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정규 대장수술 후 예방적 항생제의 24시간 사용에 대한 효과
조지훈(Ji Hoon Jo),이승현(Seung Hyun Lee),안병권(Byung Kwon Ahn),백승언(Sung Uhn Baek) 대한외과학회 2008 Annals of Surgical Treatment and Research(ASRT) Vol.74 No.2
Purpose: Although the two or three-postoperative doses of prophylactic antibiotics are recommended, the tendency for surgeons to prolong the administration of prophylactic antibiotics after colorectal surgery is a well-known fact. The aim of this study was to assess the prophylactic efficacy of two or three-doses of prophylactic antibiotics over a 24 hour period after elective colorectal surgery. Methods: We reviewed the surgical complications in 69 patients who underwent elective colorectal surgery from April to Jun, 2006. All patients had preoperative mechanical bowel cleansing performed. As antibiotic prophylaxis, oral metronidazole was administered 2∼3 times on the day before surgery and second generation cephalosporin were administered intravenously 30 minutes before surgical incision. After surgery, second generation cephalosporin, aminoglycoside and metronidazole were given to all the patients, at 2∼3 doses for 24 hours. Wound conditions were checked on alternate days during the hospital stay and the patients were followed up for at least 30 days after discharge. Results: In 69 patients, the diseases were cancer in 64 cases (92.8%). The procedures were anterior resection or lower anterior resection in 38 cases (55.1%), hemicoloectomy in 16 cases (23.2%), segmental resection in 9 cases, and abdomino-perineal resection or Hartmann’s procedure in 6 cases. The wound complications were wound seroma in 3 cases (4.3%), wound dehiscence in 3 cases (4.3%) and anastomotic leakage in 1 case (1.4%). Conclusion: The wound complication rate was not high after antibiotic prophylaxis for 24 hours in patients who underwent elective colorectal surgery. Further studies are required to establish appropriate guidelines for antibiotic prophylaxis after elective colorectal surgery.
위암 환자에서 위아전절제술후 재건 방법에 따른 술후 체중 변화의 비교 연구
이승도(Sung Do Lee),신동훈(Dong Hoon Shin),최경현(Kyung Hyun Choi),백승언(Seung Uhn Baek),이충한(Choong Han Lee) 대한소화기학회 1993 대한소화기학회지 Vol.25 No.6
N/A Weight. loss and malnutrition are common complications after subtotal gastrectomy. The authors campared weight changes, Visick grade and performance status according to reconstructing method after subtotal gastrectomy. The reconstruction methods were Roux-en-Y gastrojejunostomy and jejunojejenostomy (R-Y method) or Billorth-II gastrojejunostomy and Braun jejunojejunostomy (B-II method) after subtotal gastrectomy. The results were as follow; In stage I stomach cancer, weight recovery period were significantly decreased in R- Y method than B-II method in male and female. In stage llI stomach cancer, weight recovery period were no significant differences between R- Y method and B-II method in male and female. There were no significant differences in body weight change during 2 years after subtotal gastrectomy between R-Y method and B-II method in stage I and III stomach cancer. There were no significant differences in Visick grade and performance status during 2 years after subtotal gastrectomy between R - Y method and B- II method in stage I and III stomach cancer. Our conclusion was that weight reovery period was shortened in R-Y method than B-II method in stage I stomach cancer.
N2 Nodal Stage의 결장직장암에서 재발에 대한 위험 인자
정주원(Joo-Won Jeong),이철민(Chul-Min Lee),이승현(Seung-Hyun Lee),안병권(Byung-Kwon Ahn),백승언(Sung-Uhn Baek) 대한종양외과학회 2012 Korean Journal of Clinical Oncology Vol.8 No.2
배경 : 결장직장암에서 림프절 전이 여부와 정도는 근치적 수술 후 발생하는 재발 및 전이를 예측하는 중요한 인자 중 하나이다. 결장직장암의 림프절 전이에 대한 병기가 N2인 경우에서 임상적 및 병리학적 인자에 따른 수술 후 재발 및 전이 여부를 조사하여 위험 인자를 알아보고자 한다. 대상 및 방법 : 2004년 1월부터 2006년 12월까지 결장 및 직장의 원발성 선암으로 진단되어 수술을 받은 675명의 환자 중 림프절 전이에 대한 병기가 N2인 환자 130명을 대상으로 하여 성별, 연령, 수술 전 암태아성항원, 종양의 위치, 종양의 크기 및 병기, 병리적 인자들을 조사하였다. 결과 : 림프절 전이에 대한 병기가 N2인 환자 중 근치적 절제수술을 받은 환자는 총 87명이었다. 성별 분포는 남자 43명, 여자 44명이었으며, 평균 연령은 60.3세(34~86세)였다. 종양의 위치는 결장 25예, 직장 62예였으며, 종양의 크기는 평균 5.8cm(2.0~19cm)이었다. TNM 병기 중 T병기는 T2, T3, T4가 각각 1예, 80예, 6예이었으며, 수술 후 획득된 림프절 수는 평균 21.1개(7~110개)였다. 추적 관찰 기간은 평균 30.5개월(5~48개월)이었으며, 이 중 재발 및 전이를 보인 경우는 34예(39.1%)였다. 성별, 종양의 크기, 수술 전 암태아성항원, 림프절 전이 비율, 종양 세포의 혈관 침습, 림프관 침습, 신경 침습 분포에 따른 재발 및 전이 여부에는 유의한 차이가 없었다. 결론 : 림프절 전이에 대한 병기가 N2 stage인 결장직장암에서 재발 및 전이에 대한 임상적 및 병리적 위험 인자를 찾을 수 없었다. 향후 대규모 환자들을 대상으로 면역화학적 혹은 유전자적 인자의 관련 여부에 대한 연구가 더 필요할 것이다. Purpose : The aim of this study is to figure out the clinicopathologic factors associated with recurrence in colorectal cancers with four or more lymph node metastasis (N2 stage). Material and Method : From 2004, Jan to 2006, Dec, a total of 675 patients with colorectal adenocarcinoma were underwent surgery in our hospital. One hundred thirty patients with N2 stage were selected for retrospective review with medical records. Clinicopatholotic factors, such as sex, age, preoperative CEA, tumor location, tumor size, tumor differentiation, T-stage, were studied. Results : Of the 130 patients, eighty-seven patients were underwent radical surgery for colorectal adenocaricinoma. Mean age was 60.6(34-86 years). Tumors were located in the colon, 25 patients and the rectum 62 patients. Mean tumor size was 5.8 (2.0-19cm). With TNM classification, T2, T3, T4 were 1, 80, 6 patients, respectively. Mean number of retrieved lymph node was 21.1(7-110). Mean follow-up period was 30.5 (5-48 months). Recurrence was identified in 34 patients (39.1%). According to tumor differentiation, recurrence rate was 36.8% of well and moderate differentiation, 54.5% of poor differentiation (p=0.327). Recurrence rate was 37.5% in T3 stage, and 66.7% in T4 stage (p=0.267). Conclusions : Recurrence rate was not different significantly according to clinicopathologic factors in colorectal adenocarcinoma with N2 stage after radical surgery. Further study is necessary to identify the risk factor for recurrence in colorectal adenocarcinoma with N2 stage.
위장관 ; 직장암에서 복강경과 개복 수술법의 장기 임상 결과의 비교: 단일 기관 후향적 연구
김재현 ( Jae Hyun Kim ),안병권 ( Byung Kwon Ahn ),박선자 ( Seun Ja Park ),박무인 ( Moo In Park ),김성은 ( Sung Eun Kim ),백승언 ( Sung Uhn Baek ),이승현 ( Seung Hyun Lee ),박시성 ( Si Sung Park ) 대한소화기학회 2015 대한소화기학회지 Vol.65 No.5
Background/Aims: Laparoscopic surgery has been proven to be an effective alternative to open surgery in patients with colon cancer. However, data on laparoscopic surgery in patients with rectal cancer are insufficient. The aim of this study was to compare the long-term outcomes of laparoscopic and open surgery in patients with rectal cancer. Methods: A total of 307 patients with rectal cancer who were treated by open and laparoscopic curative resection at Kosin University Gospel Hospital (Busan, Korea) between January 2002 and December 2011 were reviewed retrospectively. Results: Regarding treatment, 176 patients underwent an open procedure and 131 patients underwent a laparoscopic procedure. The local recurrence rate after laparoscopic resection was 2.3%, compared with 5.7% after open resection (p=0.088). Distant metastases occurred in 6.9% of the laparoscopic surgery group, compared with 24.4% in the open surgery group (p 0.001). In univariate analysis, age (≥75 years vs. ≤60 years), preoperative staging, surgical approach (open vs. laparoscopic), elevated initial CEA level, elevated follow-up CEA level, number of positive lymph nodes, and postoperative chemotherapy affected overall survival and disease free survival. However, in multivariate analysis, the surgical approach apparently did not affect long-term oncologic outcome. Conclusions: In this study, long-term outcomes after laparoscopic surgery for rectal cancer were not inferior to those after open surgery. Therefore, laparoscopic surgery would be an alternative operative tool to open resection for rectal cancer, although further investigation is needed. (Korean J Gastroenterol 2015;65:273-282)