피하매몰 중심정맥포트 설치술:천자위치와 시술방법에 따른 비교

신병석,안문상,Shin, Byung-Suck,Ahn, Moon-Sang 대한영상의학회 2003 대한영상의학회지 Vol.49 No.3

목적: 피하매몰 정맥포트 삽입시 설치경로와 방법에 따른 결과와 합병증을 알아보고자 한다. 대상과 방법:2001년 4월부터 2002년 10월까지 피하매몰 중심정맥포트를 삽입하였던 95명의 환자,103개의 피하매몰 정맥포트를 대상으로 하였다.모든 예에서 항암요법을 실시하기 위해서 일체형(n=39)과 분리형 (n=64)의 정맥포트를 삽입하였다. 천자는 좌측 쇄골하정맥(n=35), 우측 쇄골하정맥 (n=5),좌측 내경정맥 (n=9),우측 내경정맥 (n=54)에서 시행하였다. 설치경로와 방법에 따른 포트의 사용기간과 합병증을 분석하였다. 결과: 모든 예에서 피하매몰 정맥포트를 성공적으로 설치를 하였다.도관의 삽입 기간은 8-554일(평균 159일, 총 17,872일)이었다. 시술과 관련된 초기합병증으로 일시적인 폐동맥 공기색전 (n=1),소량혈종(n=1)과 일체형의 포트사용시 도관의 위치이상 (n=2)이 발생하였다. 후기합병증으로 도관의 이동 (n=5),포트기능부전 (n=3), 도관폐쇄(n=1)와 감염 (n=11)이 발생하였고 이중 15예(14.5%)에서 포트를 제거하였다. 도관의 이동이 있던 예는 모두 쇄골하정맥을 천자한 경우이며 내경정맥은 발생하지 않았다 (13%,p=.008).감염은 10.7%(0.61 per1000 catheter days)에서 발생하였다. 도관과 연관된 중심정맥 혈전증의 발생은 없었다. 결론: 피하매몰 포트의 삽입은 안전하게 시행할 수 있으며 쇄골하정맥보다는 우측 내경정맥을 천자위치로 선택하는 것이 합병증 발생이 적으며 포트는 분리형을 사용하는 것이 시술시 보다 편리한 것으로 보인다. 시술 후 장기적으로 사용하기 위해서는 포트에 대한 적절한 관리가 필요하다. Purpose: To evaluate the results and complications of placement of implantable port according to approach routes and methods. Materials and Methods: Between April 2001 and October 2002, a total of 103 implantable chemoport was placed in 95 patients for chemotherapy using preconnected type (n=39) and attachable type (n=64). Puncture sites were left subclavian vein (n=35), right subclavian vein (n=5), left internal jugular vein (n=9), right internal jugular vein (n=54). We evaluated duration of catheterization days, complications according to approach routes and methods. Results: Implantable chemoport was placed successfully in all cases. Duration of catheterization ranged from 8 to 554 days(mean 159, total 17,872 catheter days). Procedure related complications occurred transient pulmonary air embolism (n=1), small hematoma (n=1) and malposition in using preconnected type (n=2). Late complications occurred catheter migration (n=5), catheter malfunction (n=3), occlusion (n=1) and infection (n=11). Among them 15 chemoport was removed (14.5%). Catheter migration was occured via subclavian vein in all cases (13%, p=.008). Infection developed in 10.7% of patients(0.61 per 1000 catheter days). There were no catheter-related central vein thrombosis. Conclusion: Implantation of chemoport is a safe procedure. Choice of right internal jugular vein than subclavian vein for puncture site has less complications. And selection of attachable type of chemoport is convenient than preconnected type. Adequate care of chemoport is essential for long patency.

담도 낭선종과 낭선암

서경석(Kung Suk Suh),안문상(Moon Sang Ahn),김선희(Sun Whe Kim),이건욱(Kuhn Uk Lee),박영현(Yong Hyun Park),김수태(Sun Whe Kim) 대한외과학회 1996 Annals of Surgical Treatment and Research Vol.50 No.3

마우스 간의 허혈-재관류 손상에 대한 Haematococcus 추출물의 효과

윤익진(Ik-Jin Yun),안문상(Moon Sang Ahn),김동철(Dong-Chul Kim),유병일(Byeung-Il You),이건국(Gun Kuk Lee),하종원(Jongwon Ha),김상준(Sang Joon Kim) 한국간담췌외과학회 2004 한국간담췌외과학회지 Vol.8 No.3

직장 결장암의 간전이 환자에서 VEGF-A, C, D 발현의 비교연구

전광식(Kwang-Sik Chun),이경하(Kyung-Ha Lee),송인상(In-Sang Song),김지연(Ji-Yeon Kim),김제룡(Je-Ryong Kim),안문상(Moon-Sang Ahn),이상일(Sang-Il Lee),박종현(Jong-Hyun Park),최송이(Song-E Choi),강대영(Dae-Young Kang),송규상(Kyu-Sang Son 대한외과학회 2009 Annals of Surgical Treatment and Research(ASRT) Vol.76 No.5

Purpose: We aimed to investigate the correlations between expressions of angiogenic cytokines VEGF-A, C, D of primary colorectal cancer and liver metastasis. Methods: We examined paraffin-embedded primary colorectal cancer tissue from 45 patients who had liver resection due to colorectal liver metastasis (metastasis group) and 37 patients who had surgical resection due to colorectal cancer only (control group). In the control group, local recurrence and distant metastasis had not occurred. Immunohistochemical staining for VEGF-A, C and D was performed. We analysed the correlations between expression of VEGF-A, C and D in primary colorectal cancer tissues and clinicopathologic parameters. Results: VEGF-A expressions of primary colorectal carcinoma were not different between the two groups. VEGF-C was more frequently expressed in the metastasis group (P=0.008) but VEGF-D was more expressed in the control group (P=0.003). Patients with VEGF-C negative and VEGF-D positive expression were predominant in the control group (P=0.020). Tumor location, T stage, lymph node metastasis and tumor differentiation were not related with the expressions of VEGF-A, C, D but only preoperative CEA was positively correlated with VEGF-A and C expression. Conclusion: Expressions of VEGF-C in primary tumor were more frequent in metastatic colorectal cancer and expressions of VEGF-D were more frequent in nonmetastatic colorectal cancer. More large-scale prospective studies for VEGF-C and D expression in colorectal cancer are necessary.

신 이식 직후 신장 스캔 소견과 이식신 장기 생존의 관계

소영(Young So),이강욱(Kang Wook Lee),신영태(Young Tai Shin),안문상(Moon Sang Ahn),배진선(Jin Sun Bae),설종구(Chong Koo Sul),정인목(In Mok Jung) 대한핵의학회 2001 핵의학 분자영상 Vol.35 No.4

N/A Purpose: We investigated the possibility of early postoperative Tc-99m DTPA scintigraphy in predicting long-term renal transplant survival. Materials and Methods: 64 living donor (LD) grafts were divided into two groups according to the graft function on early post-operative renal scintigraphy. Survival analysis was performed using Kaplan-Meier method and Cox proportional hazard model. Chi-square test was performed to evaluate the difference in the frequency of acute rejection. Results: Cumulative renal transplant survival was decreased in 11 patients with abnormal renal scintigraphy, but it was not statistically significant. Decreased graft function on early post-operative renal scintigraphy was not a predictor of long-term graft survival. The frequency of acute rejection was higher in abnormal scintigraphy group, and the difference was statistically significant. Conclusion: Decreased graft function on early post-operative renal scintigraphy has no direct effect on long-term renal transplant survival in LD transplantation. But it may have an indirect effect through increasing the frequency of acute rejection. (Korean J Nucl Med 200135-251-257)

선천성 담도 폐쇄증에 대한 부분 간이식

김수태(Soo Tae Kim),김건표(Keon Pyo Kim),이건욱(Kuhn Uk Lee),김상준(Sang Joon Kim),윤여규(Yeo Kyu Yoon),윤효영(Hyo Young Yoon),안문상(Moon Sang Ahn),김우기(Woo Ki Kim),박귀원(Kwi Won Park),조마해(Ma Hae Cho),김성권(Suhng Gwon Kim),이효 대한외과학회 1994 Annals of Surgical Treatment and Research Vol.47 No.2

상지 원위부 색전을 동반한 흉곽출구증후군에서의 수술적 치료 1예

김상준,허승,이정언,하종원,정중기,안문상,정인목,민승기,성숙환 대한혈관외과학회 1999 Vascular Specialist International Vol.15 No.2

Thoracic outlet syndrome (TOS) is an uncommon condition which is caused by compression of subclavian artery, vein or brachial plexus in the region of thoracic outlet area, which is composed by the first rib, clavicle, anterior and middle scalene muscles and other connective tissue. In arterial TOS, chronic arterial compression causes arterial stenosis, poststenotic dilatation, aneurysm formation, intramural thrombus and peripheral arterial embolism. We present herein a case of arterial TOS patient with multiple distal embolization. The patient was 43-year old male with crutch ambulation because of sequelae of polioviral infection in his youth. His chief complaint was discoloration and gangrenous change of five right digits for 1 month. A rudimentary first right rib was found in simple chest X-ray. Angiographic findings were stenosis and poststenotic dilatation of right subclavian artery, multiple peripheral arterial embolic obstructions and numerous collateral vessel formation. Right thoracoscopic sympathectomy (T2), resection of the abno#rmal first rib and the abnonnal axillary arterial segment was perfonned through the supraclavicular and transaxillary incision, then interpositional graft with saphenous vein was done for arterial reconstruction. A minor lymphatic fluid collection around the area of operation occurred, but it was easily controlled by percutaneous drainage. The gangrenous wounds of digits were improved after restoration of blood circulation.

압박대를 이용한 슬와하부 동맥 우회로술

김상준,허승,정중기,안문상,민승기 대한혈관외과학회 1999 Vascular Specialist International Vol.15 No.2

Refinements in surgical technique have resulted in significant improvement in the patency rates of infrapopliteal artery revascularizations, but the cumulative patency rate were still low. Possibly the principle cause for the late graft failure was the constricting scar formation around the distal anastomosis following surgical injury. Thus we adopted a nandissection method, using pneumatic tourniquet occlusion technique, to simplify the procedure of distal anastomosis and to lessen the surgical injury. Six patients underwent infrapopliteal artery revascularizations with this method. Three of them were diagnosed with arteriosclerosis obliterans and the others with thromboangiitis obliterans, Tourniquet pressures of 350 mmHg were applied from 32 to 60 minutes. All patients were given systemic anticoagulants. The distal anastomoses were performed to peroneal artery in three cases, posterior tibial artery in two, and anterior tibial artery in one. Hemostasis was adequate in all cases and no alternative occlusive devices were required. There were no complications attributable to the use of the pneumatic tourniquet. Therefore we suggest that tourniquet occlusion technique may simplify the infrapopliteal artery revascularization and minimize surgical injury at the distal anastomosis contributed to the long-term patency of the distal bypass.

슬와동맥에 국한된 동맥 병변

김상준,박재형,정진욱,허승,하종원,정중기,안문상,민승기 대한혈관외과학회 1999 Vascular Specialist International Vol.15 No.2

Purpose: The popliteal artery is the site of uncommon conditions such as popliteal artery entrapment syndrome (PAES), adventitial cystic disease (ACD) and aneurysmal disease. Because of their rarity, these nonatheromatous conditions are often not diagnosed until they reach an advanced stage. We conducted this retrospective study to analyse the clinical characteristics of popliteal arterial disease and to establish a proper diagnostic and therapeutic strategy. Methods: Among the 31 patients who underwent an operation for popliteal arterial disease between Jan. 1986 and Dec. 1998 in SNUH, 14 patients with isolated popliteal arterial disease were included in this study, excluding 17 patients with combining significant arterial disease in other area. The symptoms, risk factors for vascular disease, laboratory findings, radiologic findings and the patency rate after operation were analyzed. Results: The mean age of the patients were 38 years (12∼64) and male-to-female ratio was 13: 1, There were 6 cases of PAES, 2 cases of popliteal aneurysms, ACD and thromboangiitis obliterans respectively, and 1 case of atherosclerosis obliterans and embolism each. Arteriography was performed in all cases and duplex sonogram (5 cases), CT (2), CT angiography (3), and MR angiography (2) was performed additionally. For treatment of the arterial occlusion, bypass or interposition graft was done in all cases. Along with the arterial reconstruction, division of medial head of gastrocnemius muscle was done in 4 cases of PAES, excision in 1 case of ACD, and aneurysmectomy in 1 case of popliteal aneurysm. Patency rates of the graft after 1 and 3 years were 92% and 80.9% respectively. There was no limb or patient loss. Conclusion: Isolated occlusive disease of popliteal artery is mostly nonatheromatous condition such as PAES or ACD. Therefore those diseases should be suspected in young patient with leg ischemia without other risk factor for systemic vascular disease. Duplex ultrasound and CTA or MRA are accurate diagnostic tools to differentiate the lesions and make the proper therapeutic plan.

Takayasu 동맥염의 수술적 치료

김민영,김상준,허승,하종원,정중기,안문상,민승기 대한혈관외과학회 2001 Vascular Specialist International Vol.17 No.1

Purpose: Takayasu arteritis is an inflammatory arteriopathy which predominantly affects young females and involves the aorta and its major branches. There is little information on reconstructive arterial surgery for Takayasu arteritis. We aim to evaluate the effectiveness and safety of the operation performed for symptomatic Takayasu arteritis. Method: Eighteen patients (5 men and 13 women) with Takayasu arteritis treated surgically from 1985 to 1999 at Seoul National University Hospital were reviewed. Result: Hypertension was the main symptom in our patients. Four paitients initially underwent medical treatment. Eighteen patients have undergone 21 vascular procedures for the occlusive arteria1 disease. Surgical indications included renovascular hypertension (17), cerebrovascular insufficiency (3), and extremity ischemia (1). Twelve patients with renovascular hypertension treated by unilateral or bilateral aortorenal bypass. Six patients have undergone renal autotransplantation. Aorto-aortic bypass was performed in 4 abdominal aortic coarctation. Two patients with cerebrovascular ischemia were treated by aortocarotid bypass. One patient with upper extremity and cerebrovascular ischemia have undergone femoroaxillary bypass and axillovertebral bypass. There were no postoperative mortality or morbidity except acute renal failure in one patients with full recovery. Revision of the initial reconstruction has been required for recurrent renovascular hypertension in two patients. All patients except two showed beneficial effect after procedures for renovascular hypertension. Conclusion: Surgical treatment of symptomatic Takayasu arteritis is highly effective and safe. Symptomatic improvement and excellent long-term graft patency can be expected after arterial reconstrucion. Considering their young age, aggressive surgical intervention is needed in the patient with Takayasu arteritis.