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미상엽에 위치한 간전이 병변에 대해 시행된 복강경 간절제술
윤유석(Yoo-Seok Yoon),한호성(Ho-Seong Han),신상현(Sang-Hyun Shin),조재영(Jai Young Cho),장진영(Jin-Young Jang),서경석(Kyung-Suk Suh),김선회(Sun-Whe Kim),이건욱(Kuhn Uk Lee),박용현(Yong-Hyun Park) 대한외과학회 2007 Annals of Surgical Treatment and Research(ASRT) Vol.73 No.4
Isolated resection of the caudate lobe of the liver is a technically demanding operation because of its unique anatomical location. Moreover the laparoscopic approach for this operative procedure has been rarely attempted. We report on a total laparoscopic liver resection of the caudate lobe including Spiegel lobe and most of paracaval portion that was performed in a 63-year-old male with a colorectal liver metastasis. The operative procedure was performed using five trocars with the patient placed in the lithotomy position. The operative time was 170 minutes. Blood loss was 350 ml and no perioperaive transfusion was needed. The patient was discharged on postoperative day 4 without any significant complications. This case shows that total laparoscopic liver resection of the caudate lobe is a feasible operation and that laparoscopic approach may be a useful option for the lesion located in Spiegel lobe in selected cases.
윤유석(Yoo-Seok Yoon),한호성(Ho-Seong Han),신상현(Sang-Hyun Shin),조재영(Jai Young Cho),강창권(Jiang Chang Quan),장진영(Jin-Young Jang),김선회(Sun-Whe Kim) 대한외과학회 2008 Annals of Surgical Treatment and Research(ASRT) Vol.74 No.5
Infected pancreatic necrosis is generally considered as an indication for surgical management, and this condition has traditionally been treated by laparotomy. However, open surgery still has high morbidity and mortality rates. The application of minimally invasive surgery to this disease entity has been recently tried with the possibility of incurring less morbidity. Herein we report on two cases of successful laparoscopic necrosectomy for treating infected pancreatic necrosis. Two patients developed acute necrotizing pancreatitis that involved the neck, body and tail of the pancreas after heavy drinking. Initially, percutanous drainage (PCD) was performed for these lesions. However, surgical debridement was decided on due to the patients’ non-responsiveness to medical treatment and infection was documented in the drainage fluid. Laparoscopic necrosectomy was performed using 5 trocars. The transmesocolic approach was adopted for the lesion around the pancreas body and tail, and the transgastrocolic approach was used for the lesion around the pancreas neck. The operation time was 190 and 225 minutes, respectively. There was no mortality. Although a pancreatic fistula occurred in one patient, it was improved by conservative management. Our cases show the technical feasibility and effectiveness of laparoscopic necrosectomy, but more experience is needed for this procedure to become a useful treatment option for infected pancreatic necrosis.
형광 동소 보합법을 이용한 췌장암의 세포유전학적 변화에 대한 분석과 그 임상적 의의
윤유석(Yoo-Seok Yoon),이동순(Dong Soon Lee),민현정(Hyun Chung Min),장진영(Jin-Young Jang),이승은(Seung Eun Lee),황대욱(Dae Wook Hwang),한호성(Ho-Seong Han),김선회(Sun-Whe Kim) 한국간담췌외과학회 2008 한국간담췌외과학회지 Vol.12 No.1
Purpose: The purposes of this study are to examine the cytogenetic alterations of pancreatic cancer, by using fluorescent in situ hybridization (FISH), to determine thier correlation with the clinico-pathologic prognostic factors and to identify the cytogenetic factors that can predict the prognosis of pancreatic cancer. Methods: Fresh frozen tissues of pancreatic cancer and normal pancreas that were obtained via pancreatic resection from 20 patients with pancreatic ductal adenocacinoma were analyzed by performing FISH with using locus-specific c-myc, p16, p53 probes and chromosome 18q, 20q probes. We cpmpared the FISH results with the clinico-pathologic prognostic factors. We also examined 16 paraffin-embedded tissues of pancreatic cancer by performing immunohistochemical staining (IHC) with monoclonal antibody to c-myc, p16, p53 and DPC. We then evaluated the correlation between the results of FISH and the results of IHC. Results: At least one alteration of genes or chromosomes was detected in 18 (90.0%) of the 20 pancreatic cancer tissues by FISH, as compared with no alternation in the normal pancreatic tissues: these alteration were an increased copy number of c-myc (66.7%), a decreased copy number of p16 (70.6%), deletion of p53 (100%), loss of chromosome 18q (56.3%) and gain of chromosome 20q (45.0%). IHC demonstrated overexpression of c-myc and p53 in 31.3% and 50.0% of the pancreatic cancer specimens, respectively, and the loss of expressions of p16 and DPC in 25.0% and 93.3% of the pancreatic cancer specimens, respectively. The concordance rate of IHC with FISH was 33.3% to 61.5%. Analysis of the correlation between the cytogenetic changes identified by FISH or IHC and the pathologic prognostic factors showed that only chromosome 20q gain was significantly correlated with the histologic grade (p=0.098) and lymphovascular invasion (p=0.092). However there was no clinical correlation of the cytogenetic changes with respect to recurrence after operation. Conclusion: This study confirms that most pancreatic cancers have cytogenetic alternations, as can be determined by FISH. Especially, the correlation between chromosome 20q gain and the prognostic pathologic factors offers the possibility of a new prognostic biologic marker located in chromosome 20q. However, further studies with more cases are needed to clarify the clinical significance of cytogenetic alternations in pancreatic cancer.
윤유석(Yoo-Seok Yoon),한호성(Ho-Seong Han),신상현(Sang-Hyun Shin),전광식(Kwang-Sik Chun),장진영(Jin-Young Jang),서경석(Kyung-Suk Suh),김선회(Sun-Whe Kim),이건욱(Kuhn Uk Lee),박용현(Yong-Hyun Park) 대한외과학회 2007 Annals of Surgical Treatment and Research(ASRT) Vol.72 No.4
Until now, reports on laparoscopic liver resections have mainly involved the antero-lateral segments (Couinaud segments Ⅱ∼Ⅵ), but those on laparoscopic major liver resection including a right hepatectomy are rare. Herein, we report on two total laparoscopic right hepatectomy cases. One patient was a 69-year-old female, with a hepatocellular carcinoma, and the other a 59-year-old female, with right intrahepatic duct stones. A total laparoscopic right hepatectomy was performed using four or five trocars. After cholecystectomy, the right liver was dissected from the IVC and surrounding ligaments until the right hepatic vein was visualized. After full mobilization of the right liver, the right portal vein, hepatic artery and bile duct were dissected and individually divided. The hepatic parenchyma was dissected along the ischemic line, using a Harmonic scalpel, into the superficial parenchyma and CUSA into the deep parenchyma. The large branches of the hepatic veins were controlled with endoclips. The right hepatic vein was transected with endo-GIA. The epigastric trocar site was extensionally incised for removal of the specimen. The operative times were 385 and 480 minutes the first and second case, respectively. Intraoperative transfusion was needed in the second patient due to biliary cirrhosis and distorted anatomy associated with an IHD stone. The two patients were discharged on postoperative days 15 and 6, respectively, without postoperative complications. These cases confirm that a total laparoscopic right hepatectomy is a feasible and safe operation. However, the technical problems, such as long operation time and bleeding during liver parenchymal resection, should be resolved in order that this procedure can be accomplished more safely.