복강경을 이용한 서혜부 탈장 교정술과 기존 탈장교정술의 비교 분석 : 복강을 통한 전복막 접근법의 고찰 Transabdominal Preperitoneal Floor Repair

류석용,이명수,김형국,한세환,김홍주,김영덕,김홍용 인제대학교 1998 仁濟醫學 Vol.19 No.1

인제대학교 상계백병원 외과학교실에서는 복강경하 탈장교정술의 유용성을 확인하고자 복강경수술을 희망한 서혜부 탈장 환자 15명을 대상으로 복강을 통한 전복막 탈장교정술을 시행하였고 비교 분석군으로는 같은 기간 내원하여 기존의 탈장교정술을 시행한 서혜부 탈장 환자 50명을 비교하여 다음과 같은 결과를 얻었다. 1) 남녀 비는 남자 12명, 여자 3명이었고, 기존의 탈장교정술을 시행한 환자에서는 남자 45명, 여자 5명이었다. 2) 나이는 19세부터 80세까지 다양하였고 평균 나이는 51.47세였다. 기존의 탈장교정술을 시행한 환자에서는 17세부터 88세까지로 평균 나이는 53.96세였다. 3) 복강경 시술 환자에서 발생 부위는 우측 6예, 좌측 7예, 양측성 탈장 2예였고, 발생 형태는 간접 탈장이 14예, 직접 탈장이 3예, 재발성 탈장이 1예였다. 4) 기존의 탈장교정술에서는 평균 70.1분의 수술 시간이 소요되었으나 복강경 탈장교정술에서는 투관침 삽입부터 제거까지 50분에서 100분까지 다양하였으며 평균수술 시간은 75.3분이었다. 5) 입원 기간은 기존의 탈장교정술시 평균 5.66일인데 비하여 복강경 탈장교정술시는 2∼7일까지 다양하였고 평균 입원기간은 3일로 나타났다. 6) 합병증은 복강경 시술환자 15명중 1명(6.7%)에서 나타났는데 비교적 경미한 서혜부 혈종이었고 보존적 치료후 호전되어 퇴원하였다. 시술 환자 15명중 재발은 없었다. 그리고 복강을 통한 전복막 접근법시 흔한 합병증 중의 하나인 장유착에 의한 장폐색 및 장관 손상은 관찰 기간동안 발생하지 않았다. 결론적으로 복강을 통한 전복막 탈장교정술은 기존의 탈장교정술에 비해 입원 기간을 단축시킬 수 있고 복벽의 긴장을 필요로 하지 않아 통증 감소의 효과가 있으며 사회경제학적, 미용적인 관점 등 여러 가지 장점을 갖고 있는 효과적인 치료법이라 생각된다. Laparoscopic herniorrhaphy is a new and presently evolving technique applied to the repair of ingunal defects. Currently there are three popular methods of performing laparoscopic herniorrhaphy. These include the intraperitoneal onlay mesh repair(IPOM) , the totally ex-traperitoneal approach(TEPA), and the transabdominal preperitoneal floor repair(TAPP). Laparoscopic inguinal herniorrhaphy has following potential advantages : 1) less postoperative discomfort/pain, 2) reduced recovery time, allowing an earlier return to full activity, 3) easier repair of a recurrent hernia because the repair is performed in tissue that has not been dissected previously, 4) the ability to treat bilateral hernias, 5) the performance of a simultaneous diagnostic laparoscopy, 6) the highest possible ligation of the hernia sac, and 7) an improved cosmesis. The earlier return to full activity is an important socioeconomic factor because the decrease in time away from work could potentially offset the higher operative costs. We performed 15 laparoscopic inguinal herniorrhaphies using transabdominal preperitoneal floor repair at the department of Surgery of Sanggye Paik Hospital from October 1996 to September 1997. In our series, 15 patients had 17 hernia repairs. Of this group, 14 hernias were indirect, 3 direct, 1 recurrent, and 2 bilateral. The results are summerized briefly as follows : 1) The male to female ratio was 12:3 2) The operation time of laparoscopic herniorrhaphy(from Verress needle insertion to removal) varified from 50 minutes to 100 minutes and mean operation time was 75.3 minutes. 3) A minor complication, subcutaneous hematoma in right inguinal area, occurred. 4) There were no other complications such as bowel perforation, adhesive bowel obstruction and bladder injury occurring in TAPP repair. 5) There were no recurrent hernia. In conclusion, laparoscopic inguinal herniorrhaphy is an effective method to correct an inguinal hernia. It can be offered safely to patients undergoing other abdominal procedures.

외상환자에게 혈청 Interleukin-4, 6, 10, 12, TNF-α 의 농도와 외상의 정도 및 예후와의 관계

류석용,진헌철,노준영,김홍용,한세환,김기환,김성준,한태희 대한응급의학회 2003 大韓應急醫學會誌 Vol.14 No.4

출혈성 치핵 환자에 대한 적외선 응고법

류석용,김영덕,이명수,한세환,김홍주,김홍용 인제대학교 1997 仁濟醫學 Vol.18 No.2

증상을 호소하는 치핵의 치료법은 아주 다양하나 확실한 방법은 없다고 할 수 있다. 고섬유질 음식의 섭취, 좌욕, 좌약의 사용과 같은 보존적 치료법에 반응하지 않는 치핵에 대하여 여러 가지 외과적 치료법이 다양하나 그 장단점이 있어 서로 보완적이라 할 수 있다. 그래서 인제대학교 상계백병원 외 과학교실로 내원한 1,2,3도의 출혈성 치핵 환자 95명을 대상으로 적외선 응고술을 시행하였고 다음과 같은 결과를 얻었다. 1) 조사시간은 1.5초였고 3-5회 조사하였다. 2) 93.7%의 환자에서 증상의 호전을 볼 수 있었고 6.3%의 환자에서 수술을 시행하였다. 3) 부작용은 미미하였다. 결론적으로 적외선 응고술은 출혈을 호소하는 1,2,3도의 치핵환자를 대상으로 외래에서 간단히 시행할 수 있는 효과적인 치료법이라고 생각한다. Many modes of therapy have been advocated for the treatment of symptomatic hemorrhoids unresponsive to conservative management such as hot sitz bath or application of local preparations. These include injection sclerotherapy, cryotherapy, rubber band ligation, infrared photocoagulation, diathermy, internal sphincterotomy, manual dilation of the anus, and surgical hemorrhoidectomy. Despise an abundance of non-surgical therapies, none has been consistently more efficaclous. Infrared photocoagulation is a recently developed method of treatment. Initially, as recommended by the manufacturers, two pulses were applied at each site. But we found three to five pulses mode effective and similar complications. Ninety five patients with a diagnosis of bleeding hemorrhoids grade I-III were treated with infrared photocoagulation from June 1992 to June 1995 at outpatient department. 1) The duration of each infrared photocoagulation was 1.5 seconds. Numbers of application were varied in proportion to the size of hemorrhoid from three to five times. 2) Eighty-nine cases(93.7%) became symptomatically improved or asymptomatic. Among the six patients(6.3%) without improvement, five cases had hemorrhoidectomy because they had persist bleeding or unchanged hemorrhoid. 3) For of the patients, side effects were rare. (i.e. bleeding, mild discomfort) In conclusion, infrared photocoagulation is a safe, rapid, non-invasive comfortable method for treatment of the 1st and the 2nd degree hemorrhoids at outpatient department.

수술로 확인된 출혈성 황체에 대한 임상적 고찰

류석용,김홍용,김원율,김경환 인제대학교 2001 仁濟醫學 Vol.22 No.1

Backgrounds: Ovarian hemorrhage from the corpus luteum due to menstruation or pregnancy can be a life-threatening surgical condition and occurs at all stages of a woman's reproductive life. The condition is often confused with other surgical emergencies, such as appendicitis and ectopic pregnancy. Materials and Methods: From the records of the Department of Emergency Medicine, Inje University, Sanggye Paik Hospital, 50 consecutive cases of a hemorrhagic corpus luteum, which had been diagnosed from July 1995 to July 1999, were reviewed and analyzed. Results: The ages of the patients ranged from 15 to 44 years with a mean of 32.6 years. Twenty-six cases (52.0%) involved the right ovary, and twenty-four cases (48.0%) involved the left ovary. Rupture of the corpus luteum occurred most frequently between the 20th and the 30th days of the menstrual cycle. Lower abdominal pain was the most common clinical symptom (35 cases, 70.0%). Blood transfusions were required in 15 patients with an intraperitoneal blood loss of more than 500ml. Ultrasound was done in all patients, and 31 patients (62.0%) had fluid collections within cut-de-sacs. Culdocentesis was done in 35 patients, and was positive for hemoperitoneum in 32 patients (91.4%). Ultrasound or culdocentesis was positive for hemoperitoneum in 47 cases (94.0%) . Conclusions: There are no typical symptoms and signs that will make a definitive diagnosis possible as they are mimicked by other surgical emergencies such as acute appendicitis and ectopic pregnancy. The diagnosis of a hemorrhagic corpus luteum should be considered in the differential diagnosis of an "acute abdomen" in a woman of childbearing age. We suggest that a precise history, ultrasound, and culdocentesis are essential for the diagnosis of a hemorrhagic corpus luteum.

위암환자의 예후인자로서 cyclin D1의 유용성에 관한 연구

류석용,김홍용,한세환,배병노 인제대학교 백병원 2002 仁濟醫學 Vol.23 No.1

■ Objectives This study was conducted to evaluate the clinical implication of cyclin D1 expression in human gastric cancer. In addition, clinical utility of cyclin D1 as a prognostic marker in human gastric cancer was also evaluated. ■ Methods and materials Medical records and archival pathology tissues from 76 primary gastric cancer patients who underwent curative gastric resection and same postoperative adjuvant chemotherapy were evaluated. Correlation between cyclin D1 expression and clinicopathological parameters was investigated. ■ Results Expression of cyclin D1 was observed in 22 of 76(28.9%) gastric cancer tissues. Expression of cyclin D1 did not correlate with depth of tumor infiltration(p=0.15), lymph node metastasis (p=0.54) and pathologic stage of the disease(p=0.45). Cyclin D1 expression slightly increased in intestinal type tumors. but there was not significant correlation between cyclin D1 expression and Lauren's classification(p=0.50). Increased expression of cyclin D1 was observed more frequently in the tumors with high levels of S-phase fraction but there was not a sign ficant correlation between expression of cyclin D1 and S-phase(p=0.14). Cyclin D1 expression increased in diploid cancers but the result showed no statistical significance(p=0.47). In the analysis for prognostic significance of cyclin D1 in gastric cancer, there was not significant correlation between clinical outcome of the patients and cyclin D1 expression (p=0.39). ■ Conclusions Cyclin D1 expression was not significant correlation with clinicopathologic characteristics, cell growth and differentiation in human gastric cancer and expression of cyclin D1 did not have prognostic significance. Additional study seems to be necessary to elucidate the clinical utility of cyclin D1 as a useful prognostic marker in human gastric cancer.

소방구급대원의 응급처치 적절성 평가와 재교육 필요성

류석용,김원율,김경환,이상래,이경호,김홍용,이승한 대한응급의학회 2000 대한응급의학회지 Vol.11 No.2

Background: The prehospital emergency medical system(EMS) for 119 rescue has progressed considerably, but leaves much to be desired. To improve prehospital EMS, we need to evaluate prehospital patient care, and reeducation. Methods: The records of 1,882 patients, who visited Sanggye Paik Hospital Emergency Department via 119 rescue from April 1 to July 30, 1999, were analyzed according to the quality of patient care as documented by the 119 rescue protocol and database. Patients are grouped into 5 classes based on the quality of the care received. Class 1A received adequate care, class 1B received inadequate care, class 1C did not receive the necessary care, and class 2A received unnecessary care, class 2B did not receive unnecessary care. The results of such analyses are presented to the fireman at monthly meetings, thus reeducating them. Results: The overall results were 1027 cases in Class 1A(55%), 83 in 1B(4%), 149 in 1C(8%), 21 in 2A(1%), and 602 in 2B(32%). Well performed care(1A+2B) occured in 1629 cases(87%) and badly performed care(1B+1C+2A) occured in 253cases(13%). Well perfomed care gradually increased from April to July (April 83%, May 85%, June 87%, and July 89%). Conclusion: Meticulous appraisal of the quality of prehospital patient care and reeducation through the regular meetings of EMS physicians and firemen in each community is needed for developing a model protocol for indirect retrospective medical control of the prehospital EMS.

219. 팽대부 주위암 환자에서 혈청 빌리루빈의 변화에 따른 혈중 CEA와 CA19-9수치의 변화에 대한 연구

류석용,한세환,유병희,김홍용,이명수,김홍주,김영덕 대한외과학회 1998 대한외과학회 학술대회 초록집 Vol.1998 No.5

췌공장문합시 췌관 Stent를 경피적으로 배액하는 방법 및 문합부의 감시

류석용(Seok Yong Ryu),강현철(Hyeon Chul Kang),김홍용(Hong Yong Kim),한세환(Sehwan Han),이명수(Myeong Soo Lee),김홍주(Hong Ju Kim),김영덕(Young Duck Kim) 한국간담췌외과학회 1998 한국간담췌외과학회지 Vol.2 No.2

남성에서 발생한 췌장 유두상 낭성종양 1례 보고

류석용(Seok Yong Ryu),김홍용(Hong Yong Kim),박지호(Ji Ho Park),한세환(Sehwan Han) 한국간담췌외과학회 1999 한국간담췌외과학회지 Vol.3 No.2

팽대부 주위암에서 빌리루빈의 변화에 따른 CEA와 CA19-9의 변화

류석용(Seok Yong Ryu),한세환(Sehwan Han),유병희(Byung Hee You),이명수(Myung Soo Lee),김홍주(Hong Joo Kim),김영덕(Young Duck Kim),김홍용(Hong Yong Kim) 대한외과학회 1998 Annals of Surgical Treatment and Research Vol.55 No.3