소아 갑상선 결절의 수술

오흥권,김현영,박귀원,정성은,김우기,Oh, Heung-Kwon,Kim, Hyun-Young,Park, Kwi-Won,Jung, Sung-Eun,Kim, Woo-Ki 대한소아외과학회 2006 소아외과 Vol.12 No.2

Thyroid nodules are less common in children than in adults and their management is still controversial. The clinical presentations, operations, complications, histopathologic findings, and postoperative progressions of 34 pediatric patients that underwent thyroidectomy for palpable thyroid nodule at the Department of Surgery, Seoul National University Children Hospital between 1986 and 2003 were studied retrospectively by reviewing medical records and telephone interviews. The mean age of the patients was 11.8 years old. There were 23 females (67.6 %) and 11 males (32.4 %). Surgical indications were clinical need of histological confirmation (n=15), unresponsiveness to thyroxin replacement therapy (n=10), suggestion of the carcinoma on fine needle aspiration cytology (n=5), cosmetic purpose-a huge benign nodule (n=2), completion thyroidectomy for medullary thyroid carcinoma (n=1), and prophylactic thyroidectomy in a MENIIpatient (n=1). Unilateral Lobectomy was performed in 20 patients (57.1 %), subtotal thyroidectomy in 8 (22.9 %), total thyroidectomy in 5 (14.7 %), and completion thyroidectomy in 1 (2.9 %). Lymph node dissection was performed in 9 cases. Benign tumor was found in 23 patients (67.6 %), adenomatous goiter (n=18) and follicular adenoma (n=5). Malignant tumor was found in 11 children (32.4 %), 9 papillary carcinomas (26.5 %), and 2 medullary carcinomas (5.9 %). Of the 9 papillary carcinomas, 7 cases (77.8 %) had lymph node metastasis. No lymph node metastasis was found in 2 medullary carcinomas. Complications developed in 5 cases - transient hypocalcaemia (n=2), and temporary hoarseness (n=3). There was no mortality. Median follow-up period was 7.4 years (0.5-18 years). One patient showed recurrence in cervical lymph nodes 10 years after surgery and modified radical neck dissection was performed. Because of the high incidence of malignancy and advanced stage at initial presentation, more meticulous diagnostic work up is necessary for children with thyroid nodule, and more radical surgical treatment should be performed when malignant nodule is suggested.

공공병원에서 시행한 위암 수술의 단기 임상결과

박인규(In-Kyu Park),오흥권(Heung-kwon Oh),박세혁(Sei Hyeog Park),박종민(Jong-Min Park) 대한종양외과학회 2012 Korean Journal of Clinical Oncology Vol.8 No.2

목적 : 사회경제적 위치에 따라 위암 환자의 임상 결과에 차이가 있다는 여러 연구결과가 있음에도 불구하고 우리나라에서는 연구가 부족한 실정이다. 이 연구는 공공병원에서 위암으로 수술을 시행 받은 환자의 건강보험 종류에 따른 단기 임상 결과의 차이를 알아보고자 하였다. 대상 및 방법 : 2007년 3월부터 2012년 7월까지 위암으로 수술을 시행 받은 186명의 환자들을 후향적으로 분석하였다. 사회경제적 위치는 의료급여 수급권자를 하위 계층으로, 건강보험 가입자를 상위 계층으로 구분하여 수술 후 임상 결과를 조사하였다. 결과 : 186명의 환자 중 의료급여 수급권자는 81명, 건강보험 가입자는 105명이었다. 각 군의 평균연령은 63.6세와 65.3세, 동반질환은 65.4%와 78.1% 무증상 검진율은 32.1%와 46.7%였다. 근치적 절제율은 74.1%와 85.7%, 합병 절제율은 34.6%와 21.9%, 조기 위암의 비율은 33.3%, 51.4%로 의료 급여 수급권자에서 진행된 병기의 환자가 많았다. 근치적 절제 후 재발율은 16.7%와 5.6%였다. 결론 : 의료급여 수급권자들의 경우 조기 진단이 늦어져 진행성 위암의 비율이 높았으며, 수술 시 근치적 절제율이 낮고, 재발율 또한 높게 나타남을 알 수 있었다. Introduction : Although there are several studies which have shown the difference between the clinical outcome and socioeconomic status, there is still insufficient research in Korea. This study will show the difference of short term clinical outcome according to the type of health insurance for patients who have had surgery for gastric cancer in public hospital. Methods : From March 2007 to July 2012, 186 patients who underwent surgery for gastric cancer were retrospectively analyzed. Patients were examined by socioeconomic status. It classified patient in two groups. One was lower class for patients who were beneficiaries of medical aid. Another was upper class for patients who benefitted from health insurance. Results : 186 patients were 81 beneficiaries and 105 health insurance patients. The mean age was 63.6 years and 65.3 years for each group. Comorbidity disease was 65.4% and 78.1%. Asymptomatic checkup rate was 32.1% and 46.7%. Radical resection was 74.1% and 85.7%. Combined resection was 34.6% and 21.9%. There were many currently advanced stage patients in beneficiaries. The recurrence rate was 16.7% and 5.6% after radical resection. Conclusions : Medical aid beneficiaries had the higher proportion of progressive gastric cancer due to lack of an early screening and the low radical resection rate after undergoing operation. The rate of recurrence was high for beneficiaries too.

대장절제술 환자에서 수술 전 경구용 Carbohydrate-Rich 음료 복용과 인슐린 저항성 관계

체리안시오 ( Cherry Ann Sio ),정규환 ( Kyuw Han Jung ),강성범 ( Seong Bum Kang ),김덕우 ( Duk Woo Kim ),오흥권 ( Heung Kwon Oh ),윤미옥 ( Miok Yoon ) 한국정맥경장영양학회 2015 한국정맥경장영양학회지 Vol.7 No.2

Purpose: Reducing preoperative fasting time showed positive effects in several studies, and current guidelines suggest use of a preoperative oral carbohydrate-rich solution before elective surgeries. For elective colectomy procedures, some surgeons favor two-day bowel preparation with diet restriction and administration of laxatives. Aside from patients experiencing the discomfort of nil per os (NPO), there are reported benefits regarding intake of liquids until at least two hours prior to surgery, including decrease in insulin resistance, without additional postoperative surgical complications. The aim of this study is to show the benefits of administration of oral rehydration solution (ORS) two hours prior to surgery for patients undergoing elective colectomy, particularly postoperative insulin resistance. Methods: This is a randomized controlled trial. All patients undergoing elective colectomy were included and randomized to the control arm or treatment arm. The control arm consisted of the standard bowel preparation and one day of NPO, while the treatment arm consisted of the standard bowel preparation and allowing intake of carbohydrate-rich ORS until 2 hours before surgery. The insulin, glucose, cortisol, and triglyceride levels were determined immediately after induction, 6 hours, 24 hours, and 48 hours post-op, and compared. The homeostatic model assessment-insulin resistance, insulin, glucose, cortisol, and triglyceride levels were determined and compared between the two groups. Anxiety and postoperative complications were monitored and assessed as well. Results: There was less insulin resistance in patients who received ORS 2 hours prior to surgery. Insulin, glucose, cortisol, and triglyceride levels were lower in the treatment group compared to the control group. Taking ORS 1 day prior and until 2 hours before surgery decreased anxiety and discomfort, and alleviated hunger. Conclusion: Regarding complications, there was no difference in the incidence of aspiration and postoperative complications. There were fewer wound complications and incidence of paralytic ileus in the treatment group.

북한 이탈 주민에서 발생한 암의 임상병리적 특징

박재민(Jae Min Park),김은영(Eunyoung Kim),정일용(Il Yong Chung),박세혁(Sei-Hyeog Park),박종민(Jong-Min Park),윤여규(Yeo-Kyu Youn),오흥권(Heung-Kwon Oh),김중석(Joong-Suck Kim),주성홍(Sung-Hong Joo) 대한종양외과학회 2014 Korean Journal of Clinical Oncology Vol.10 No.2

Purpose: In this study, we compared characteristics of cancer of North Korean defectors to South Korean. In order to clarify the clinicopathologic characteristics of cancer in North Korean defectors. Methods: This study is a retrospective study through chart review of patients diagnosed as cancer at National Medical Center from 2008 to 2013. Control group included South Korean cancer patients who were diagnosed as cervical cancer, thyroid cancer, liver cancer, stomach cancer at same hospital during same period. Two groups were analyzed and compared by sex, age, past medical history, cancer origin, cancer stage, and treatment. Results: Among 1,760 North Korean defector patient registered in National Medical Center, 61 patients were diagnosed as cancer, which was 3.5%. Cervical cancer (19.7%), thyroid cancer (19.7%), liver cancer (14.1%) and stomach cancer (10.3%) were 4 most frequent cancer. In South Korean cancer patient, percentage was as follows: thyroid cancer (33.7%), stomach cancer (7.8%), liver cancer (7.3%), cervical cancer (3.7%). Conclusion: Cancers closely related to socio-economic status, such as cervical cancer and hepatitis-B related liver cancer, were relatively more frequent in North Korean defectors than South Koreans. As for cancers in which early diagnosis is important such as thyroid cancer and stomach cancer, there were no significant differences in age-prevalence, disease course and treatment.