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간암환자에 있어서 Doppler 초음파 검사로 진단된 간내 동맥 - 문맥루
강진경(Jin Kyung Kang),최흥재(Heung Jai Choi),김원호(Won Ho Kim),정재복(Jae Bock Chungj),안광진(Kwang Jin Ahn) 대한소화기학회 1988 대한소화기학회지 Vol.20 No.3
Doppler ultrasonography, which provides noninvasive evaluation of bloodflow patterns has used widely in cardiovascular diseases. Recently intratumoral Doppler signal has been analysed to evalu- ate intra and peritumoral blood flow and to differentiate malignant from benign neoplasm. Hepatocellular carcinomas have characteristic vascular appearance including arteriovenous shunts that aid in their diagnosis and Doppler ultrasonography allows recognition of these arteriovenous shunts. But Doppler ultrasonographic observation of arterio-portal fistula involving relatively large branch of portal vein is very rare. We present a 55-year-o)d female patient with hepatoce)lular carcinoma showing characteristic L)oppler signal consistant with intrahepatic arterio-portal fistula which was confirmed by hepatic arteriography. After transarterial embolization with Gelfoam this high velocity flow signal was clisappeared.
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췌장암의 임상적 고찰 - 생존율 및 예후관련인자를 중심으로
이상주(Sang Joo Lee),이용찬(Yong Chan Lee),송시영(Si Young Song),정재복(Jae Bock Chungj),강진경(Jin Kyung Kang),박인서(In Suh Park) 대한소화기학회 1994 대한소화기학회지 Vol.26 No.6
N/A To identify the clinical characteristics and those factors associated with prognosis, we ana- lyzed 179 patients with pancreatic cancer who were histologically confirmed from January 1981 to August 1990 at Severance Hospital, Yonsei University. The mean age of the patients was 56.3 years, and the male to female ratio was 2.6 to 1. The most common symptom was abdominal pain(87.7%) and sign abdominal tenderness(63.7%). The elevation of serum CEA (more than 5ng/ml) was noted in 67.2%. The diagnostic accuracies for the pancreatic carci- noma of abdominal ultrasonography, computed tomography and ERCP were 86.7%, 94.3% and 92.4% respectively. The head of pancreas was the most common location(64.3% ), tail(17.9 body(15.6%), and diffuse type(2.2%) were in next order of frequency. Adeno- carcinoma was the most common type of malignancy(82.1% ). The remainings were mucinous adenocarcinoma, undifferentiated carcinoma, duct cell carcinoma, acinar cell carcinoma, cystadenocarcinoma, papillary adenocarcinoma and epidermoid carcinoma. Among 163 pa- tients who could be evaluated the clinical stages, only 6 cases(3.7% ) belong to stage I and the number of patients belong to stage II, stage III and stage IV were 14(8.6% ), 46(28.2% ), 97(59.5% ) cases respectively. And the two common sites of distant metastasis were liver(42.9 %) and peritoneum(22.7%). The median survival of 100 patients who could be evaluated the survival was 4.2 months. The survival rates were 35.9% at 6 months, 14.7% at 12 months and 4.0% at 24 months. There was no significant difference in survival rates according to the loca- tion of the tumor. The survival rate of the patients with stage I was significantly higher than that of the rest of patients with other stages(p<0.05). According to the treatment modalities, the median survival was 3.1 months in the group of no treatment, 4.3 months in surgical drainage group, 9.7 months in chemotherapy and/or radiotherapy group and 19.4 months in curative resection group. The survival rate of curative resection group was significantly higher than that of other treatment group(p<0.05). The survival rate of surgical drainage group was significantly higher than that of no treatment group(p<0.05). (Korean J Gastro- enterol 1994; 26: 1010 1020)
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내시경적 유두괄약근절개술의 조기합병증 및 위험인자에 관한 연구
김원호,강진경,박인서,문영명,송시영,이천균,정재복,이루다 대한소화기학회 1998 대한소화기학회지 Vol.30 No.6
Background/Aims: Although initially endoscopic sphincterotomy(EST) has been performed for the removal of bile duct stone and drainage of the biliary tree, recently its spectrum has been widely extended for the management of various pancreaticobiliary diseases, Despite its relative safety, various complications - bleeding, acute pancreatitis, perforation, cholarigitis and sepsis - could be developed in about 5-10%. Even though the incidence of these complications has been well known, the studies focused on the risk factors of complication are lacking and ramain to be solved. The purpose of this study is to assess the various early complications of EST and elucidate the risk factors. Methods: The clinical records of 643 patients who performed EST between Jan. 1985 and Aug. 1995 were analysed. Analysis for tbe complications and risk factors were focused on 552 cases whose clinical records could be completely reviewed. Results: Arnong 643 patients, 368 were male and 280 were fernale and their mean age 59.3(25-88) years. Tjnderlying disease on where EST is performed were gallstone(373 cases), bile duct cancer(116 cases), gall bladder cancer(16 cases), benign bile duct stricture(20 cases), postoperative bile duct injury (8 cases), malignant bile duct obstruction(14 cases), pancreatic cancer(42 cases), pancreatic stone(12 cases), pancreatic leak(1 case), ampullary cancer(22 cases) and sphincter of Oddi dysfunction(14 cases). Overall success rate of EST was 94.9%(610/643 cases). Indications of EST were removal of bile duct stone(338 cases), drainage of bile duct(246 cases), peroral choledochoscopy(24 cases), peroral pancreatoscopy(3 cases), management of benign biliary stricture(8 cases), treatment of sphincter of Oddi dysfunction(14 cases), removal of pancreatic stone(9 cases), drainage of pancreatic duct(6 cases), obtaining cholangiogram(29 cases), transpapillary biopsy of pancreatic or biliary duct(23 cases). Early complications were developed in 7.6%(42 cases). Bleeding was the most common(16 cases). Others were acute pancreatitis(12 cases), sepsis(14 cases), and duodenal perforation(2 cases). Statistically significant risk factors for the developrnent of early complicrtions were failure of EST, larger bile duct stone($gt; 2cm), failure of stone removal or biliary drainage(p=0.044, 0.009, 0.023, 0.047, respectively). The presence of juxtapapillary diverticulum and its location, common bile duct dilation, number of stone, type of papillotome were not influenced the development of complications. The significant risk factors for the bleeding were failure of EST, removal of stone and biliary drainage(p$lt;0.0001, 0.004, 0.0004, respectively) and for the acute pancreatitis size of bile duct stone and ampullary buldging(p=0.037, 0.0001, respectively). Conclusions: These fin- dings suggest that the development of early complications of EST is mainly deJ$gt;end on the failure of procedures undergone after EST, such as biliary drainage and stone remov;il rather than EST itse]f or other procedure not related conditions. Therefore the procedures after EST should be done carefully with full review to prevent the EST related early complications.
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