치료 의사의 전문 분야에 따른 게실염의 임상 특성 및 치료 성적

전승정,차재명,이정일,주광로,신현필,박재준,전정원,임준욱,서윤종,문수영,이치훈 대한장연구학회 2013 Intestinal Research Vol.11 No.2

목적: 급성 대장게실염의 임상 경과에 영향을 주는 인자들로 나이, 비만, 병변의 위치 등이 알려져 있지만 진료 의사의 전문성이 미치는 영향에 대해서는 보고된 바가 없었다. 이번 연구에서는 진료 의사의 전문 분야에 따라 게실염의 임상 특성 및 치료 성적을 분석하였다. 방법: 2006년 6월부터 2012년 12월까지 경희대학교 강동경희대병원에서 급성 대장게실염을 처음 진단받고 입원 치료를 시작한 239명 환자의 의무기록을 후향적으로 분석하였다. 소화기내과 전문의가 진료했는지의 여부에 따라 게실염 환자의 임상 특성 및 치료 성적을 비교 분석하였다. 결과: 소화기내과 전문의가 치료한 환자는 38명(15.9%)이었으며, 소화기내과 전문의가 아닌 의사가 치료한 환자는 201명(84%)이었다. 두군 사이에 나이, 성별, 체질량지수, 동반질환, 재발률, 합병증 등에는 차이가 없었으나, 타 과 전문의가 진료했던 게실염 환자들에게 우측 게실염이 유의하게 많았다(79.0% vs . 91.0%, P=0.028). 또한 합병증이 없는 게실염 환자의 치료에서 소화기내과 분과 전문의는 소화기내과 전문의가 아닌 의사들보다 주사 항생제를 경구용 항생제로 더 일찍 변경하였다(평균 3.3일 vs . 4.4일, P=0.032). 주사용 항생제 사용 기간에대한 다변량 분석 결과 소화기내과 전문의의 진료 여부가 주사용 항생제 사용 기간에 대한 독립적인 예후 인자(교차비 3.272, 95% 신뢰구간1.005-10.650, P=0.049)로 판명되었으며, 소화기내과 전문의가 아닌 의사들은 소화기내과 전문의에 비해 주사 항생제를 3일 이상 사용할위험이 약 3.8배 더 높게 관찰되었다. 결론: 소화기내과 전문의는 합병증을 동반하지 않은 게실염 환자의 치료에서 수술이나 재발의 증가 없이 짧은 기간 주사 항생제를 사용하는효과적인 치료를 하고 있었기 때문에, 진료 의사의 전문성에 따라 주사용 항생제 사용 기간이 단축될 수 있다고 해석할 수 있다. Background/Aims: Several factors affecting the severity and outcomes of diverticulitis have been reported, but there is little research on physician specialty related with this disease. Therefore, we evaluated the clinical characteristics and outcomes of diverticulitis depending on physician’s specialty. Methods: Medical records of 239 patients, who had been hospitalized with first-diagnosed acute colonic diverticulitis at Kyung Hee University Hospital in Gang Dong (Seoul, Korea) from June 2006 to December 2012, were retrospectively analyzed. The patients were classified according to whether they had been managed by gastroenterologists or not. Clinical characteristics and treatment outcomes were compared between two groups. Results: Of these 239 patients, 38 (15.9%) patients were treated by a gastroenterologist and 201 (84.1%) patients by a non-gastroenterolo-gist. Clinical characteristics such as age, gender, body mass index, comorbidity, medication, laboratory results, recurrence and complication were not significantly different between two groups. However, right-sided diverticulitis predominated in the non-gastroenterologist group (79% vs. 91%, P=0.028). From the sub-group analysis of uncomplicated diverticulitis, intravenous anti-biotics was used for a shorter period of time by gastroenterologists than non-gastroenterologists (3.3±1.9 days vs. 4.4±2.8 days,P=0.032). Multivariate logistic regression analysis showed that the 3 day administration of intravenous antibiotics significantly depended on the physician’s specialty (odds ratio 7.984, 95% confidence interval 1.990-32.043, P=0.003). Conclusions: The results suggest that the duration of intravenous antibiotics for treating uncomplicated colonic diverticulitis was shortened by gastroenterology specialists without increasing operation or recurrence. (Intest Res 2013;11:92-99)

안내염과 대장암이 동반된 재발성 간농양

전승정,김태헌,류민선,오다연,송명은,이신아,류재인,김혜인,문일환,유권 이화여자대학교 의과학연구소 2011 EMJ (Ewha medical journal) Vol.34 No.2

The causes of pyogenic liver abscess has been known as biliary tract disease or intrabadominal infection but the large proportions of the patients has no apparent underlying disorders. Recently colonic mucosal lesions were reported in patients with cryptogenic liver abscess and it has been suggested that colonic mucosal break may play a role in developing liver abscess in otherwise healthy patients. We experienced a patient of severe recurrent liver abscess complicated with endophthalmitis only 3 months after successful treatment of initial cryptogenic liver abscess and a polypoid colon cancer was discovered by chance. It seems prudent to proceed colonoscopic examination in patients with cryptogenic liver abscess especially when it is recurrent.

대장내시경 전임의 수련에서 실시간 회수시간 기록의 유용성

태정현,정성애,전승정,노선희,최주영,강민정,정지민,김성은,심기남,정혜경,김태헌,유권,문일환 대한소화기내시경학회 2011 Clinical Endoscopy Vol.42 No.6

Background/Aims: Attempts to increase colonoscopy withdrawal time have been the topic of several recent publications. We assessed whether the real-time measurement of withdrawal time affected the withdrawal time and polyp detection rate. Methods: Real-time colonoscopy withdrawal time was measured in 197 subjects in a study group and 184 subjects comprised a control group without real-time measurements. Colonoscopies were performed by four endoscopy specialists and three fellows during their first year of training. Withdrawal time, clinical features, bowel preparation, and polyp detection rates were comparatively analyzed. Results: No significant differences in age, gender, bowel preparation, or polyp history were found in the two groups. Withdrawal time was significantly higher in the study group than that in the control group when a fellow performed the withdrawal. However, polyp detection rate did not significantly increase in the study group, regardless of physician. Conclusions: Real-time measurement of colonoscopy withdrawal time did not increase polyp detection rate, but the withdrawal time was significantly higher when a fellow performed the withdrawal phase than when a specialist performed withdrawal. Therefore, the real-time measurement of colonoscopy withdrawal time seems to be a useful tool for fellow training. 목적: 대장내시경의 질 관리 지표로 회수시간이 중요하게 고려된다. 이번 연구에서는 대장내시경 검사 중 회수시간을 실시간으로 측정하여 검사자가 회수시간을 측정한다는 사실을 알고 있을 때, 회수시간에 유의한 변화가 있는지 알아보고 이에 따른 용종 발견율에 차이가 있는지 알아보고자 하였다. 대상 및 방법: 대장내시경 중 실시간으로 회수시간을 측정한 197건과 회수시간을 측정하지 않은 184건을 대상으로 하였다. 대장내시경은 4명의 내시경 전문의와 3명의 1년차 전임의가 참여하였다. 회수시간의 측정과 함께 연구 대상군의 나이, 성별과 장 정결도, 용종 발견율을 비교 분석하였다. 결과: 회수시간을 측정한 군과 측정하지 않은 군 사이에 나이, 성별, 장 정결도와 대장 용종의 과거력은 차이는 없었다. 전임의가 회수한 경우, 실시간으로 회수시간을 측정한 군에서 회수시간을 측정하지 않은 군보다 유의하게 높은 회수시간을 보였다. 그러나 전임의와 내시경 전문의 모두에서 회수시간의 측정에 따른 용종 발견율의 증가는 없었다. 결론: 회수시간을 실시간으로 측정하는 방법은 용종 발견율에 영향을 주지는 않았다. 그러나 전임의에서는 회수시간을 실시간으로 측정하는 방법이 실제로 더 많은 회수시간을 할애하여 검사하도록 하였다. 따라서 회수시간을 실시간으로 측정하는 방법은 전임의가 충분한 시간을 할애하여 검사하도록 수련하는데 좋은 방법이 될 수 있다.

변비로 발현한 직장 간질종양

이신아,심기남,노선희,이민진,김혜인,전승정,오다연,홍승철,류재인,김광호 이화여자대학교 의과학연구소 2011 EMJ (Ewha medical journal) Vol.34 No.2

A gastrointestinal stromal tumor (GIST) is the most common mesenchymal tumor of the gastrointestinal tract and expresses CD117, a c-kit proto-oncogene, which can be detected immunohistochemically. We reported a GIST of the rectum of a 61-year-old-woman who had visited emergency room complaining of constipation over one week. Upon rectal examination, a round hard mass was palpated. Colonoscopy showed a 7×5 cm sized protruded lesion with surface ulceration on a rectum, adjacent the anus. And abdomen computed tomography revealed the soft tissue mass compressing anterolateral wall of the rectum and these findings suggest possibility of rectal submucosal tumor such as GIST. The patient had been treated with a ultra anorectal anastomosis with loop ileostomy. Immunohistochemical studies on the surgically resected specimen showed c-kit (+) and CD34 (+). The final diagnosis was a GIST of the rectum. She was grouped into high risk and she has been given adjuvant chemotherapy with Imatinib.

고등급 이형성을 보인 편평톱니샘종

권경주,정성애,심기남,정정화,강석형,송도경,전승정,김혜인 이화여자대학교 의과학연구소 2012 EMJ (Ewha medical journal) Vol.35 No.1

Until recently, colorectal polyps were classified predominantly as hyperplastic or adenomatous. While adenomatous polyps are well-characterized precursor lesions of adenocarcinomas, hyperplastic polyps have been considered as benign lesion. However, some hyperplastic polyps with serrated morphology of the crypts have been recognized to have distinctive features and these polyps were termed ‘serrated adenomas’. Recent data show that sessile serrated adenomas (SSA) might be the precursors of serrated colonic cancers, underlining the necessity of identifying them. SSA is approximately 3% of all polyps, commonly appears as flat or sessile and yellowish due to mucus production. In the pathogenesis of SSA, progression to high grade dysplasia or early invasive carcinoma may be associated with serrated neoplasia pathway different from adenoma-carcinoma sequence. We report a case with a colon polyp diagnosed as sessile serrated adenoma with high grade dysplasia after endoscopic submucosal dissection.

수술 전 Carbohydrate Antigen 19-9 검사는 대장암 환자의 병기와 생존율을 예측할 수있다

문수영,차재명,이정일,주광로,신현필,박재준,전정원,임준욱,전승정,서윤종,이치훈 대한장연구학회 2013 Intestinal Research Vol.11 No.3

Background/Aims: The purpose of this study was to determine whether preoperative carbohydrate antigen 19-9 (CA 19-9) levels can predict the stage of diseases or survival rate in patients with resectable colorectal cancer (CRC). Methods: A total of 247 patients who underwent curative resections at Kyung Hee University Hospital at Gangdong between 2006 and 2011 were enrolled. We investigated the correlations of preoperative serum levels of CA19-9 with clinicopathological features of CRC. Receiver operative curve was constructed for evaluating the efficiency of the serum CA 19-9 levels in the stratifying stage of CRC. Survival analysis was performed with Kaplan-Meire method and log-rank test. Cox regression analysis was used for the multivariate analysis for survival. Results: Abnormal level of serum CA 19-9 (>37 IU/mL) were associated with advanced T stage (P<0.001), N stage (P=0.002) and TNM stage (P<0.001) in patients with resectable CRC. Furthermore, abnormal level of serum CA 19-9 were related with vascular invasion (P=0.002) and lymphatic invasion (P=0.026). The area under the curve was 0.75 (95% confidence interval [CI] 0.67-0.83) for T4 stage CRC and 0.680 (95% CI 0.61-0.75) for TNM stage III CRC. In patients with TNM stage III CRC, a preoperative CA 19-9 higher than 60 IU/mL (P=0.033) and presence of vascular invasion (P=0.002) were identified as significant predictors of survival rate on multivariate analysis. Conclusions: In patients with resectable CRC, preoperative CA 19-9 correlates with T stage, N stage and TNM stage of disease. Serum CA 19-9 >60 U/mL was an independent predictor of survival rate in the patients with TNM stage III CRC. (Intest Res 2013;11:184-190) 목적: 대장암에 대한 혈청 carbohydrate antigen 19-9 (CA 19-9)의 역할에 대한 연구는 많지 않으며, 특히 CA 19-9과 대장암의 임상 병리학적인 연관성 및 예후에 대한 보고는 거의 없었다. 이번 연구는 단일기관에서 대장암으로 수술을 시행하였던 환자를 대상으로 수술 전 혈청 CA19-9과 임상병리학적인 상관관계를 분석하고, 예후인자로서 혈청 CA 19-9의 역할에 대해 규명하기 위하여 시행하였다. 방법: 2006년 6월 1일부터 2011년 12월 31일까지 강동경희대학교병원에서 대장암으로 진단되어 수술 전 혈청 CA 19-9을 측정한 환자를 대상으로 후향적으로 분석하였다. 수술 전 혈청 CA 19-9와 대장암의 임상병리학적 상관관계를 분석하였다. 혈청 CA 19-9 수치가 진행성 대장암을 진단할 수 있는지 receiver operative curve 분석을 시행하였고, TNM III 병기 대장암 환자들의 5년 생존율을 분석하였다. 결과: 총 247명의 환자들이 연구에 포함되었다. T 병기, N 병기와 TNM 병기가 각각 높아질수록 혈청 CA 19-9 수치가 비정상(>37 U/mL)인 환자들의 빈도가 증가하였고, 혈청 CA 19-9 수치가 비정상인 환자군에서 림프관 침범과 혈관 침범의 빈도가 더 높았다. T4 병기의 대장암 진단에 대한 area under the curve (AUC)는 0.75 (95% confidence interval [CI] 0.67-0.83)였으며, TNM III 병기의 대장암 진단에 대한AUC는 0.680 (95% CI 0.61-0.75)였다. TNM III 병기 대장암 환자에서 혈관 침범과 혈청 CA 19-9 (>60 U/mL)은 5년 생존율에 영향을미치는 독립적인 예후인자로 판명되었다. 결론: 수술 전 혈청 CA 19-9을 측정하여 진행성 대장암의 병기에 대한 예측을 할 수 있을 뿐만 아니라, 혈청 CA 19-9은 TNM III 병기 대장암에서 수술 후의 생존율을 예측할 수 있는 독립적인 예후인자이다. 향후, 대장암 환자에 대한 CA 19-9의 예후적인 역할을 규명할 수 있는전향적인 대규모 생존율 연구가 필요할 것으로 생각한다.

Clinicopathological Characteristics of Colorectal Cancer according to Gender Difference

김대호,차재명,이정일,주광로,신현필,박재준,전정원,임준욱,전승정,서윤종 대한장연구학회 2012 Intestinal Research Vol.10 No.4

Background/Aims: Colorectal cancer (CRC) has been one of the major causes of death and has become a major public health concern. The incidence of CRC has been increasing regardless of gender in Korea. Until now, however, the studies on gender-based clinicopathological characteristics of CRC focused on pathology have never been reported. Therefore, we aimed to evaluate the difference in clinicopathological characteristics of CRC according to gender in Korea. Methods: Medical records of 342 patients with advanced CRC who underwent surgical resection at Kyung Hee University Hospital at Gangdong from June 2006 to December 2011 were retrospectively analyzed. The data of the clinicopathological characteristics of CRC by gender difference were compared. Results: Of these 341 patients, 203 (60%) patients were male and 138 (40%) patients were female. The male preponderance was noted in all age groups for total CRC and left-sided CRC. However, for right-sided colon cancer, this male preponderance was significantly decreased with increasing age groups (P=0.025) and was finally reversed in elderly groups (age ≥60 years). The microsatellite instability represented by negative staining for hMLH1 and hMSH2 was more frequently detected in women than men (P=0.037). Conclusions: The male preponderance in right-sided colon cancer decreased with increasing age groups and finally reversed in age groups more than 60 years. Microsatellite instability with immunohistochemical staining was more frequently detected in women. However, further studies with a large number of patients are warranted on this issue. (Intest Res 2012;10:365-371)

비소세포성 폐암으로 인한 기관지 림프절 누공

김서우 ( Seo Woo Kim ),김현경 ( Hyun Kyung Kim ),전승정 ( Sung Joung Jeun ),박혜성 ( Hye Sung Park ),장중현 ( Jung Hyun Jang ),이진화 ( Jin Hwa Lee ),류연주 ( Yon Ju Ryu ),심성신 ( Sung Shin Sim ),천은미 ( Eun Mi Chun ) 대한결핵 및 호흡기학회 2010 Tuberculosis and Respiratory Diseases Vol.68 No.4

Lymphadenopathy in the thoracic cavity is frequently caused by inflammatory diseases. In very rare cases, the node-bronchial fistula has been reported to be the cause of complications of pulmonary tuberculosis. A male patient with necrotizing pneumonia and mediastinal lymph node enlargements identified by chest computed tomography was also found to have a node-bronchial fistula caused by lung cancer. The patient was treated for tuberculosis with pneumonia for one week before a definitive diagnosis was made. A further investigation revealed him to have non-small cell lung cancer (NSCLC, adenocarcinoma) and multiple mediastinal lymphadenopathies accompanied with the node-bronchial fistula. We report this specific case that had been previously treated for tuberculosis but was later revealed to be NSCLC accompanied with a node-bronchial fistula.

경피적 내시경위루술을 통한 영양 공급 개선 효과

서윤종,차재명,이정일,주광로,신현필,박재준,전정원,임준욱,전승정,문수영,이치훈,조미란,이정숙 대한장연구학회 2013 Intestinal Research Vol.11 No.2

목적: 경피적 내시경위루술(percutaneous endoscopic gastrostomy, PEG)은 가장 흔히 이용되는 장기간 인공 장관영양법으로 그 안전성과 임상적 유용성은 많이 보고되어 왔지만, PEG의 영양 공급 개선 효과에 대한 연구는 아직까지 국내에서 시행된 적이 없었다. 따라서 이번 연구에서는 PEG 시행 전후의 영양 공급 개선 효과에 대해 연구하였다. 방법: 2006년 6월부터 2012년 2월까지 강동경희대학교병원에서 PEG를 시행한 196명 환자의 의무기록을 후향적으로 분석하였다. PEG 시행 전후로 열량 및 단백질을 포함한 영양 공급 개선 효과를 비교 분석하였다. 결과: PEG 시행 후 영양 공급이 유의하게 증가하여 평균 113 kcal (기저값의 13.5%)의 열량과 평균 4.8 g (기저값의 17.5%)의 단백질을 추가 공급할 수 있었다(각각 P=0.001). 권장영양량의 90% 이상을 공급할 수 있었던 환자들도 유의하게 증가하였는데, PEG 시술 전과 비교하여 PEG 시술 후 권장영양량의 90% 이상을 공급할 수 있었던 환자들이 열량과 단백질에 대해 각각 25.4%와 20.2%씩 증가하였다(각각P=0.001). 권장영양량의 90% 이상을 공급하는 데 걸리는 시간은 약 11일(열량, 11.6±4.4일; 단백질, 11.4±4.4일)이 필요하였다. PEG 시술 관련 합병증은 8.1%의 경증 합병증이 관찰되었고, 조기 사망은 발생하지 않았다. 결론: PEG 시술은 환자들의 영양 공급 상태를 개선시킬 수 있는 효율적인 시술임과 동시에 비교적 안전한 시술이다. Background/Aims: Percutaneous endoscopic gastrostomy (PEG) is the most common method of enteral nutrition for pa-tients who require long term artificial nutrition. PEG has been used as a method of nutritional support; however, improvement of nutritional support via PEG has not yet been reported. In this study, we analyzed the efficacy of nutritional support via PEG. Methods: We conducted a retrospective analysis of 196 consecutive patients who underwent PEG at Kyung Hee University Hospital in Gang Dong from 2006 to 2012. We analyzed clinical characteristics, the method of nutritional support, and the pro-portion of intake to establish recommendations for nutritional requirements and the duration needed to reach the level of ap-propriate nutrition. Results: A total of 196 patients included 130 men and 66 women, and their mean age (standard deviation)was 69.1±14.0 years. Compared with caloric and protein supplementation before PEG, 113 kcal (13.8% of baseline) and 4.8 g of protein (17.5% of baseline) could be additionally supplied with PEG (P=0.001, respectively). The number of patients who could take more than 90% of the recommended requirements of caloric and protein supplementation after PEG showed increased caloric and protein intake by 25.4% and 20.2%, respectively, in comparison with those before PEG (P=0.001 and P=0.001, re-spectively). The mean duration of catch-up for more than 90% of the recommended caloric and protein intake was approxi-mately 11 days. Procedure related complications and early mortality were reported in 8.1% and 0% of patients, respectively. Conclusions: PEG is an effective and safe nutritional support method for patients who require long term artificial nutrition. (Intest Res 2013;11:120-126)