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5 ㎝ 이하의 간세포암에 대한 제한적 간절제술과 대량간절제술후 결과 및 장기 생존율 비교
김혜진(Hye Jin Kim),황윤진(Yoon Jin Hwang),김종렬(Jong Yeol Kim),권형준(Hyung Jun Kwon),김규성(Gyu Sung Kim),천재민(Jae Min Chun),김상걸(Sang Geol Kim),윤영국(Young Kook Yun) 대한외과학회 2010 Annals of Surgical Treatment and Research(ASRT) Vol.78 No.1
Purpose: Though major hepatic resections including hemihepatectomy, trisectionectomy, and central bisectionectomy are most commonly employed for small (<5 ㎝) hepatocellular carcinoma (HCC), limited hepatic resection is indicated in some HCC patients with impaired liver function, poor physical condition, or tumors peripherally located. We compared the clinicopathological features and long-term survival between the patients who underwent major resection and limited resection. Methods: From January 1998 to May 2007, 223 patients who underwent hepatic resection for small HCC were enrolled. 123 patients underwent limited resection and 100 patients underwent major resection. Clinocopathologic features, overall, and disease-free survival were compared between both groups. Results: The limited resection group had lower mean serum albumin levels (3.86±0.41 vs. 4.11±3.61, P<0.0001) and higher mean ICG R15 (12.66±0.87 vs. 7.51±4.33, P<0.0001). Patients with esophageal varix and liver cirrhosis were more common in the limited resection group (34.1% and 73.1% versus 9% and 45% respectively). Morbidity and mortality were not different in both groups. Overall 1-, 3-, 5-year survivals in both limited resection and major resection groups were 89.4%, 77.3%, 43.8% and 87.8%, 76.5%, 62.1% respectively (P=0.161) and 1-, 3-, 5-year disease free survivals were 80.2%, 50.2%, 38.6% and 79.9%, 63.2%, 50.4% respectively (P=0.10). Conclusion: Despite indifference of overall and disease-free 5-year survival rates between limited and major resection groups, careful follow up is essential to detect late recurrence in the limited resection group, since limited resection tends to have more frequent recurrence, especially 2 years after surgery.
박인규 ( In Kyu Park ),황윤진 ( Yoon Jin Hwang ),권형준 ( Hyung Jun Kwon ),윤경진 ( Kyung Jin Yoon ),김상걸 ( Sang Geol Kim ),천재민 ( Jae Min Chun ),박진영 ( Jin Young Park ),윤영국 ( Young Kook Yun ) 대한외상학회 2012 大韓外傷學會誌 Vol.25 No.4
Purpose: Severe pancreaticoduodenal injuries are relatively uncommon, but may result in high morbidity and mortality, especially when management is not optimal, and determining the appropriate treatment is often difficult. The objective of this study was to review our experience and to evaluate the role of a pancreaticoduodenectomy (PD) in treatment of pancreaticoduodenal injuries. Methods: We performed a retrospective review of 16 patients who underwent an emergency PD at our hospital for severe pancreaticoduodenal injury from 1990 to 2011. Demographic data, clinical manifestations, mechanism and severity of the injury, associated injuries, postoperative complications and outcomes were reviewed. Results: The mean age of the 16 patients was 45±12 years (mean±standard deviation), and 15(93.8%) patients were male. All patients underwent an explorative laparotomy after a diagnosis using abdominal computed tomography. Almost all patients were classified as AAST grade higher than Ⅲ. Thirteen(83.3%) of the 16 patients presented with blunt injuries; none presented with a penetrating injury. Only one(6.3%) patients had a combined major vascular injury. Fifteen patients underwent a standard Whipple`s operation, and 1 patient underwent a pylorus-preserving pancreaticoduodenectomy. Two of the 16 patients required an initial damage-control procedure; then, a PD was performed. The most common associated injured organs were the small bowel mesentery(12, 75%) and the liver(7, 43.8%). Complications were intraabdominal abscess(50%), delayed gastric emptying(37.5%), postoperative pancreatic fistula(31.5%), and postoperative hemorrhage (12.5%). No mortalities occurred after the PD. Conclusion: Although the postoperative morbidity rate is relatively higher, an emergency PD can be perform safely without mortality for severe pancreaticoduodenal injuries. Therefore, an emergency PD should be con-sidered as a life-saving procedure applicable to patients with unreconstructable pancreaticoduodenal injuries, provided that is performed by an experienced hepatobiliary surgeon and the patient is hemodynamically stable. (J Trauma Inj 2012;25:115-121)
조자윤(Ja Yun Cho),김종열(Jong Yeol Kim),장수근(Su Kurn Chang),김상걸(Sang Geol Kim),황윤진(Yoon Jin Hwang),윤영국(Young Kook Yun) 대한외과학회 2009 Annals of Surgical Treatment and Research(ASRT) Vol.76 No.4
Purpose: Biliary tract disease is one of the most common causes of acute abdominal pain in elderly patients, but there is still some debate over treatment. The aim of this study is to determine the safety and surgical outcomes of laparoscopic cholecystectomy (LC) for benign gallbladder disease in octogenarian patients. Methods: We selected 42 patients of 80 years or older who underwent LC or open-converted cholecystectomy(OC) from February 1992 to November 2006. We evaluated clinicopathological features, treatment modalities, and surgical outcomes retrospectively. Results: The patients included 17 males and 25 females. The mean age of the patients was 83.3 and 83.7, respectively. Right upper quadrant pain was the most common symptom, present in 85.7% of the patients. Gallstones were present in 85.7%. ASA class Ⅱ and Ⅲ comprised 92.9% of the patients. Comorbidities included hypertension, cardiac disease, pulmonary disease, and diabetes mellitus. Preoperatively biliary drainage was performed in 12 cases (endoscopic drainage in 8, percutaneous drainage in 4 cases). Preoperative cholecystostomy was performed in 5 cases. Emergency operations were more frequent than elective surgery (25 vs. 17). Mean hospital stay of LC patients was 5 days, whereas that of OC patients was 13 days. Open conversion rate was 16.7%. No surgical mortality was present and postoperative morbidity included acute myocardial infarction in one patient and wound infection in one patient. Conclusion: LC in octogenarian patients was safe. However, since the incidence of comorbidities is high in these patients, great care should be taken to evaluate and manage the comorbidities before surgery.
Mandibular Clinical Arch Forms in Koreans with Normal Occlusions
Yun, Young-Kuk,Kook, Yoon-Ah,Kim, Seung-Hoon,Mo, Sung-Seo,Cha, Kyung-Suk,Kim, Jong-Ghee,Tae, Ki-Chul 대한치과교정학회 2004 대한치과교정학회지 Vol.34 No.6
본 연구의 목적은 한국인 정상교합자에서 하악치열궁의 형태적 차이를 알아보고자 하였다. 한국인 102명의 정상교합자를 대상으로 하악 모형의 교합면을 복사한 후 13개의 접촉점중에서 가장 협측으로 위치한 부분을 digitize하였고 각 치아의 브라켓위치에 해당하는 점을 하악치아의 두께에 의거하여 4개의 선계측과 2개의 비율을 측정하였다. 치열궁의 형태를 square, ovoid, tapered from으로 분류하여 그 빈도를 남녀성별에 따라 비교한 결과 특이한 차이점을 보이지 않았으나 대구치간 폭경에서는 남녀성별의 차이를 보였다. 정상교합자에서 치열궁 형태분포는 ovoid, square, tapered순 이었고 tapered arch from은 10%미만이었다. 치열궁 형태의 빈도분포에 있어서 남녀간의 차이는 없었다. The purpose of this study was to clarify morphologic characteristics between mandibular clinical arch forms in Koreans with normal occlusions. The study included data from 102 Koreans. The most facial portion of 13 proximal contact areas was digitized from photocopied images of the mandibular dental arches. Clinical bracket points were calculated for each tooth based on mandibular tooth thickness data. Four linear and two proportional measurements were taken. The dental arches were classified into ovoid, square and tapered forms. The frequency distributions of the three mandibular arch form classifications were determined and compared between male and female subjects. No significant differences in arch form size were found between the sexes. However, there were a few differences in molar width. It was useful to classify mandibular clinical arch forms present in normal occlusion samples into ovoid, square and tapered categories. The frequency of the ovoid form was the highest, and that of the square form was the second highest. The tapered arch form was found in less than 10 percent of subjects. No significant differences in their frequency distributions and dimensions were shown between males and females.