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복강경 위절제술과 개복 위절제술을 유사한 시기에 수술자로서 경험한 외과 전문의의 수술 결과 및 생존율
이대상 ( Dae Sang Lee ),이승수 ( Seung Soo Lee ),류승완 ( Seung Wan Ryu ),김인호 ( In Ho Kim ),손수상 ( Soo Sang Sohn ) 대한임상종양학회 2011 Korean Journal of Clinical Oncology Vol.7 No.1
목적: 지금까지 복강경 위절제술과 개복 위절제술을 비교한 연구들은 개복 위절제술의 경험이 풍부한 상태에서 복강경 위절제술을 시작한 수술자에 대한 보고이거나, 수술자의 경험에 대한 언급이 없는 경우가 많았다. 본 연구에서는 개복 위절제술과 복강경 위절제술을 유사한 시기에 시작한 한 수술자에서, 각각에 대한 수술 성적을 확인했다. 대상 및 방법: 본원의 한 외과의는 2004년부터 위암환자의 복강경 보조 원위부 위절제술 및 개복 원위부 위아전절제술을 수술자로서 경험했다. 2004년부터 2009년까지 조기위암으로 복강경보조 원위부 위절제술을 받은 환자(LADG군)와 개복 원위부 위아전절제술을 받은 환자(ODG군)는 각각 160명과 76명 이었으며, 이들 두군간의 임상병리학적 특징, 수술 결과, 생존율을 분석했다. 결과: LADG군과 ODG군의 수술시간은 각각 250.6 ± 63.5분과 173.0 ± 45.8분이었으며(p<0.001), 출혈양은 각각 77.8 ± 135.0mL와 254.4 ± 158.1mL이었다(p<0.001). 절제된 림프절수는 LADG군은 49.0 ± 17.3개, ODG군은 60.2 ± 24.2개로 유의한 차이가 있었다(p<0.001). 합병증은 LADG군과 ODG군에서 유의한 차이가 없었으며, 생존율은 각각 93.3%와 93.7%로 유의한 차이가 없었다. 결론: 개복 위절제술과 복강경 위절제술을 비슷한 시기에 수술자로서 경험한 외과의의 각각에 대한 수술 결과, 및 생존율은 다른 보고와 유사하였다. 개복 위절제술의 상대적으로 적은 경험때문에 복강경 위절제술을 주저할 필요는 없겠다. Purpose: The aim of this study was to compare the clinical outcomes and prognosis after laparoscopy assisted distal gastrectomy (LADG) and open distal subtotal gastrectomy (ODG) by a surgeon who started his role as an operator for LADG and ODG contemporaneously. Materials and Methods: A surgeon started his role as an operator for LADG and ODG in late 2004 around the same time. Between September 2004 and August 2009, 236 patients with early gastric cancer underwent LADG (n = 160) or ODG (n = 76). The clinicopathological characteristics, surgical outcomes and survival were analyzed from the review of medical records. Result: The operation time was significantly longer in LADG group (p<0.001), and the amount of surgical bleeding was significantly smaller in LADG group (p<0.001). The numbers of retrieved lymph nodes were 49.0 °æ 17.3 in LADG group and 60.2 °æ 24.2 in ODG group (p<0.001). The rates of complications were not significantly different between two groups. Five-year overall survival of LADG group and ODG group were 93.3% and 93.7% respectively(p=0.665). Conclusion: For a surgeon who started the role as an operator for LADG and ODG contemporaneously, performing LADG was feasible and safe. The high level of expertise in ODG as an operator may not be an essential requirement for surgeons to start LADG.
장은숙(Eun Sook Chang),손수상(Soo Sang Sohn),조승제(Seung Che Cho),김인호(In Ho Kim),김상표(Sang Pyo Kim),강중신(Joong Shin Kang) 대한두경부종양학회 1997 대한두경부 종양학회지 Vol.13 No.1
Although normal thyroid epithelial cells do not constitutively express HLA-DR antigen, their expression in wide spread within thyroid glands obtained from the human with autoimmune thyroid disease and with many neoplastic thyroids. We have, therefore, studied immunohistochemically with regard to the expression of HLA-DR antigen of thyroidectomy specimens from 50 patients of various thyroid diseases with use of paraffin-embedded tissue. One or two sections from each case were stained with commercially available mouse monoclonal antibody for class II HLA-DR antigen(HLA-DR/Alpha, DAKO) and examined by semiquantitative counting system for thyrocytes, neoplastic thyrocytes and other cells expressing HLA-DR antigen. All patients with lymphocytic thyroiditis(2/2) and diffuse hyperplasia(Graves' disease)(5/5), most patients with Hashimoto's disease(9/ll) expressed HLA-DR antigens in thyrocyte with abundant HLA-DR expressing lymphocytic infiltrates with lymph follicle formation in its vicinity or adjacent to the lesion. Most patients with papillary carcinoma(9/1l) had HLA-DR antigen detected in malignant thyrocytes ; while follicular carcinoma(0/3) and follicular adenoma(0/5) did not have detactable HLA-DR immunoreactivity. Adenomatous goiter(3/7) had HLA-DR antigen detected focally in lesser than half cases. Conversely, in four papillary carcinomas and three adenomatous goiters, HLA-DR expression of thyrocytes was found in the absence of HLA-DR expressing lymphoid infiltrates. In such cases therefore other factors more than thyroid autoimmunity must be causative for HLA-DR immunoreactivity. The results of this study indicate as follows. 1) The expression of HLA-DR on thyrocytes involved in autoimmune reactions appeared to be secondary to cytokine release from associated lymphocytic infiltrates. 2) Thyrocytes in thyroid lesions with equal degrees of lymphocytic infiltration without HLADR expression exhibited no HLA-DR immunoreactivity. 3) In neoplastic thyrocytes, most papillary carcinoma(9/11) exhibited detactable HLA-DR expression, while follicular carcinoma/adenoma(0/3/0/5) exhibited no detactable HLA-DR immunoreactivity which suggest the existence of divergent mechanisms inducing and modulating HLA-DR expression of different types of neoplastic thyrocytes.