예를 경험하였기에 문헌 고찰과 아울러 보고하는 바이다. Rhabdomyosarcoma is the most common soft tissue sarcoma in childhood and young adult. Genitourinary tract is the econd most common site of rhabdomyosarcoma. Rhabdomyosarcoma can be classified into one of four major types; embryonal, alveolar, pleomorphic and undifferentiated. Embryonal rhabdomyosarcoma of the female genital tract is rare malignant tumor and usually occurs during childhood in the vagina. In rare cases, rhabdomyosarcoma can originate in the uterine cervix, with a peak incidence in the second decade. Recently we have experienced two cases of embryonal rhabdomyosarcoma of the uterine cervix. These cases are presented with a brief review of the literature.

자궁내막에 발생한 점막 연관 림프조직 (MALT) 림프종 1예

전균호,조현진,박성균,김천복,김대연,김종혁,김용만,김영탁,목정은,남주현 대한부인종양 콜포스코피학회 2003 Journal of Gynecologic Oncology Vol.14 No.4

Non-Hodgkin's 림프종의 약 40%는 결절외(extranodal) 림프종으로 대개 위장관에서 발생하며 이들 중 점막 연관 림프조직(mucosa-associated lymphoid tissue: MALT)에서 기원한 림프종은 MALT 림프종으로 분류된다. 위 외의 부위에서 원발성으로 발생하는 MALT 림프종은 매우 드물지만 실제 거의 모든 신체 장기에 발생하는 것으로 알려져 있는데, 가장 흔한 부위인 위 외에도 폐, 갑상선, 침샘, 눈물샘에 발생하고, 드물게 안구, 유방, 방광, 신장, 흉선 등에도 보고된 바 있다. MALT 림프종은 오랜 기간동안 원격 전이하지 않고 국소 병변으로 남아 있는 특징이 있어 치료 방향 또한 국소 병변의 치료에 집중되며, 예후도 림프절 기원의 림프종에 비해 양호한 것으로 알려져 있다. 본 저자 등은 자궁 내막에 원발성으로 발생한 MALT 림프종 1예를 경험하였기에 문헌 고찰과 함께 이를 보고하고자 한다. Mucosa associated lymphoid tissue (MALT) lymphoma can rarely develop primarily in extranodal sites other than stomach which is the most common site for it. Other rare primary sites are small intestine, colorectum, esophagus, lung, thyroid, salivary gland, lacrymal gland, breast and skin. MALT lymphoma represents a distinct clinicopathologic features: it is usually localized to their original site for a long time and shows much more favorable prognosis than lymphoma at other site, but some MALT lymphoma can arise simultaneously or successively in different organ or give rise to another MALT lymphoma of other organ and can be multifocally disseminated or recurred. We report a very rare case of high grade B-cell lymphoma of mucosa associated lymphoid tissue (MALT) of the uterine endometrium, which was confirmed by immunohistochemical assay.

하악골에 발생된 Low grade 골육종:증례보고

조현이,정종철,김호성,최재욱,성대경,서지훈,김성범,이계혁 大韓顎顔面成形再建外科學會 2000 Maxillofacial Plastic Reconstructive Surgery Vol.22 No.1

Osteosarcoma is a primary malignant tumor arising most often in the long bone, but rare in jaw bone. Especially osteogenic sarcoma of the mandible is a rare tumor, comprising less than 0.5% of all head and neck tumors. Osteosarcoma occurs cheifly in young persons, and presenting very survival rates. Histopathologically this tumor can be classified three types, osteoblastic, fibroblastic, chondroblastic and classified from low grade to high grade by anaplasia or mitosis of the tumor cells. Sometimes, the exact diagnosis of osteosarcoma is difficult especially in low grade osteosarcoma, even if clinical or radiographical findings suggest to osteosarcoma. So suspcious to malignant bone tumor in clinical or radiological findings, biopsy should be taked from deep portion and multiple area, and sharing the patient history and radiographs with pathologist will assist in the development of the diagnosis. We report a case of low grade osteosarcoma on the mandible initially difficulty in accurate diagnosis. The patient visited our hospital for routine dental treatment but radiographic findings displayed ill-defined radiolucency with osteoid formation on the mandible. Final diagnosis was difficulty in initial biopsy but subsequent biopsy taked from deep portion presented infiltrative growth and mitosis of the tumor cell in some area with small osteoid bone formation, so we could reach final diagnosis as low grade sarcoma. We treated this patient with bloc resection of the mandible and immediate reconstruction with iliac corticocancellous block.

Malignant Germ Cell Tumors of the Ovary: Fertility and Ovarian Function after Conservative Surgery

( Dae Yeon Kim ),( Mi Kyung Kim ),( Jong Hyeok Kim ),( Yong Man Kim ),( Young Tak Kim ),( Jung Eun Mok ),( Joo Hyun Nam ) 대한산부인과학회 2001 대한산부인과학회 학술대회 Vol.87 No.-

난소의 악성 배세포종양에서 림프절 절제술의 필요성 및 보존적 수술 후 난소기능 및 가임력 유지에 대한 연구

김대연 ( Dae Yeon Kim ),남주현 ( Joo Hyun Nam ),유항조 ( Hang Jo Yoo ),김미경 ( Mi Kyung Kim ),김종혁 ( Jong Hyeok Kim ),김용만 ( Yong Man Kim ),김영탁 ( Young Tak Kim ),목정은 ( Jung Eun Mok ) 대한산부인과학회 2002 Obstetrics & Gynecology Science Vol.45 No.11

목적: 난소의 악성 배세포종양 환자에서 보존적 수술 후 장기적인 가임력 및 출산력을 평가하고 재발 양상을 확인하며, 보존적 수술 시 후복막 림프절 평가의 중요성을 알아보고자 하였다. 연구 방법: 1991년부터 2001년까지 서울아산병원 산부인과에 내원하여 난소의 악성 배세포종양으로 진단 받고 치료 받은 50명의 환자들의 의무기록을 후향적으로 고찰하고 전화 인터뷰를 통하여 월경력 및 출산력을 확인하였다. 결과: 54개월의 평균 추적 관찰기간 동안 6명 ( Objective: To evaluate the long-term fertility and reproductive outcomes after conservative surgery, to observe the recurrence pattern and to elucidate the significance of retroperitoneal lymph node evaluation in patients with malignant ovarian germ cell

Cytotoxic activity of arsenic trioxide in ovarian cancer cell Lines

김대연 ( Dae Yeon Kim ),( Eun Hye Hur ),( Yang Kyun Kim ),( Dae Shik Suh ),( Jong Hyeok Kim ),( Yong Man Kim ),( Young Tak Kim ),( Joo Hyun Nam ) 대한산부인과학회 2007 대한산부인과학회 학술대회 Vol.93 No.-

Prognostic value of preoperative 18-FDG PET/CT in high-grade neuroendocrine carcinoma of cervix

( Ju-hyun Kim ),( Jong Jin Lee ),( Shin-wha Lee ),( Jeong-yeol Park ),( Dae-yeon Kim ),( Dae-shik Suh ),( Jong-hyeok Kim ),( Yong-man Kim ),( Young-tak Kim ) 대한산부인과학회 2019 대한산부인과학회 학술대회 Vol.105 No.-

Objective: We investigate prognostic value of metabolic parameters measured by preoperative 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET)/computed tomography (CT) in surgically treated early-stage high-grade(HG) neuroendocrine cervical carcinoma (NECC). Methods: Between 1993 and 2017, 29 patients with FIGO 2009 stage IA-IIA HG NECC who underwent preoperative 18F-FDG PET/CT were initially treated with radical hysterectomy in Asan Medical Center. The PET/CT parameters and clinicopathological variables of the patients were retrospectively reviewed from electronic medical records. Maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV2.5, MTV3.0), and total lesion glycolysis (TLG2.5, TLG3.0) of the primary tumors were measured. Cox proportional hazards regression was used to identify potential prognostic factors. Results: The median follow-up period was 28.2 months (range, 3.83-202.5). The overall survival (OS) rate was 65.5%(19/29), and the disease-free survival (DFS) rate was 31.0%(9/29). Univariate analysis determined that hazard ratios (HRs) for disease progression for SUVmax, MTV2.5, MTV3.0, TLG2.5, TLG3.0 were 1.046 (95% confidence interval [CI]=0.955-1.146), 1.015 (95% CI=0.996-1.034), 1.017 (95% CI=0.996-1.038), 1.33 (95% CI=1-1.58) and 1.003(95% CI=1-1.005) respectively. And, HRs for death were 1.023 (95% CI=0.935-1.12), 1.009 (95% CI=0.987-1.031), 1.002(95% CI=0.999-1.005) and 1.001 (95% CI=0.998-1.005), respectively. Only TLG 2.5 was significantly risk factor for recurrence (p value =0.044). Conclusion: In conclusion, TLG2.5 of primary HG NECC was significant prognostic factor for predicting recurrence. Because of small sample size, further studies need to be warranted.

Experience with TVT-O for the Surgical Treatment of Female Stress Urinary Incontinence

( So Ra Kim ),( Gun Ho Jeon ),( Dae Yeon Kim ),( Sung Hoon Kim ),( Hee Dong Chae ),( Jong Hyeok Kim ),( Chung Hoon Kim ),( Yong Man Kim ),( Young Tak Kim ),( Byung Moon Kang ),( Joo Hyun Nam ) 대한산부인과학회 2009 Journal of Womens Medicine Vol.2 No.1

Objective: We evaluated the clinical efficacy and safety of inside-out transobturator vaginal tape (TVT-O) for the surgical treatment of female stress urinary incontinence. Methods: We analyzed the medical records of 239 women with stress urinary incontinence and who were treated with TVT-O between March 2004 and July 2007. We retrospectively investigated the patient characteristics, the operative time, the number of hospital days, the efficacy, and the complication rate by conducting a 1 year follow-up survey. Results: One hundred eighty-three patients were included in the study. The mean age was 55.7 years (range, 31~74 years) and the mean operative time was 20.1 minutes (range, 12~40 minutes). Of the 76 patients who underwent TVT-O only, 94 patients were discharged the same day of surgery and the mean hospital stay was 0.4 days (range, 0~4.0 days). Of the 183 patients who were followed for 1 year, 162 (88.7%) were assessed as completely dry, 15 (8.2%) showed improvement, and 4 (2.2%) were deemed to have failed. There were no intra-operative bladder, urethral, or bowel injuries; 32 cases (17.5%) showed complications of surgery during the 1 year follow-up period. Thirteen (7.1%) cases were shown to have de novo urgency, 5 (2.7%) cases had urinary retention, 6 (3.3%) cases had vaginal erosions, and 8 (4.4%) cases had wound hematomas and lower extremity discomfort. Conclusion: Our experience showed that TVT-O is an effective and safe procedure for the surgical treatment of female stress urinary incontinence.

The Efficacy of Radical Hysterectomy plus Tailored Adjuvant Therapy in non-Bulky Node-positive Early Cervical Cancer

( Seong-hee Kim ),( Yong-man Kim ),( Ju-hyeon Nam ),( Yeong-tak Kim ),( Jong-hyeok Kim ),( Dae-sik Suh ),( Jeong-yeol Park ),( Shin-hwa Lee ),( Ju-hee Kim ),( Ji-hoon Lee ),( Oak-ju Kang ),( Dae-yeon 대한산부인과학회 2018 대한산부인과학회 학술대회 Vol.104 No.-

Objective: The controversy between the proponents of radical pelvic surgery and those of radiotherapy for primary treatment in early cervical cancer still exists for a long time. The aim of this study is to demonstrate the efficacy of radical hysterectomy as primary treatment in non-bulky node-positive early cervical patients. Methods: Patients that were diagnosed with cervical cancer and received RH at Asan Medical Center between January 2013 and December 2015 were identified from an electronic database at our center, and their medical records were reviewed retrospectively. The eligibility criteria for patients inclusion in this study were as follows: previously untreated; pathologically diagnosed cervical cancer; an age of 20-80 years at the time of surgery; laparoscopic or open radical hysterectomy with pelvic and/or para-aortic lymphadenectomy; clinical tumor or MIR tumor size under 4cm and lymph node positive in imaging study. Patients whose cell type was small cell carcinoma or neuroendocrine carcinoma, who underwent neoadjuvant chemotherapy, or who had other coexisting malignancies were excluded. Results: Of the 53 patients, 6 patients (11.3%) were recurred, and 4 patients were died among the recurred patients. 15 patients (28.3%) were not received any adjuvant therapy after radical hysterectomy. 2years overall survival was 93%, and 3years overall survival was 90% in non-bulky lymphadenopathy cervical cancer patients. 2years recurrence-free survival rate was 86%. 15 patients (28.3%) were not received any adjuvant therapy after radical hysterectomy. Conclusion: In non-bulky lymphadenopathy cervical patients who received radical hysterectomy as primary treatment, it presented good overall survival and recurrence-free survival rates. It was single-arm study. The necessity of multicenter prospective randomized controlled comparative study between radical pelvic surgery and radiotherapy as primary treatment in high risk early cervical cancer was highly required.