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- 저자 : 박세혁(Sei-Hyeog Park) (검색결과 11 건)
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박세혁(Sei Hyeog Park),임선구(Sun Gu Lim),양시준(Shi Jun Yang),김종흥(Jong Heung Kim) 한국간담췌외과학회 2010 한국간담췌외과학회지 Vol.14 No.1
Gallbladder carcinoma is the most common primary hepatobiliary carcinoma and the fifth most common malignancy of the GI tract. The most common type of gallbladder carcinoma is adenocarcinoma. Squamous cell carcinoma of the gallbladder is rarer and is responsible for up to 12.7% of gallbladder tumors. A 78-year-old man was incidentally suspected of having a gallbladder mass on an abdominal CT scan and underwent laparoscopic cholecystectomy. Pathology results confirmed the mass as a squamous cell carcinoma. Here we report a case of keratinizing squamous cell carcinoma of the gallbladder and review the literature.
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고의로 섭취한 커터칼날의 내시경 및 보존적 치료 증례 보고
박종민 ( Jong Min Park ),김성엽 ( Seong Yup Kim ),정일용 ( Il Yong Chung ),김우식 ( Woo Shik Kim ),신용철 ( Yong Chul Shin ),김영철 ( Yeong Cheol Kim ),박세혁 ( Sei Hyeog Park ) 대한외상학회 2013 大韓外傷學會誌 Vol.26 No.4
Food bolus impaction is the most common cause of esophageal foreign body obstruction in adults. Other causes include intentional ingestion in psychiatric patients or prison inmates. We experienced successful treatment of a patient with intentional ingestion of multiple sharp foreign bodies(25 cutter and razor fragments). A 47-year-old male patient who was suffering from chronic alcoholism was admitted, via the emergency room, with dysphagia and neck pain. He was suffering from alcoholic liver cirrhosis and psychiatric problems, such as chronic alcoholism, anxiety disorder and insomnia. The patient had intended to leave the hospital after having swallowed the sharp objects. Plain radiographs and computed tomography (CT) scan showed multiple, scattered metal fragments in the esophagus, stomach, and small bowel. We performed emergent endoscopy and successfully removed one impacted blade in the upper esophagus using by a snare with an over tube. The rest of the fragments had already passed through the pylorus, so we could not find them with endoscopy. We checked the patient with simple abdominal radiographs and careful physical examinations every day. All remaining fragments were uneventfully excreted through stool during the patient`s 6 day hospital stay. Finally, we were able to confirm the presence of the objects in the stool, and radiographs were negative. The patient was discharged without complications after 14 days hospital stay and then was followed by the Department of Psychiatry.
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이제희,양시준,전영웅,박세혁,김종흥,박종민,Lee, Jei Hee,Yang, Shi Joon,Jeon, Young Woong,Park, Sei Hyeog,Kim, Jong Heung,Park, Jong Min 대한위암학회 2008 대한위암학회지 Vol.8 No.3
Purpose: With the introduction of H. pylori eradication and proton pump inhibitor, the operative treatments for the acute or chronic complications of peptic ulcer, such as perforation, bleeding and stricture, have decreased. Also owing to the development of non-operative treatment such as interventional endoscopic treatment, the surgical approach to the acute complications, like perforation and bleeding, has diminished. The non-operative treatments for the stricture and obstruction of chronic peptic ulcer in part related to discontinuation of medication have not been satisfactory. We analyzed the clinical outcomes of the patients who underwent operative treatment for outlet obstruction with peptic ulcer. Materials of Methods: From January 1994 to December 2007, we reviewed 31 patients who had been operated on at the National Medical Center for peptic ulcer obstruction. We excluded the cases of adhesive obstructions that were caused by a former ulcer operation and also the cases of obstructions found during emergency operations for treating perforation and bleeding. We classified the surgical treatment group into the bypass operation group and the surgical resection group. We evaluated the effects of the operations by the Visick score. The recurrences were confirmed only by the endoscopic observation of peptic ulcer. Results: The number of patients in the bypass operation group was 6 (19.4%) and that of resection group was 25 (80.6%). The mean age was 57.5 (25~81) years. The number of male patients was 29 (93.5%) and the number of females was 2 (6.5%). The mean symptom duration was 29.6 months. There were 19 smokers (61.3%), 6 NSAID users (19.4%) and 7 H. pylori positive patients (22.6%). Two patients underwent endoscopic balloon dilatation with no success. The locations of lesion were the stomach, the duodenum and both in 9, 20 and 2 cases, respectively. There were operative complications in 13 cases (41.9%), recurrent ulcers in 2 cases (6.5%), and reoperations in 4 cases. The mean Visick score was 1.8 (1~4). There were no statistically significant clinicopathologic differences between the bypass operation group and the resection group. The two groups had 1 case each of recurrence. Although the bypass group had a greater complication rate (83.3%) than the resection group (32%), this was not statistically meaningful (P=0.175). The mean Visick score was 3.0 in the bypass group and 1.6 in the resection group, so the resection group was better (P=0.001). Conclusion: For a case of chronic peptic ulcer with outlet obstruction, even though it has been reported that endoscopic balloon dilatation worked well, surgery is still regarded as an important treatment. If you consider the patients' satisfaction and the difficulty of diagnosing malignant ulcers, surgical resection should be recommended more often than a bypass operation. 목적: 소화성 궤양의 급만성 합병증으로 대표되는 천공, 출혈, 협착의 수술적 치료에서 Helicobacter pylori (H. pylori) 제균요법과 proton pump inhibitor의 도입, 중재적 내시경 치료와 같은 비수술적 치료의 발달로 천공, 출혈 등의 급성기 합병증의 수술은 점차 감소되고 있다. 그러나 내과적 소화성 궤양의 협착, 폐색에 대한 비수술적 치료의 결과는 만족스럽지 못한 상태로 수술의 역할이 중요하다. 이에 저자들은 만성 소화성 궤양으로 위출구 폐색을 동반한 환자들의 수술적 치료 후 임상결과를 분석하고자 하였다. 대상 및 방법: 1994년 1월부터 2007년 12월까지 국립의료원 외과에서 소화성 궤양 폐색으로 수술한 31명의 환자를 후향적으로 분석하였고, 이전의 궤양 수술로 인한 유착성 폐색 및 천공이나 출혈로 인한 응급수술시 발견된 폐색동반의 예는 제외하였다. 각 임상병리학적 결과를 수술방법에 따라 우회수술군과 절제수술군으로 분류하였고, 수술결과의 평가는 Visick score를 이용하였다. 수술 후 재발의 기준은 소화성 궤양의 임상증상이 나타나 내시경으로 확진된 경우만을 포함하였다. 결과: 우회수술군이 6명(19.4%), 절제수술군이 25명(80.6%)이었다. 평균 연령은 57.5세(25~81세)이었고, 남자 29명(93.5%), 여자 2명(6.5%)이었다. 평균 증상 지속기간 29.6개월이었고, 흡연자가 19명(61.3%), NSAID 복용자가 6명(19.4%), H. pylori 양성환자가 7명(22.6%) 있었다. 수술 전 내시경적 확장술은 2명에서 시도되었으며, 주병변의 위치는 위, 십이지장이 각각 9명, 20명, 양쪽이 2명이었다. 수술 후 합병증은 13명 (41.9%)에서, 궤양의 재발은 2명(6.5%)에서 있었고, 재수술이 4명(12.9%)에서 필요하였다. 평균 Visick score는 1.8 (1~4)이었다. 우회수술군과 절제수술군의 비교에서 두 군의 임상병리학적 차이는 없었으며, 두 군에서 각각 1명이 재발되었고 합병증은 각각 5명(83.3%), 8명(32%)으로 우회수술군에서 많았으나 통계적 유의성은 없었다(P=0.175). 평균 Visick score는 각각 3.0점, 1.6점으로 절제수술군에서 좋은 결과를 보였다(P=0.001). 결론: 만성 소화성 궤양으로 배출구 폐색을 동반한 환자의 치료에 있어서 내시경적 확장술 등의 비수술적 치료가 비교적 좋은 결과를 보고하고 있지만 여전히 수술은 중요한 치료 방법이다. 궤양 폐색의 수술적 치료시 악성 궤양과의 감별이 용이하지 않고 수술 후 환자의 만족도를 고려한다면 우회수술보다는 절제수술이 바람직한 술식으로 생각된다.
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박종민 ( Jong Min Park ),김성엽 ( Seong Yup Kim ),정일용 ( Il Yong Chung ),김우식 ( Woo Shik Kim ),신용철 ( Yong Chul Shin ),김영철 ( Yeong Cheol Kim ),박세혁 ( Sei Hyeog Park ) 대한외상학회 2013 大韓外傷學會誌 Vol.26 No.4
Blunt abdominal trauma is commonly encountered in the emergency department. The lack of historical data and the presence of distracting injuries or altered mental status, from head injury or intoxication, can make these injuries difficult to diagnose and manage. We experienced a case of traumatic organized hematoma misdiagnosed as intra-peritoneal tumor with intestinal obstruction. A 52-year-old homeless male patient who have chronic alcoholism was admitted via emergency room with infra-umbilical abdominal pain. At admission, he was drunken status and so we could not be aware of blows to the abdomen. He had a unknown large operation scar on mid abdomen. A computed tomography (CT) scan showed the intestinal obstruction of the ileum level with 5.5cm sized mesenteric tumor. We performed adhesiolysis and widely segmental resection of small bowel including tumor with side-to-side anastomosis due to great discrepancy in size. He stated later that he was a victim of the violence before 3 weeks. A final pathologic report revealed well encapsulated, traumatic mesenteric hematoma with organizing thrombi, ischemia and abscess formation with multiple adhesion bands. Finally, the patient was discharged without complications on postoperative day 14.
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박재민(Jae Min Park),김은영(Eunyoung Kim),정일용(Il Yong Chung),박세혁(Sei-Hyeog Park),박종민(Jong-Min Park),윤여규(Yeo-Kyu Youn),오흥권(Heung-Kwon Oh),김중석(Joong-Suck Kim),주성홍(Sung-Hong Joo) 대한종양외과학회 2014 Korean Journal of Clinical Oncology Vol.10 No.2
Purpose: In this study, we compared characteristics of cancer of North Korean defectors to South Korean. In order to clarify the clinicopathologic characteristics of cancer in North Korean defectors. Methods: This study is a retrospective study through chart review of patients diagnosed as cancer at National Medical Center from 2008 to 2013. Control group included South Korean cancer patients who were diagnosed as cervical cancer, thyroid cancer, liver cancer, stomach cancer at same hospital during same period. Two groups were analyzed and compared by sex, age, past medical history, cancer origin, cancer stage, and treatment. Results: Among 1,760 North Korean defector patient registered in National Medical Center, 61 patients were diagnosed as cancer, which was 3.5%. Cervical cancer (19.7%), thyroid cancer (19.7%), liver cancer (14.1%) and stomach cancer (10.3%) were 4 most frequent cancer. In South Korean cancer patient, percentage was as follows: thyroid cancer (33.7%), stomach cancer (7.8%), liver cancer (7.3%), cervical cancer (3.7%). Conclusion: Cancers closely related to socio-economic status, such as cervical cancer and hepatitis-B related liver cancer, were relatively more frequent in North Korean defectors than South Koreans. As for cancers in which early diagnosis is important such as thyroid cancer and stomach cancer, there were no significant differences in age-prevalence, disease course and treatment.
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박인규(In-Kyu Park),오흥권(Heung-kwon Oh),박세혁(Sei Hyeog Park),박종민(Jong-Min Park) 대한종양외과학회 2012 Korean Journal of Clinical Oncology Vol.8 No.2
목적 : 사회경제적 위치에 따라 위암 환자의 임상 결과에 차이가 있다는 여러 연구결과가 있음에도 불구하고 우리나라에서는 연구가 부족한 실정이다. 이 연구는 공공병원에서 위암으로 수술을 시행 받은 환자의 건강보험 종류에 따른 단기 임상 결과의 차이를 알아보고자 하였다. 대상 및 방법 : 2007년 3월부터 2012년 7월까지 위암으로 수술을 시행 받은 186명의 환자들을 후향적으로 분석하였다. 사회경제적 위치는 의료급여 수급권자를 하위 계층으로, 건강보험 가입자를 상위 계층으로 구분하여 수술 후 임상 결과를 조사하였다. 결과 : 186명의 환자 중 의료급여 수급권자는 81명, 건강보험 가입자는 105명이었다. 각 군의 평균연령은 63.6세와 65.3세, 동반질환은 65.4%와 78.1% 무증상 검진율은 32.1%와 46.7%였다. 근치적 절제율은 74.1%와 85.7%, 합병 절제율은 34.6%와 21.9%, 조기 위암의 비율은 33.3%, 51.4%로 의료 급여 수급권자에서 진행된 병기의 환자가 많았다. 근치적 절제 후 재발율은 16.7%와 5.6%였다. 결론 : 의료급여 수급권자들의 경우 조기 진단이 늦어져 진행성 위암의 비율이 높았으며, 수술 시 근치적 절제율이 낮고, 재발율 또한 높게 나타남을 알 수 있었다. Introduction : Although there are several studies which have shown the difference between the clinical outcome and socioeconomic status, there is still insufficient research in Korea. This study will show the difference of short term clinical outcome according to the type of health insurance for patients who have had surgery for gastric cancer in public hospital. Methods : From March 2007 to July 2012, 186 patients who underwent surgery for gastric cancer were retrospectively analyzed. Patients were examined by socioeconomic status. It classified patient in two groups. One was lower class for patients who were beneficiaries of medical aid. Another was upper class for patients who benefitted from health insurance. Results : 186 patients were 81 beneficiaries and 105 health insurance patients. The mean age was 63.6 years and 65.3 years for each group. Comorbidity disease was 65.4% and 78.1%. Asymptomatic checkup rate was 32.1% and 46.7%. Radical resection was 74.1% and 85.7%. Combined resection was 34.6% and 21.9%. There were many currently advanced stage patients in beneficiaries. The recurrence rate was 16.7% and 5.6% after radical resection. Conclusions : Medical aid beneficiaries had the higher proportion of progressive gastric cancer due to lack of an early screening and the low radical resection rate after undergoing operation. The rate of recurrence was high for beneficiaries too.
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