소아외과의 지수 질환 - 대한소아외과학회 정회원을 대상으로 한 2000년도 전국 조사 -

이명덕,김상윤,김우기,김인구,김성철,김신곤,김재억,김재천,김현학,박귀원,박우현,서정민,송영택,오수명,유수영,이두선,이석구,이성철,정상영,정성은,정을삼,정풍만,조마해,Lee, M.D.,Kim, S.Y.,Kim, W.K.,Kim, I.K.,Kim, S.C.,Kim, S.K.,Kim, J.E.,Kim, J.C.,Kim, H.H.,Park, K.W.,Park, W 대한소아외과학회 2001 소아외과 Vol.7 No.2

Membership qualifications and recognition of the subspecialty training programs by the Korean Association of Pediatric Surgeons(KAPS) have been determined by criteria based on the number of neonatal and total pediatric surgical cases registered, since 1989 (Index cases). The numbers are based on a survey of the 14 founding members of the society by Jung et al. in 1987. The current survey is to review the present status of the index cases from 1997 to 1999 among 36 members of the KAPS. Two surveys were undertaken for this study. In the first survey, cases were collected by the registration form, composed of neonatal(N), important pediatric surgical cases (I), tumor and other similar operations(T) and other common pediatric surgical cases(O). Thirty members responded. and the result was discussed at the Topic Discussion section of the 15th Annual Congress of KAPS, 2000. The second survey analyzed additive data, proposed during discussion at the Congress. Twenty-three members responded. This report is the analysis of the both surveys. The average numbers of the cases/year/surgeon of N, I, T, O and total were 19.5, 51.8, 9.5, 77.1 and 356.5. respectively. The number of index cases(N+I+T)/year/surgeon was 80.8. The ratio of (N+I+T)/total cases was 0.3. Seventeen of 30 members have more than 20 cases of N per year. Twelve members have more than 150 cases, and 13 do more than 100 cases of I per year. Fourteen members have more than 10 cases of T per year. Nineteen and 10 members experienced more than 150 and 100 of index cases(N+I+T) per year. A new list of the index cases and coding system are proposed for the future regular update. 대한소아외과학회의 연례 행사인 2000년도 주제토의를 소아외과의 지수 질환으로 정하여 1999년 말 현재 3년 이상의 진료 실적을 가진 대한소아외과학회 정회원 36명을 대상으로 미리 작성된 조사서에 의하여 2차례의 수술 증례 수 등록을 시행하였다. 대상 환자는 1997년부터 1999년 말까지 3년간 수술이 시행된 환자로 하였으며, 1차 조사에서 30명이 응답하였고, 미비점 보완을 위한 2차 조사에는 26명이 응답하여 이 성적을 요약하였다. 본 성적을 바탕으로 향 후 대한소아외과학회의 지수 질환 대상 목록표를 작성 제시하였으며, 이를 코드화 하고자 제안하였다.

한국의 항문-직장 기형 -1999년도 대한소아외과학회 회원 대상 전국 조사-

이명덕,김상윤,김우기,김인구,김재억,김재천,김현학,박귀원,박우현,송영택,오수명,유수영,이두선,이석구,이성철,장수일,정상영,정성은,정을삼,정풍만,Lee, M.D.,Kim, S.Y.,Kim, W.K.,Kim, I.K.,Kim, J.U.,Kim, J.C.,Kim, H.H.,Park, K.W.,Park, W.H.,Song, Y.T.,Oh, S.M.,Yoo, S.Y 대한소아외과학회 2000 소아외과 Vol.6 No.2

The purpose of the survey was to clarify the clinical features and management of the anorectal malformations (ARM) in Korea. Twenty-seven members of the Korean Association of Pediatric Surgeons were surveyed. The members completed a case registration form for each patient during the two years period of 1996-1997, and a questionnaire that contained their management preferences for primary and complicated patients. Twenty-four members of the 22 institutions registered 295 cases of the ARM, and 27 out of 34 members (77.1 %) responded to the questionnaire. The patients were classified by the Wingspread classification of ARM(1984). The case registration form was a modification of Wingspread workshop for the postoperative assessment and case registration. The male to female ratio was 1.7 : 1. The average number of patients per surgeon was 6.1 cases per year. Prematurity(< 36 weeks) was present in 1.9 % of cases and low birth weight (< 2.6 Kg) in 12.1 %. Among 187 male patients, 62 were high(H) type, 29 intermediate(l) type, 88 low(L), and 8 unclassified. In female, there were 2 cases of cloacal anomalies(C), 4 H type, 30 I type, 66 L type and 6 unclass ified. For male, 87.9 % of H and I type were operated by the Pena procedure, but only 7.9 % in L types. In female, all of C, H and I types, and 40.9 % of L type were done by the Pena procedure. One case expired (MR; 0.003%) as a result of surgical complication. Over-all complication rate was 12.5 %. Among 6 cases of reoperation, 4 were failed Pena procedures. Among 140 colostomies sigmoid colon was utilized in 75.7%, and loop colostomy was commonly used. Ten surgeons prefered primary maturation of the stoma. In conclusion, posterior sagittal anorectoplasty is popular for high types of ARM in this country, but considerable number of patients are still suffering from failed operations. For better understanding and analysis, necessity of prospective study by new classification was discussed.

항공기 노즐 형상에 따른 벽면 및 플룸의 온도 변화 연구

강동우(D. W. Kang),김인덕(I. D. Kim),명노신(R. S. Myong),김원철(W. C. Kim) 한국전산유체공학회 2014 한국전산유체공학회 학술대회논문집 Vol.2014 No.5

벽면 열전달을 고려한 항공기 노즐 표면의 온도 변화 연구

강동우(D.W. Kang),김인덕(I.D. Kim),장민욱(M.U. Jang),명노신(R.S. Myong),김원철(W.C. Kim) 한국전산유체공학회 2013 한국전산유체공학회 학술대회논문집 Vol.2013 No.5

The temperature changes on nozzle surface are investigated for the purpose of analysing the infrared signature level of aircraft propulsion system. A virtual subsonic aircraft is first selected and then a convergent nozzle, which meets the mission requirements, is designed. Using a compressible CFD code, an analysis of thermal flow field and nozzle surface temperature distribution is conducted. Finally, qualitative information for the effect of wall heat transfer on temperature changes of aircraft nozzle surface is obtained.

선천성 장폐쇄증 2차 조사 - 대한소아외과학회 회원을 주 대상으로 한 전국조사 -

김성철,김대연,김상윤,김인구,김인수,김재억,김재천,김현영,박귀원,박우현,박진영,서정민,설지영,오수명,오정탁,이남혁,이명덕,이석구,이성철,정상영,정성은,정연준,정풍만,최금자,Kim, Seong-Chul,Kim, D.Y.,Kim, S.Y.,Kim, I.K.,Kim, I.S.,Kim, J.E.,Kim, J.C.,Kim, H.Y.,Park, K.W.,Park, W 대한소아외과학회 2010 소아외과 Vol.16 No.1

본 조사는 2007년부터 2009년까지 3년간 본 학회 정회원들에 의하여 수술받은 장폐쇄증 환아를 대상으로 한 후향적 조사이다. 또한 본 학회에서는 1994년부터 1996년까지 3년간의 증례를 대상으로 같은 조사(1 차조사)를 진행한 바 있다. 1 차 조사와 비교하여 본 조사에서 보이는 특징은 아래와 같이 요약할 수 있다. - 총 증례 수는 비슷하였으나 출생률을 감안하여야 할 것이다. - 각 기형별 비율은 비슷하였다. - 미숙아 및 저출생체중아의 비율은 증가 하였다. - 산전진단율은 증가하였다. - 복부단순촬영만 한 경우는 감소하였다. - 다른 기형이 동반된 예가 증가하였다. - 사망률이 13.8 %에서 3.6 %로 감소하였다. 장운동의 회복은 공장폐쇄증에서 십이지장이나 회장폐쇄증에서 보다 더뎠다. 하지만 십이지장-공장 이행부에서 문합부까지의 거리가 기술되지 않은 예가 많아 소위 "High Jejunal obstruction"에서의 장운동 회복기간을 알아 보지 못 하는 아쉬움이 있었다. 또한 주름형성술(plication) 또는 장의 직경을 줄이는 수술(tapering)의 효과도 시행한 예수가 작고, 문합부 위치의 기술 부족으로 알아 보지 못 하였다. 십이지장폐쇄증의 화타씨유두부와 위치 역시 향후 보다 정확한 수술기록을 토대로 조사되어야 할 것으로 생각된다. 치료 성적의 눈부신 향상은 여러 회원들의 각고의 노력과 의학의 발달에 기인한 것으로, 사망률 0 %를 향한 노력이 지속되어야 할 것이다. The members of the Korean Association of Pediatric Surgeons conducted a retrospective study of two hundred and twenty-two cases of intestinal atresia for the period from January 1, 2007 to December 31, 2009. Seventeen hospitals were involved. There were 76 duodenal, 65 jejunal, and 81 ileal atresias (3 colonic). The male to female ratio was 0.85:1 in DA and 1.34:1 in JIA. Ninety-four patients(43.3 %) were premature babies (DA 40.3 %, JA 64.6 %, IA 28.8 %), and 70 babies (32.0 %) had low birth weight (DA 38.7 %, JA 44.4 %, IA 16.0 %). Antenatal diagnosis was made in 153 cases (68.9 %). However, 27 infants (17.6 %) with antenatal diagnosis were transferred to the pediatric surgeon's hospitals after delivery. Maternal polyhydramnios was observed in 81 cases (36.59 %) and most frequent with proximal obstruction. In forty-four cases (19.8 %), only simple abdominal film was taken for diagnostic study. The associated malformations were more frequently observed in DA - 61.8 % in DA and 22.6 % in JIA. Meconium peritonitis, small bowel volvulus and intussusception were more frequently associated with ileal atresia. The overall mortality rate was 3.6 %. (Abbreviations: DA;duodenal atersia, JA;jejunal atresia, JIA;jejunoileal atresia, IA;ileal atrsia).

담도폐쇄증 -대한소아외과학회 회원 대상 전국 조사-

오정탁,김대연,김성철,김인구,김해영,김현영,남소현,박귀원,박우현,박진영,서정민,이남혁,이명덕,이석구,이성철,정상영,정성은,정재희,최금자,최순옥,최승훈,최윤미,한석주,홍정,Oh, J.T.,Kim, D.Y.,Kim, S.C.,Kim, I.K.,Kim, H.Y.,Kim, H.Y.,Nam, S.H.,Park, K.W.,Park, W.H.,Park, J.Y.,Seo 대한소아외과학회 2013 소아외과 Vol.19 No.1

The Korean Association of Pediatric Surgeons (KAPS) performed the second nationwide survey on biliary atresia in 2011. It was a follow-up study to the first survey, which was performed in 2001 for the retrospective analysis of biliary atresia between 1980 and 2000. In the second survey, the authors reviewed and analyzed the clinical data of patients who were treated for biliary atresia by the members of KAPS from 2001 to 2010. A total of 459 patients were registered. Among them, 435 patients primarily underwent the Kasai operation. The mean age of patients who underwent the Kasai operation was $66.2{\pm}28.7$ days, and 89.7% of those patients had type III biliary atresia. Only five patients (1.4%) had complications related to the Kasai operation. After the Kasai operation, 269 (61.8%) of the patients were re-admitted because of cholangitis (79.9%) and varices (20.4%). One hundred and fifty-nine (36.6%) of the patients who underwent the Kasai operation subsequently underwent liver transplantation. The most common cause of subsequent liver transplantation was persistent hyperbilirubinemia. The mean interval between the Kasai operation and liver transplantation was $1.1{\pm}1.3$ years. Overall the 10-year survival rate after the Kasai operation was 92.9% and the 10-year native liver survival rate was 59.8%. We had 23 patients for primary liver transplantation without the Kasai operation. The mean age patients who underwent primary liver transplantation was $8.6{\pm}2.9$ months. In summary, among the 458 Kasai-operation and liver-transplantation patients, 373 lived, 31 died, and 54 were unavailable for follow up. One-third of the patient who survived have had complications correlated with biliary atresia. In comparison with the first survey, this study showed a higher survival rate and a greater number of liver transplantation.

1999년도 한국 신생아외과 현황 -대한소아외과학회 회원대상 전국조사(제 2 차)-

김우기,김상윤,김신곤,김인구,김재천,김현학,박귀원,박우현,송영택,오수명,유수영,이두선,이명덕,이성철,이석구,서정민,정상영,정성은,정을삼,정풍만,Kim, W.K.,Kim, S.Y.,Kim, S.K.,Kim, I.K.,Kim, J.C.,Kim, H.H.,Park, K.W.,Park, W.H.,Song, Y.T.,Oh, S.M.,Yoo, Y.S.,Lee, D.S 대한소아외과학회 2001 소아외과 Vol.7 No.1

To understand the current status of neonatal surgery in Korea, a survey was made among the 36 members of the Korean Association of Pediatric Surgeons. The response rate was 75 % (26 surgeons in 20 hospitals). Five hundred fifty three neonatal surgical patients treated in 1999 were analyzed. Regional numbers of patients were closely related to the regional population in most areas. Ano-rectal malformations (17 %), pyloric stenosis (16 %), Hirschsprung's disease (13 %), atresia/stenosis of the gut (11 %), esophageal atresia (8 %) were the most common anomalies treated. The majority of operations were done within the first week of life. Seventy one per cent of cases were major life threatening or so-called neonatal index cases. Over-all mortality was 8 per cent. Higher mortality was observed in patients with diaphragmatic hernia (26 %), gastro-intestinal perforation (18 %), NEC (18 %), and esophageal atresia(14 %). Higher mortality was observed in patients with extremely low birth weight (33%) and low birth weight (18 %). Associated anomalies were observed in 20 %. Prenatal ultrasound was performed in 36 per cent with sensitivity of 20 %. Result of this study was compared to the previous report (1994) and that of Japan (1998).

선천성 보흐다레크 횡격막 탈장 - 대한소아외과학회 회원 대상 전국 조사 -

김재천,김대연,김상윤,김성철,김인구,김재억,김해영,김현영,박귀원,박우현,박진영,백홍규,서정민,송영택,오수명,이남혁,이두선,이명덕,이석구,이성철,정상영,정성은,정연준,정을삼,정풍만,Kim, Jae-Chun,Kim, D.Y.,Kim, S.Y.,Kim, S.C.,Kim, I.K.,Kim, J.E.,Kim, H.Y.,Kim, H.Y.,Prak, K.W.,Prak, 대한소아외과학회 2006 소아외과 Vol.12 No.1

This is a survey on congenital posterolateral diaphragmatic hernia, conducted by the Korean Association of Pediatric Surgeons(KAPS). A registration form for each patient during the 5-year-period between 1998 and 2002 and a questionaire were sent to each member. Twenty-ninemembers in 22 institutions returned completed forms. The average number of patients per surgeon was 1.4 cases a year. The male to female ratio was 1.64: 1, and annual incidencewas 1/14,522 live births. In this review, factors influencing survival in congenital posterolateral diaphragmatic hernia were age at admission, birth weight, time of antenatal diagnosis, birth place, Apgar score, onset time of symptoms and signs, preoperative cardiopulmonary resuscitation, associated anomalies of themusculoskeletal system, central nervous system, or chromosomes, preoperative stabilization, levels of preoperative $FiO_2$, pH, and $AaDO_2$, perioperative complications, bilaterality of defect, size of the defect, and presence or absence of hernia sac.

담관낭종 -대한소아외과학회회원 대상 전국조사-

최금자,김대연,김상윤,김성철,김신곤,김우기,김인구,김재억,김재천,김해영,김홍주,박귀원,박우현,박진영,백홍규,서정민,송영택,오수명,유수영,이두선,이명덕,이석구,이성철,박영식,이태훈,정상영,Choi, Kum-Ja,Kim, D.Y.,Kim, S.Y.,Kim, S.C.,Kim, S.K.,Kim, W.K.,Kim, I.K.,Kim, J.E.,Kim, J.C.,Kim 대한소아외과학회 2003 소아외과 Vol.9 No.1

본 조사 결과는 32개 병원의 39명의 회원에 의해 수술받은 환자 348명의 기록과 회원 37명의 설문 응답자를 분석한 것으로 많은 수의 기록지가 내용이 불충분하거나 일치되지 않은 기술로 인해 자료로서의 한계가 있었다. 특히 췌담관합류 이상에 대한 기록 중 약 절반이 미상으로 기록된 것에서 알 수 있드시 자료가 매우 미흡하였고, 담관낭종의 유형을 정하는 것 예후 인자 및 산 전 진단된 담관낭종의 수술 적기등에 대하여도 회원마다 견해 차이가 있으나 심도있는 토론이 이루어지지 않았다. 따라서 이 결과를 외국의 통계 분석과 비교하는 것 보다는 회원들의 향 후 진료와 연구에 참고가 될 수 있다는 것에 의미를 두고자 하며, 회원들이 동일한 등록지를 작성하는 전향적 연구로 우리나라 담관낭종에 대한 분류, 췌담관 합류이상, 예후 인자들에 대한 재 논의의 출발점이 되기를 기대한다. A nationwide survey on choledochal cyst was undertaken among 39 members of the Korean Association of Pediatric Surgeons. The members were required to complete a questionnaire and the case registration form for each patient during the five year period of 1997 to 2001. Three hundred and forty eight patients were registered from 32 institutions. The average number of patients per surgeon was one to two every year. The male to female ratio was 1:3.4. The age of patients on diagnosis was $49.0{\pm}44.4$ months. The geographic distribution was 34.8% in Seoul and Kyoungki-do, 33.3% in Kyoungsang-do, 17.9% in Cholla-do, and 8.5% in Choongchung-do, in order of frequency. The three common clinical presentations were abdominal pain (63.8%), vomiting (35.3%), and jaundice (29.1%). Only seven patients (2%) presented with classic triad, and 25 patients were diagnosed by antenatal ultrasonographic examination. According to the Todani Classification, 238 patients (7l.3%) were type 1, 3 (0.9%) type 11, and 93 (27.8%) type IV. At the time of the operation, three important associated conditions were choledocholithiasis in 45 patients (15.1%), liver fibrosis (Grade 1-4) in 35, and previous operative procedure for biliary diseases in 10. Associated anomalies were observed in 13 patients (3.8%). Three hundred thirty nine (98.8%) of 343 lesions were treated by Cyst excision and Roux-Y hepaticoiejunostomy. One hundred seventy-six patients had an anomalous arrangement of the pancreatobiliary ductal system (APBD): APBD was not in 92 patients, biliary duct joined to the pancreatic duct in 51, and pancreatic duct joined to the biliary duct in 26. There were 8.5% early, and 7.7% late phase operative complications. The major complications were bleeding, anastomotic leakage, and acute pancreatitis. The combination of acute abdomen and choledochal cyst may suggest spontaneous rupture. Because of the development of late intrahepatic bile duct stones, long term follow up after cyst excision and hepaticojejunostomy is required. The optimal time of surgical intervention should also be considered in the situation of routine use of antenatal ultrasonographic examination. This is the first review of the choledochal cyst in Korea and provides baseline data for future comparisons.

급성 충수염 - 2006년 대한소아외과학회회원 대상 전국조사 -

이석구,김대연,김상윤,김성철,김신곤,김우기,김인구,김재억,김재천,박귀원,박우현,서정민,송영택,오정탁,이남혁,이두선,이명덕,이성철,장수일,전용순,정상영,정성은,정을삼,정풍만,Lee, Suk-Koo,Kim, D.Y.,Kim, S.Y.,Kim, S.C.,Kim, S.G.,Kim, W.K.,Kim, I.K.,Kim, J.E.,Kim, J.C.,Park, K.W. 대한소아외과학회 2007 소아외과 Vol.13 No.2

본 조사 결과는 21개 병원에서 수술 받은 환자 476명의 기록에 대한 전향적인 분석과 23명의 회원에 대한 설문 응답지에 의한 것이다. 미리 환자등록지를 배부하여 6개월 간 전향적으로 기록한 것으로 그 의의가 크다고 할 수 있다. 그러나 전향적 연구계획에 의한 것이 아니므로 통계적인 비교는 시도하지 않았고 급성충수염에 대한 회원들의 전체적인 의견과 성향을 파악하는데 중심을 두었다. 복강경수술은 아직 전체 충수절제술의 30 %에 못 미치고 있으나 설문지에 답한 회원 약 50 %가 복강경 충수절제술을 시행하고 있으며 이 숫자는 계속 증가할 것으로 보인다. 그러나 복강경수술의 결과는 아직 개복수술과 크게 차이가 없는 것으로 보인다. 한편 단순충수염에 대한 예방적 항생제투여 방법과 기간 등에 대한 설문결과에 큰 차이가 있어 이에 대한 학회 중심의 논의가 필요하다고 생각한다. A nationwide survey on acute appendicitis (AAP) was undertaken among members of the Korean Association of Pediatric Surgeons. The members were required to complete a questionnaire and the case registration form for each patient during the 6 months period from the $1^{st}$ October, 2005 to $31^{st}$ March, 2006. Questionnaires were collected from 23 members. Four hundred seventy six patients were registered from 21 hospitals where the members were working. The male to female ratio was 1.67:1. Average age was 9 years and 5 months (range 21 months-20 years). Operations were performed on average 10.4 hours (range 1-230 hours) from arrival at hospital. The average operation time was 59.1 minutes. The average admission days were 5.8 days (range 2-45 days). The most frequent symptoms were abdominal pain (95.1 %), vomiting (50.6 %) and fever (43.7%). The average duration of symptoms was 42.2 hours (range 1 hour-22 days). Leukocytosis (WBC count > 10,000) was found in 85.9%. The most popular diagnostic tools were ultrasonography and CT. Open surgery was performed in 72.1 % and laparoscopic surgery in 27.5 %. Two laparoscopic surgeries were converted to open surgery (0.4 %). Simple appendicitis was found in 54.5 % and complicated appendicitis such as abscess, gangrenous change and perforation in 45.5%. According to the questionnaires 12 hospitals were performing open surgery only in all patients. Four hospitals were performing laparoscopic surgery in all patients. Seven hospitals are performing both surgical methods according to surgeon or occasion. Regarding the use of antibiotics in acute appendicitis, three kinds of antibiotics were used in 40 % of total simple appendicitis patients. The results showed the trend of management in acute appendicitis in Korea. Especially it is necessary for the members to discuss the use of antibiotics for prophylaxis in the simple appendicitis.