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박근명,최윤미,김장용,최선근,허윤석,이건영,김세중,조영업,안승익,홍기천,신석환,김경래,서정민,Park, Keun-Myoung,Choe, Yun-Mee,Kim, Jang-Young,Choi, Sun-Keun,Heo, Yoon-Seok,Lee, Keon-Young,Kim, Sei-Joong,Cho, Young-Up,Ahn, Seung-Ik,Hong, Kee-C 대한소아외과학회 2010 소아외과 Vol.16 No.2
남녀의 비는 1.8로 남아가 많았으며, 진단시 나이는 76.9 % 에서 4주 이내 신생아시기에 진단되었다. 임상증상은 복부팽만 84.6 %, 태변 배출지연이 46.1 %, 설사 와 변비가 23.1 % 였다. 무신경절의 범위가 89.7 %에서 직장 및 에스자형 결장에 한정되었으며, 전결장에 침범한 경우가 8 %였다. 69.2 %에서 결장조루술 후 근치적 수술을 시행하였으며, 30.8 %에서 바로 근치적 수술을 시행하였다. 수술 후 6개월 이상 추적은 54 % 였으며, 추적 관찰 환자 중 14.3 %에서 대변 지림을 보였고, 19.0 %에서 변비를 보였다. The aim of this study is to review our clinical experience with patients with Hirschsprung's disease (HD) Medical records of 39 children who underwent definitive surgery for HD at Inha University Hospital from September 1996 to June 2008 were analyzed by age at presentation, sex, gestational age, birth weight, clinical presentation, diagnostic tools, level of aganglionosis, surgical procedures, postoperative complications, and postoperative bowel function. Twenty-five patients (64.1 %) were males and 14 (35.9 %) were females. Thirty patients (76.9 %) were diagnosed and treated in the neonatal period. The transitional zone was at the rectosigmoid region in 89.7 %. Twenty-seven patients (69 %) were treated by preliminary colostomy or ileostomy. Twenty-four patients had the Duhamel operation, 6 patients anorectal myectomy, and 9 patients had transanal endorectal pull-through (TEP). Five of 9 patients who had the TEP procedure did laparoscopic assistance. Postoperatively, seventeen patients (83 %) passed stool once or more times per day and 3 patients had stool soiling. This study demonstrated that the majority of the patients had good results. To determine which treatment is most effective comparative review by operation method would be required.
복부대동맥류의 혈관 내 치료 중 발생한 Endoleak 경험
박근명(Keun Myoung Park),김장용(Jang Young Kim),정지은(Ji Eun Jung),전용선(Yong Sun Jeon),조순구(Soon Gu Cho),최윤미(Yun-Mee Choe),최선근(Sun Keun Choi),허윤석(Yoon Seok Heo),이건영(Keon Young Lee),김세중(Sei-Joong Kim),조영업(Young 대한외과학회 2010 Annals of Surgical Treatment and Research(ASRT) Vol.78 No.4
Purpose: Endoleak is a common complication following endovascular aortic aneurysm repairs (EVAR). The aim of this study was to discover the frequency and characteristics after EVAR with on-label use. Methods: A retrospective review was performed on 25 patients who underwent EVAR in Inha University Hospital between December 2005 and February 2009. The data included in this study accounted for patient characteristics, anatomic features, operative technical details, and types of devices used. The results of EVAR were analyzed for clinical success, technical success and endoleak. Results: Endoleaks were observed during 11 (47.8%) procedures. Type Ⅰ endoleaks were observed in 2 (18.2%) cases. A total of 6 type Ⅱ intraoperative endoleaks (54.5%) were observed. 3 type Ⅲ endoleaks (27.3%) occurred. But all endoleaks were resolved without additional intervention CT scan after 6 months. Conclusion: Although the endovascular management of AAAs is less invasive than open surgery, many complications including endoleak were still the most common adverse event during the first postoperative month. However, observation may be a good treatment for minor endoleak after EVAR.
감시림프절 전이 양성인 유방암 환자에서 비감시림프절 전이 예측인자 및 예측체계의 비교 분석
박재영(Jae Young Park),박근명(Keun Myoung Park),박정미(Jeong Mi Park),이강연(Kang Yeun Lee),문연희(Youn Hee Moon),김세중(Sei Joong Kim),김준미(Joon Mee Kim),조영업(Young Up Cho),김장용(Jang Yong Kim),최윤미(Yun-Mee Choe),최선근(Sun K 대한외과학회 2010 Annals of Surgical Treatment and Research(ASRT) Vol.79 No.1
Purpose: The purpose of this study was to investigate the predictors of nonsentinel lymph node (NSLN) metastasis in breast cancer and to evaluate the usefulness of the scoring systems and nomograms. Methods: In this analysis, we reviewed the clinicopathologic features of 70 patients who had undergone sentinel lymph node (SLN) biopsy and axillary lymph node dissection. The clinical features of patients, histologic parameters and hormonal receptor status of primary tumor and histopathologic features of SLN metastasis were noted retrospectively. Furthermore, the receiver operating characteristic (ROC) curve was drawn and the area under the ROC curve (AUC) was calculated to assess the discriminative power of the scoring systems and nomograms. Results: The metastatic tumor size in SLN (P<0.001), extracapsular invasion (P=0.002), percentage of positive SLNs among the removed SLNs (P=0.011), primary tumor size (P=0.038) were associated significantly with NSLN metastasis, statistically, in univariate analysis. Based on multivariate logistic regression, the metastatic tumor size was the only prognostic factor of NSLN metastasis (P=0.012). The AUC of Memorial Sloan-Kettering Cancer Center scoring system was greater than other systems, significantly (P=0.004). Conclusion: We have shown in this study that it would be possible to predict NSLN status based on the metastatic tumor size in SLN. Although the significance was not achieved in multivariate analysis, the size of primary tumor, extracapsular invasion of metastasis in SLN, percentage of positive SLNs among the removed SLNs had the potential to be a predictive factor of NSLN metastasis. MSKCC scoring system appears to be more effective and accurate than other scoring systems for selecting patients for whom axillary lymph node dissection can be avoided.
김장용(Jang Yong Kim),박근명(Keun Myoung Park),전용선(Yong Sun Jeon),조순구(Soon Gu Cho),홍기천(Kee-Chun Hong) 대한외과학회 2009 Annals of Surgical Treatment and Research(ASRT) Vol.77 No.6
Endovascular aneurysm repairs for a ruptured AAA (EVAR for r-AAA) have been reported with limited results although endovascular aneurysm repairs for elective AAA (EVAR for e-AAA) have shown good early and late results. In this case report, the authors described successful EVAR for r-AAA. A 93-year-old female underwent emergent EVAR for r-AAA. An aortic occlusion balloon was inserted before general anesthesia for hemodynamic stability. Zenith endograft was deployed under general anesthesia. Completion angiography showed no endoleak but there was coverage of the right renal artery. She was discharged 2 weeks after overcoming transient acute renal insufficiency. We concluded that EVAR for r-AAA can be an alternative option for the treatment of ruptured AAA.