복강경적 Nissen 위저추벽성형술의 초기 경험

박근명,허윤석,신석환 대한외과학회 2009 대한외과학회 학술대회 초록집 Vol.2009 No.11

Long Term Outcomes of Femorofemoral Crossover Bypass Grafts

박근명,박양진,김영욱,현동호,박광보,도영수,김동익 대한혈관외과학회 2017 Vascular Specialist International Vol.33 No.2

Purpose: Femorofemoral crossover bypass (FCB) is a good procedure for patients with unilateral iliac artery disease. There are many articles about the results of FCB, but most of them were limited to 5 years follow-up. The purpose of our study was to analysis the results of FCB with a 10-year follow-up period. Materials and Methods: Between January 1995 and December 2010, 133 patients were operated in Samsung Medical Center (median follow-up: 58.8 months). We retrospectively analysed patient characteristics, the preoperative treatment, the operative procedure, and material used. Results: The indications for FCB were claudication in 110 and critical limb ischemia in 23 patients. Three patients were died due to myocardiac infarction, intracranial hemorrhage, and acute respiratory failure within 30 days after surgery. The oneyear primary and secondary patency rates were 89% and 97%, the 5-year primary and secondary patency rates were 70% and 85%, and the 10-year primary and secondary patency rates were 31% and 67%. The 5-year and 10-year limb salvage rates were 97% and 95%, respectively. Conclusion: Our long term analysis suggests that FCB might be a valuable alternative treatment modality in patients with unilateral iliac artery disease.

갑상선의 carcinoma showing thymus-like differentiation (CASTLE) 1예

박근명,김세중,조영업,주영채 대한외과학회 2010 대한외과학회 학술대회 초록집 Vol.2010 No.11

심내막염 후 발생한 전완의 감염성 가성동맥류

박근명,양신석,김영욱,김동익 대한혈관외과학회 2011 Vascular Specialist International Vol.27 No.3

There were many reports of infected pseudoaneurysms of the forearm that are caused by arterial injury or cannulation. However, spontaneous pseudoaneurysm of forearm artery without any history of arterial injury or cannulation is rare. Here, we report the case of an infected pseudoaneurysm in the forearm after infective endocarditis, without arterial injury or cannulation. A 76-year old man had a large, growing, pulsatile mass of the radial artery after experiencing infective endocarditis. We performed an interposition with great saphenous vein graft after removing the aneurysm. This presented case emphasizes the importance of considering pseudoaneurysms in the differential diagnosis and treatment of pain in the extremity and swelling after infective endocarditis.

Hirschsprung씨 병의 임상적 경험

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.

Intraoperative Vascular Surgical Consultation during Non-Vascular Surgeries in Tertiary Centers by Vascular Surgeon

박성빈,박근명,전용선,조순구,홍기천 대한혈관외과학회 2017 Vascular Specialist International Vol.33 No.4

Purpose: There are many types of intraoperative consultations by vascular surgeons during non-vascular surgery. Therefore, we examined the current state of intraoperative consultations during non-vascular surgery in a single center. Materials and Methods: From January 2014 to December 2015, we reviewed records of 40 patients (0.3%) who received an intraoperative consultation from a vascular surgeon for 10,734 non-vascular surgeries in Inha University Hospital. We examined patient characteristics, operative details, and clinical results. Results: There were 40 intraoperative vascular surgical consultations relating to bleeding (n=14, 35.0%), dissection from the vessel (n=13, 32.5%), arterial occlusion (n=10, 25.0%), and retroperitoneal approach (n=3, 7.5%). The locations of surgery were lower extremity (n=10, 25.0%), kidney (n=8, 20.0%), spine (n=6, 15.0%), pelvis (n=6, 15.0%), head and neck (n=4, 10.0%), abdomen (n=4, 10.0%), and upper extremity (n=2, 5.0%). The methods of surgery included primary closure or ligation (n=17, 42.5%), end-to-end anastomosis (n=12, 30.0%), bypass (n=10, 25.0%), thrombectomy (n=4, 10.0%), retroperitoneal approach (n=3, 7.5%), and embolization (n=2, 5.0%). Postoperative treatment was performed in the intensive care unit for 13 patients (32.5%), while 3 patients (7.5%) died following surgery. Conclusion: Intraoperative consultation by vascular surgeons during non-vascular surgery occurred in approximately 0.3% of non-vascular surgeries. The region undergoing operation and type of surgery were variable. Therefore, it is necessary for vascular surgeons to have a comprehensive knowledge of vascular anatomy and to make rapid surgical decisions.

Occurrences and Results of Acute Kidney Injury after Endovascular Aortic Abdominal Repair?

이재홍,박근명,정성택,조원표,홍기천,전용선,조순구,이정범 대한혈관외과학회 2017 Vascular Specialist International Vol.33 No.4

Purpose: Acute kidney injury (AKI) is an important postoperative complication that may impact mortality and morbidity. The incidence of AKI after elective endovascular aneurysm repair (EVAR) is not known well. The aim of this study is to assess the incidence of AKI after elective EVAR and examine the impact of AKI. Materials and Methods: Data were collected and analyzed retrospectively from 78 elective EVARs for abdominal aortic aneurysm (AAA) among 102 total cases of conventional EVAR performed in Inha University Hospital from 2009 to 2015. The primary endpoint was incidence and risk factors of AKI. Secondary endpoints included drop in estimated glomerular filtration rate (eGFR) and the mortality of AKI. Results: We included 78 patients (17 females, 21%; mean age, 73.9±12.5 years; mean AAA diameter, 59.3±8.9 cm), 11 (14.1%) of whom developed AKI. Within 48 hours, those with AKI experienced a decrease in eGFR from 65.5±21.2 to 51.2±19.6 mL/kg/1.73 m2, and those without AKI showed a change from 73.1±9.2 to 74.2±10.7 mL/kg/1.73 m2. There were no patients who required dialysis during follow-up (mean, 24.2±18.0 months). Development of AKI was related to operation time (odds ratio [OR], 2.024; 95% confidence interval [CI], 1.732-4.723; P<0.010) and contrast dose (OR, 3.192; 95% CI, 2.182-4.329; P<0.010). There were no differences in mortality between the 2 groups (P=0.784). Conclusion: The incidence of AKI after EVAR was related to operation time and contrast dose, but was not associated with medium-term mortality.

Can Pre-Retrieval Computed Tomography Predict the Difficult Removal of an Implementing an Inferior Vena Cava Filter?

홍신호,박근명,전용선,조순구,홍기천,신우영,최윤미 대한혈관외과학회 2016 Vascular Specialist International Vol.32 No.4

Purpose: Implementing an inferior vena cava (IVC) filter is a relatively safe procedure but potential negative long-term effects. The complications for filter retrieval have been noted. We examined filter characteristics on pre-retrieval computed tomography (CT) that were associated with complicated retrieval (CR) of IVC filters.Materials and Methods: A retrospective review of IVC filter retrievals between January 2008 and June 2014 was performed to identify patients who had undergone a pre-retrieval CT for IVC filter retrieval. CR was defined as the use of nonstandard techniques, procedural time over 30 min, filter fractures, filter tip incorporation into the IVC wall, and retrieval failure. Pre-retrieval CT images were evaluated for tilt angle in the mediolateral and anteroposterior directions, tip embedding into the IVC wall, degree of filter strut perforation, and distance of the filter tip from the nearest renal vein.Results: Of seventy-six patients, twenty-four patients (31.6%) with CRs and 56 patients (73.7%) with non-CR were evaluated for pre-retrieval CT. For IVC filter retrieval with a dwelling time of over 45 days, a tilt of over 15 degrees, the appearance of tip embedding and grade 2 perforation were associated with CR on multivariate analysis. However, for IVC filter retrievals with a dwelling time of less than 45 days, there were no factors associated with CR.Conclusion: Pre-retrieval CTs may be more effective for IVC filters with a dwelling time of over 45 days. Therefore, a pre-retrieval CT may be helpful in predicting CR of IVC filters with long dwelling times.

One Year Experience of Iliac Bifurcated Device for Aortoiliac Aneurysm in a Korean Single Center

김문환,박근명,전용선,조순구,홍기천,신우영,최윤미,신석환,김경래 대한혈관외과학회 2015 Vascular Specialist International Vol.31 No.4

One of the predominant methods for preserving the internal iliac artery (IIA) in aortoiliac aneurysms is to use an iliac bifurcated device (IBD). However, there are a few limitations to the use of IBD in Korea. Our study aims to present the technical aspects of these devices, and to provide a mid-term analysis of IBD. Since 2013, 4 IBDs were used in 4 patients, with a mean follow-up of 14 months (range, 6-22 months). A 100% technical success rate was achieved without mortality and morbidity in our cases. The mean procedural time was 176 min (range, 145-240 min), and the mean contrast dose used was 184 mL (range, 135-220 mL). Type I or III endoleaks and postoperative expansion of the aneurysms weren't observed. Our cases demonstrates that IBD is a relatively safe repair method of aortoiliac aneurysms with preservation of the IIAs. However, a longer follow-up is needed to review the midterm results.