간 , 담도 및 췌장 : 내시경적 (內視鏡的) 유두절개술의 (乳頭切開術) 문제점과 예후 (豫後)

박홍배(Hong Bae Park),명재일(Jae Il Myung),여향순(Hyang Soon Yeo),박순희(Sun Hi Park),이한기(Han Ki Lee),강명원(Myung Weon Kang),김정호(Jeong Ho Kim) 대한소화기학회 1987 대한소화기학회지 Vol.19 No.2

N/A Since 1976, 2185 cases of ERCP were performed at the Kwangju Christian Hosptial. From December 1981 to August 1986, 194 cases of endoscopic sphincteropapillotomy (EST) were performed. Following results were obtained: 1) In 194 cases of EST, CBD stones were noted in 168 cases, ascaris in common bile duct in 16 cases, clonorchiasis in 4 cases, fibrotic stenosis of a periampullary choledocho-duodenal fistula in 1 case, and pancreatic duct stones in 4 cases. 2) Results of EST; 5 cases of stones were removed by Dormia basket under direct visualization, 61 cases were passed in stool, 66 cases were confirmed at ERCP or T-tube cholangiogrphy. In 46 cases, stones were not removed but symptoms and laboratory findings showed improvement. 3) Complication of EST; 4 cases of bleeding and 1 case of peritonitis were treated by operation, 1 case of acute pancreatitis with pancreatic pseudocyst was treated by medication, 1 case of sepsis due to cholangitis was expired. And 5 cases of recurrent cholangitis, and 2 cases of recurrent pancreatitis were noted. 4) With technical improvement in EST, we could control bleeding and acute pancreatitis with a pancreatic pseudocyst due to an impacted stone and perform EST successfully in the cases with periampullary diverticula. 5) At last, although we could follow up only for 2 years, would expect that we use more EST for recurrent CBD stones.

출혈성 식도 정맥류의 내시경적 요법에 대한 연구

이상운(Sang Yoon Lee),이한기(Han Ki Lee),김정호(Jeong Ho Kim),강명원(Myung Weon Kang),박순희(Sun Hi Park),여향순(Hyang Soon Yeo),정판기(Pan Ki Jeoung),박홍배(Hong Bae Park) 대한내과학회 1987 대한내과학회지 Vol.32 No.6

N/A Hemorrhage from esophageal varices is a difficult problem for which there is no completely solution, Sixty-three patients (eight-five cases) have been treated with endoscopic injection sclerotherapy (EIS). All patients had documented variceal hemorrhage and underwent EIS while bleeding or shortly thereafter. The observed results are summarized as follows: 1) The duration of EIS from onset of hematmesis and/or melena was within 72 hours mostly, and the frequency of EIS was one to six times. 2) There were no noticable changes in Hemoglobin, SGOT, Serum bilirubin and serum albumin before and after EIS. 3) The amounts of blood transfusion was decreased significantly after EIS. 4) There were mild complications after EIS, but were serious complication or death relate to EIS. 5) The mortality rate was 13% in follow up period. Based on these results, we concluded that EIS is recommanded for managing variceal hemorrhage with- out serious complication.

식도를 포함한 전위장관을 침범한 전이성 악성 흑색종 1예

최정영,김준기,신성하,고영춘,조상욱,서강석,강명원,임연근,여향순,김경수 全南大醫大 2001 전남의대학술지 Vol.37 No.1

경피경간적 담도내시경을 이용한 거대 총담관결석의 전기수압쇄석술과 Endocoil 삽입

김명원,박홍배,여향순,오기창,강명원,조장현,조형철,추진호,김원석 대한소화기내시경학회 1997 Clinical Endoscopy Vol.17 No.5

Background/Aims: Electrohydraulic lithotrypsy(EHL) under cholangioscopic control has been performed for difficult bile duct stones. The percutaneous transhepatic approach is technically easy and useful in diagnosis and treatment of bile duct obstruction and stones. Biliary stenting with self expanding metal stent is gaining increasingly wider acceptance as a palliative treatment of bile duct obstruction. Methods: Between Sep. 1994 and Sep. 1996, EHL under choledochoscopy by percutaneous transhepatic approach was performed in 30 cases(Male: 13, Female: 17). After PTBD with 7F pig tail catheter, the percutaneous transhepatic passage was dilated over guide wire with dilaters of increasing size up to 16Fr in 3-Sdays. In one week, after fistula had been estabilished, choledochoscopy was performed. Results: (1) Mean age was 61.3 years. Mean stone number was 2.5. And mean stone size was 1.6 x 2.3 cm. (2) Com.plete removal of the stone was achieved in all patients(100%). (3) There were no serious complications. (4) In six cases, Endocoils were implanted with successful decompression of obstructions and simultaneous removal of biliary stones located at both side of stricutre. Conclusions: Percutaneous transhepatic choledochoscopy is easy and safe and assists in the diagnosis and treatment of biliary stricture and the management of difficult CBD stone.

위암에서 내시경적 초음파단층술의 유용성에 대한 평가

김명원,박홍배,여향순,오기창,강명원,조장현,조형철,추진호,김원석 대한소화기내시경학회 1997 Clinical Endoscopy Vol.17 No.1

Background: Endoscopic Ultrasonography(EUS), a combination of endoscopy and ultrasonography is one of the most useful tools for diagnosis of digestive system diseases. EUS is useful in staging the primary tumor invasion and regional lymph node metastasis because of its ability to image the gut wall and adjacent structures in unique detail. We performed a study preoperatively for assessing the accuracy and limitation of EUS in gastric carcinoma. Methods: In 75 patients(Male 54, Female 21, Mean age 62.3 years) with a gastric carcinoma confirmed by endoscopic biopsy, we performed EUS preoperatively. The results were compared with the postoperative histopathologic staging. Results: 1) In assessing the depth of tumor invasion, EUS accuracy on depth of invasion was 76.0% and overstaging and understaging were 14.7% and 9.3%, respectively. 2) In assessing the lymph node metastasis, the accuracy rate of EUS was 65.3%. A rate of false-positive diagnosis was 27.3%, and a rate of false-negative diagnosis was 24.5%. 3) In assessing the incidence of lymph node metastasis for each T stage, the involve rate was 10.5% in pT1, 36.4% in pT2, 95.7% in pT3, 100% in pT4. Conclusions: EUS is the most accurate diagnostic methods presently available to determine tumor infiltration depth and lymph node metastasis.

유두주위 담관 십이지장 누공(瘻孔)의 임상적 중요성

이승민,박홍배,이상철,여향순,강명원,김규순,최병인,오원주 대한소화기내시경학회 1988 Clinical Endoscopy Vol.8 No.1

Sine 1976, 2380 eases of ERCP were performed at the Kwangju Chrietian Hospital. Nighty eight patients with periampullary choledochaduodenal fistula diagnosed at ERCP were revewed, Following result were obtained 1) Cases were most commonly noted from fifth decade to seventh decade, and sex distribution was similar. 2) Right upper quadrant abdominal was most common clinical manifestation, and duration of illness prior to diagnosis were from 2 months to 20 years. Several weeks or days before ERCP, sudden disappearance of pain suggeeted spontaneous extrustion of a stone from the common bile duct to the duodenum with resultant PACD formation. 3) On past history, various types biliay operations had carried out in 26 patients. Subtotal gastrectomy with gastrojejunostomy in 1 patients, operation for CBD ascaris removal in 1 patient. 4) Most PACDF had finding formed recently on ERCP and fibrosis, inflamation, granulation, atrophic change, adhesive stenosis were noted additionally. 5) Most common cause of PACD by ERCP was biliary teact stone. 6) Endoscopic sphincteropapillotomy(EST) were performed in 39 patients with PACDF due to CBD stone and surgical intervention were done in 36 patients due to CBD stone also. It was interesting that EST were performed in 3 patients with old stenotic fistula.

다발성 골수종과 동반된 만성호중구성 백혈병 1례

김광현,김원영,조철현,이승욱,윤봉한,강명원,임연근,여향순,이명희 大韓血液學會 1998 大韓血液學會誌 Vol.33 No.3

위의 다발성 유암종의 내시경적 치료 1예

김경수,최정영,김준기,조상욱,여향순,강명원,신성하,고영춘,임연근 대한소화기내시경학회 2001 Clinical Endoscopy Vol.22 No.1

Multiple carcinoid tumors in stomach are very rare tumors and associated with pernicious anemia, chronic atrophic gastritis and Zollinger-Ellison syndrome. These are believed to be due to hypergastrinemia, resulting in chronic stimulation of enterochromaffine-like (ECL) cells, leading to hyperplasia, metaplasia and ultimately neoplasia. The carcinoid tumor is potentially malignant, even though it may grow slowly, so the treatment of choice must be endoscopic lumpectomy or surgical gastrectomy. The prognosis depends on the site of the tumor and its size. Most carcinoid tumors are less than 1 cm in size and metastasis is uncommon but metastasis in tumors with size over 2 cm is common. A case of multiple carcinoid tumors in stomach, which was successfully removed by endoscopy, is herein reported.

내시경적 역행성 담췌관 조영술로 진단에 실패한 총담관결석에 대한 초음파내시경의 유용성

이은우,김도현,강동구,박홍배,여향순,임연근,강명원,김윤아,박혁 대한소화기내시경학회 1999 Clinical Endoscopy Vol.19 No.3

Background/Aims: Endoscopic retrograde cholangiopancreatography (ERCP) is the best imaging procedure for the diagnosis of common bile duct (CBD) stones. But the difficulties of diagnosis are mostly due to problems involving cannulation, microlithiasis and pancreatitis etc. The diagnostic utility of endoscopic ultrasonography (EUS) for the diagnosis of CBD stones not detected by ERCP was retrogradely assessed in 8 patients. Methods: All the patients (N=98) underwent ERCP, and in the case where CBD stones were not confirmed by ERCP, EUS was performed. Final diagnosis was determined by ERCP with an endoscopic sphincterotomy (EST) or operative exploration. Results: 98 patients with CBD stones were studied. The first ERCP successfully imaged CBD stones in 90 patients and an EST was performed in 84 patients. In 6 patients, stones were removed through operative exploration. ERCP images were incomplete or of poor quality in 8 patients. EUS images were excellent or good in all 8 cases, where ERCP was ineffective. Factors associated with incomplete results for CBD stones included; inability to cannulate the ampulla of Vater (N=1), nonvisualized CBD (N=4), microlithiasis (N=2), and association with the periampullary fistula (N=1). The second ERCP and EST successfully confirmed the diagnosis of CBD stones in 6 patients. In 2 patients, operative exploration was needed to confirm the diagnosis of CBD stones. Conclusions: An EUS appears to be an accurate and useful diagnostic tool for assessing CBD stones in cases where an ERCP was ineffective.

상부 위장관 및 췌담도계 질환의 내시경적 초음파 단층술 진단 589예

이재학,박홍배,여향순,정경헌,김기현,박철성,강명원,문정식 대한소화기내시경학회 1996 Clinical Endoscopy Vol.16 No.2

Endoscopic ultrasonography (EUS)-a combination of endoscopy a.nd ultrasonography was one of the most useful tools for diagnosis of digestive system diseases. This technique was known to be very effective in the assessment of depth of invasion in gastric cancer and in pancreatico-biliary diseases. We performed EUS in 589 patients with upper gastrointestinal and pancreatico-biliary tract lesion prior to surgery for past 22 months and examined the diagnostic accuracy of EUS, respectively. The results were compared to surgical histology in esophagus and stomach cancer,to concordance witb endoscopic retrograde cholangiopancreatography(ERCP ) results for pancreaticobiliary diseases. 1) In 589 patients diagnosed with EUS, the mean age of the patients was 55.9 years with a male to female ratio of 1.7: 1. 2) Patients were divided into three groups; post-upper gastrointestinal endoscopy, post ERCP and undiagnosed with other diagnostic tools. 3) Among post-upper gastrointestinal endoscopy, 64 cases were operated due to esophageal and gastric cancer and then compared to surgical histology. After compared, EUS accuracy on depth of invasion was 78.1% and sensitivity and specificity on lymph node metastasis in gastric cancer were 76.9% and 74.3%, respectively. 4) In post-ERCP cases, EUS results were compared to ERCP results and then concordance rate was 95.4%. 5) In undiagnosed cases, EUS was performed and results were reported. EUS was very effective in the assessment of depth of invasion n gastric cancer and diagnosis of pancreatico-biliary diseases, respectively.