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이상와루(Pyriform Sinus Fistula)에 대한 내시경적 경화요법의 3예
박윤아(Yoon Ah Park),서진학(Jin Hak Seo),조상현(Sang Hyun Cho),정웅윤(Woong Yoon Chung),최은창(Eun Chang Choi),박정수(Cheong Soo Park) 대한두경부종양학회 2001 대한두경부 종양학회지 Vol.17 No.2
Pyriform sinus fistula is a rare anomaly arising from 3rd or 4th branchial apparatus and has been recognized as one cause of acute suppurative thyroiditis or acute deep neck infection. Pyriform sinus fistula must be considered when a clinician is encountered recurrent left lower neck abscess and a history of repeated incision and drainage. The confirmation of the diagnosis is made when the fistula tract is identified on a barium swallow study and when the internal orifice of the fistula is found at the apex of pyriform sinus on laryngoscopic examination. A complete excision of the fistula tract has been proposed as a treatment of choice. However, in some cases it is very difficult to resect the tract completely because of severe inflammation and repeated drainage procedure. We present three cases of pyriform sinus fistula which are successfully treated by laryngomicroscopic chemocauterization using synthetic fibrin and AgNO₃.
박윤아(Yoon Ah Park),최홍식(Hong-Shik Choi),이자현(Ja Hyun Lee) 대한두경부종양학회 2011 대한두경부 종양학회지 Vol.27 No.2
Thyroglossal duct cyst is the most common congenital neck mass. It develops from remnants of precursors of thyroid gland left behind during embryologic descent form the foramen cecum at the tongue base into the ante-rior neck during fetal development. An anterior midline neck mass presenting before the age of twenty and dis-playing vertical movement with tongue protrusion and swallowing is characteristic of this lesion. In this paper, we report on a case of TGDC without remnant duct that is presenting as thyroid cyst.
백승재(Seung Jae Baek),박윤아(Yoon Ah Park),이재우(Jae Woo Lee),이영섭(Young Sub Lee),봉정표(Jeong Pyo Bong) 대한두경부종양학회 2016 대한두경부 종양학회지 Vol.32 No.1
The aim of this report was to present a rare case of a tracheotomy site recurrence after operation and post-oper-ative radiotherapy in head and neck squamous cell carcinoma patient. Tracheotomy site recurrence other than subglottic cancer is very rare in head and neck cancer patient. The granulation tissue around tracheotomy was a fertile "soil" for tumor cell implantation. Midline mucosal sparing block which was used to decreased acute toxicity during post-operative radiotherapy could be facilitating the tumor cell implantation. The head and neck surgeon should try every effort to reduce contamination of cancer cells during operation and consider the entire operative field should be included in post-operative radiation portals.
성인에서 발생한 대장의 분절형 저신경절증 3예 증례 보고 및 국내 문헌 고찰
장재훈 ( Jae Hoon Jahng ),김지현 ( Ji Hyun Kim ),박효진 ( Hyojin Park ),박윤아 ( Yoon Ah Park ),손승국 ( Seung Kook Sohn ),박찬일 ( Chan Il Park ) 대한소화기기능성질환·운동학회 2008 Journal of Neurogastroenterology and Motility (JNM Vol.14 No.2
Hypoganglionosis is a rare form of intestinal neuronal disorder which is characterized by reduced number and size of ganglion cells in the intestinal wall occurring usually in childhood. Pathophysiology is not yet known but intestinal inflammation, ischemia, neurotoxin, or autoimmune mechanism may play a role in degeneration or reduction of ganglion cells in submucosal or myenteric plexus in the intestinal wall. Hypganglionosis in adults is even less clarified and defined. Clinically patients present with constipation, severe abdominal distension, or intestinal pseudo-obstruction. However, there are no demonstrable obstructive lesions in abdomen CT and other bowel studies. We report three cases of colonic segmental hypoganglionosis in adult patients who were treated successfully by surgical resection with a review of previously reported hypoganglionosis cases in Korean literatures. (Kor J Neurogastroenterol Motil 2008;14:133-139)
오종욱(Jong Wook Oh),허정욱(Jung Wook Huh),박윤아(Yoon Ah Park),조용범(Yong Beom Cho),윤성현(Seong Hyeon Yun),이우용(Woo Yong Lee),김희철(Hee Cheol Kim) 대한종양외과학회 2016 Korean Journal of Clinical Oncology Vol.12 No.2
Purpose: The purpose of this study was to investigate the distinctive clinicopathologic features and oncological survival outcomes of sporadic colorectal cancer in patients under the age of 30 years old. Methods: From 1994 to 2013, total 15,206 patients underwent curative or palliative surgery for sporadic colorectal cancer in our institution. 235 patients (1.5%) were under 30 years of age. Patients who presented with metachronous cancers, recurrent cancers, hereditary nonpolyposis colorectal cancer, familial adenomatous polyposis and patients without a microsatellite instability (MSI) analysis were excluded. A total 79 pateints who were ≤30 years old with sporadic colorectal cancer were enrolled. Results: Seven patients (8.9%) had family history of colorectal cancer. Location of the tumor was 23 (29.1%) in right colon, 29 (36.7%) in left colon, 27 (34.2%) in rectum. Young patients tend to present with a higher incidence of mucinous and signet ring cell tumors (15.2%), poorly differentiated tumors (11.4%) and advanced stage such as Stage III (31.6%), Stage IV (30.4%). microsatellite instability-high (MSI-H) was observed in 10 (12.7%), microsatellite stable (MSS)/ microsatellite instability-low (MSI-L) in 69 (87.3%). 66.7% (n=6) of the MSI-H tumors showed loss of hMLH1 expression; no MSS/MSI-L tumors showed hMLH1 loss. 5 years ovarall survival was 72.8%. Stage specific overall survival was 100% for stage I, 100% for stage II, 75.9% for stage III, 31.4% for stage IV. Conclusion: Patients with sporadic colorectal cancer under the age of 30 seem to have poor outcome than older patients, because of characteristic clinical and biological behaviors. Early detection of colorectal cancer (CRC) confers survival benefit to young patients.
정수진 ( Soo Jin Chung ),장재훈 ( Jae Hoon Jahng ),문희선 ( Hee Sun Mun ),박윤아 ( Yoon Ah Park ),정우희 ( Woo Hee Jung ),유정식 ( Jeong Sik Yu ),박효진 ( Hyo Jin Park ) 대한내과학회 2008 대한내과학회지 Vol.75 No.5
이번 증례에서는 S자상 결장의 내강을 반 이상 막고 있는 종괴가 있어 이의 제거 뿐만 아니라 림프절 전이 여부를 확인하기 위하여 시험 개복술을 시행하였고 그 결과 비장증을 진단받았다. 최근에는 비장 손상을 치료할 때 비록 파열이 있을 지라도 비수술적 치료를 선호하고 있기 때문에 앞으로는 비장증의 빈도가 더 늘어날 것이다. 그러므로 비장증에 대하여 유념할 필요가 있으며 복강 내 전이성 병소가 관찰되었을 때 환자에서 해당 암종에 대한 위험 인자가 없고 전이 양상이 전형적이지 않을 경우 악성 종양의 진단에 앞서 조직을 확인해 보는 것이 중요하다. 특히 복부 외상이나 비장절제술의 과거력이 있는 경우 비장증의 가능성을 반드시 염두에 두어야 하겠다. Splenosis is an ectopic implantation of splenic tissue after splenic injury or splenectomy. These splenic implants may be located throughout the abdominal cavity and may be misdiagnosed as a malignancy or tumorous condition. Here, we report a case of splenosis that was initially diagnosed as carcinomatosis from colon cancer in a patient with colon polyps that had undergone explo-laparotomy. (Korean J Med 75:574-576, 2008)
저위전방절제술에서 문합부 누출률을 줄이기 위한 피브린글루 사용의 효용성
성기완(Gi Wan Seong),조용범(Yong Beom Cho),윤정아(Jung-A Yun),박윤아(Yoon Ah Park),윤성현(Seong Hyeon Yun),김희철(Hee Cheol Kim),이우용(Woo Yong Lee),전호경(Ho-Kyung Chun) 대한종양외과학회 2014 Korean Journal of Clinical Oncology Vol.10 No.1
Purpose: Anastomotic leakage (AL) is a major complication occurring after low anterior resection (LAR). Several methods for anastomotic protection have been tried. However, the effectiveness of these methods at preventing AL is questioned. The present study examined whether direct application of fibrin glue to an anastomotic site could be an effective method for reducing aspects of AL, such as leakage rate. Methods: This study targeted patients who had undergone LAR between March and September 2012 for primary rectal cancer or rectosigmoid cancer which curative resection was possible. Anastomosis was performed with end to end anastomosis in all patients. Fibrin glue was used in 99 patients and conventional methods in the controls (130 patients). The research was conducted as a prospective non-randomized study. Results: AL occurred in seven cases (7.1%) in the fibrin glue group and seven cases (5.4%) in the control group; this difference wasn’t statistically significant. No significant differences were found between the two groups in terms of clinical stage of primary cancer, operation time, and length of hospital stay after surgery or in the severity of leakage or the treatment policy decisions for patients with AL. An analysis of risk factors showed that the occurrence of AL was significantly higher in male patients. Conclusion: Fibrin glue applied to an anastomotic site to prevent AL during LAR did not reduce the rate of AL. No differences were noted in other aspects of AL that would favor the use of fibrin glue over conventional methods.
The impact of obesity on the outcomes of laparoscopic colectomy : An observational study
Seoung Wook Choi(최승욱),Jung Wook Huh(허정욱),Bo Young Oh(오보영),Yoon Ah Park(박윤아),Yong Beom Cho(조용범),Seong Hyeon Yun(윤성현),Hee Cheol Kim(김희철),Woo Yong Lee(이우용),Ho-Kyung Chun(전호경) 대한종양외과학회 2016 Korean Journal of Clinical Oncology Vol.12 No.2
Purpose: The impact of obesity on the surgical outcomes of Asian patients undergoing laparoscopic colon surgery is not clear. The purpose was to evaluate the outcome of laparoscopic surgery in obese Asian patients with colon cancer. Methods: We retrospectively reviewed the prospectively collected data of 1,740 consecutive patients who underwent laparoscopic surgery for colon cancer between January 2008 and December 2010. Patients were classified according to the categories proposed by the International Obesity Task Force, Non-obese (body mass index [BMI]<25.0 kg/m2), Obese-I (BMI, 25.0–29.9 kg/m2), and Obese-II (BMI≥30 kg/m2). Surgical outcomes, including open conversion, operative time, and postoperative hospital stay, were compared in the Non-obese, Obese-I, and Obese-II patients. Results: Of the 1,192 patients in the study, 812 (68.1%), 360 (30.2%), and 20 (1.7%), were classified as Non-obese, Obese-I, and Obese-II, respectively. The Obese-II group had higher conversion rates (10.0% vs. 3.6% and 1.6%, P=0.008) and, longer operative times (180.35 vs. 162.54 and 147.84 minutes, P<0.001) than the Obese-I and Non-obese group. However, the other postoperative outcomes were not significantly different. The overall survival and disease-free survival were not significantly different between groups (P=0.952). Multivariate analysis showed that the independent risk factor for conversion were BMI, total operative time, previous operative history, and cancer perforation. Conclusion: The outcomes of laparoscopic colon surgery in obese patients are similar to those of non-obese patients, offering all the benefits of a minimally invasive approach. However, the conversion rate was higher in obese patients. It is therefore very important for surgeons to be aware of these risks during laparoscopic colon surgery in obese patients.
김봉균(Bong Kyun Kim),이우용(Woo Yong Lee),윤정아(Jung-A Yun),윤성현(Seong Hyeon Yun),김희철(Hee Cheol Kim),조용범(Yong Beom Cho),박윤아(Yoon Ah Park) 대한종양외과학회 2013 Korean Journal of Clinical Oncology Vol.9 No.1
Purpose: Early readmission of patients who underwent resection for primary rectal cancer will raise social costs and resources for treatment and will affect the patients’ prognosis. Thus, analysis of the characteristics of readmitted patients should be done to find a way to reduce the readmission rate. Methods: The study enrolled 521 patients who were admitted and underwent low anterior resection for primary rectal cancer at Samsung Medical Center during the period from January 1st to December 31st, 2010. The data of these patients regarding the related factors of readmission were collected retrospectively. For these related factors of readmission, we used univariate analysis by the chi-square test and multivariate analysis by the logistic regression test to find the odds ratio of the readmission rate. Results: Of 457 patients who meet inclusion criteria in the 521 patients, 22 patients (4.8%) were early readmitted within 30 days after discharge. Ten of these patients (45.5%) were readmitted due to adhesive ileus. Univariate and multivariate analyses for early readmitted patients showed that the readmission rate is significantly higher in the group of less than 65 years of age, had a history of smoking, had education less than elementary school, had an albumin level of less than 3.2 g/dL before discharge, and had complications during hospitalization. Conclusion: After surgery for rectal cancer, patients should be managed more carefully during hospitalization, and for the patients who have readmission risk factors, we should reinforce discharge criteria and education, curtail the period until the following outpatient clinic after discharge so that we may reduce the readmission rate after surgery.