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채영준,In Eui Bae,Hyun Soo Kim,Sang Gab Yoon,Jin Wook Yi,Hyeong Won Yu,Su-jin Kim,Young Jun Chai,Kyu Eun Lee,Yeo-Kyu Youn 대한외과학회 2020 Annals of Surgical Treatment and Research(ASRT) Vol.98 No.6
Purpose: The aim of this study was to compare the large multi-institutional data of surgical outcomes of bilateral axillo-breast approach (BABA) robotic (RT) and endoscopic thyroidectomy (ET) and to evaluate the merits of robotic thyroidectomy. Methods: From 2004 to 2015, 1,029 patients underwent BABA ET, and from 2008 to 2015, 2003 patients underwent BABA RT in 3 large volume centers in Korea. Two groups were retrospectively compared in terms of clinicopathologic characteristics, complications, surgical completeness, and long-term outcomes using propensity score matching analysis. Results: Both groups had similar demographic characteristics including age, sex, tumor size, pathologic stage, and hospital stay after matching. Each group had similar rate of transient hypoparathyroidism, however, ET showed significantly higher rate of permanent hypoparathyroidism (ET 5.2% vs . RT 2.3%, P = 0.05), and transient vocal cord palsy (ET 14.4% vs . RT 9.1%, P = 0.006). Total operation time was longer in the ET group irrespective of surgical extents, including lobectomy (P = 0.016), total thyroidectomy (P = 0.031), and total thyroidectomy with central lymph node dissection (P = 0.019). The rate of patients with off-Tg under 1.0 ng/mL after 1st ablation was significantly higher in RT than ET group (ET 64.6% vs . RT 92.7%, P < 0.001). In long-term follow-up of cancer patients, 1.4% experienced recurrence after ET (10 cases), while 0.3% cases experienced recurrence after RT (5 cases) (P < 0.001). Conclusion: Both ET and RT can be safe and effective methods to treat thyroid diseases. However, the application of robotic system may help to overcome the limitations of the instruments and surgeon’s skills
김영민(Young Min Kim),김수진(Su jin Kim),이진욱(Jin Wook Yi),성찬용(Chan Yong Seong),김종규(Jong Kyu Kim),유형원(Hyeong Won Yu),채영준(Young Jun Chai),최준영(June Young Choi),이규언(Kyu Eun Lee) 대한갑상선-내분비외과학회 2016 The Koreran journal of Endocrine Surgery Vol.16 No.4
Purpose: Postoperative adhesion after thyroidectomy results in neck discomfort and swallowing difficulty. However, risk factors for adhesive symptom after thyroidectomy have not been well studied. This study evaluated symptoms related to postoperative adhesion after thyroidectomy. Methods: The Glasgow-Edinburgh Throat Scale (GETS) questionnaire was used to evaluate postoperative adhesion. Patients who completed the GETS questionnaire either pre- or post- operatively were enrolled. Patient clinical and pathological details including age, gender, body weight, body mass index (BMI), tumor size, thyroid volume, extent of thyroidectomy, postoperative months, and neck thickness on ultrasonography and computed tomography (CT) were abstracted. Results: Twenty-eight preoperative (22 females, six males) and 101 postoperative (83 females, 18 males) patients were enrolled. The mean age of the pre-operative enrollees was 52.1±11.7, and of post-operative enrollees 51.8±12.4 years. Patients who were within one month post-surgery had higher GETS scores than preoperative patients (27.4±20.1 vs. 6.5±11.1, P<0.001). Two months after surgery, GETS scores of postoperative patients did not differ significantly from the scores of the preoperative patients. There were no significant associations between clinical and pathologic features (age, tumor size, BMI, neck thickness on ultrasonography and CT) and GETS scores. Conclusion: Postoperative adhesive symptoms were most severe at one month after surgery, while questionnaire scores two months after surgery were comparable with preoperative patients. Further studies will be required for better understanding of the natural course of postoperative adhesion after thyroidectomy.
원격전이가 동반된 미세 침윤형 여포암 환자의 임상병리학적 양상
주영욱(Young Wook Ju),김수진(Su jin Kim),채영준(Young Jun Chai),이진욱(Jin Wook Yi),성찬용(Chan Yong Seong),김종규(Jong Kyu Kim),유형원(Hyeong Won Yu),최준영(June Young Choi),이규언(Kyu Eun Lee) 대한갑상선-내분비외과학회 2016 The Koreran journal of Endocrine Surgery Vol.16 No.4
Purpose: Although minimally invasive follicular thyroid carcinoma (MIFTC) is considered a thyroid tumor with low malignant potential, some MIFTC can spread, metastasize, and eventually lead to death. This study investigates the risk factors for distant metastasis in MIFTC patients. Methods: Between 1981 and 2014, the records of 365 consecutive patients who underwent thyroidectomy for MIFTC at Seoul National University Hospital were reviewed. Univariate and multivariate analyses were performed to identify risk factors associated with distant metastasis. Results: Of 351 patients, 10 (2.9%) presented with distant metastasis. Of these, two (0.6%) were found at the time of thyroidectomy, while eight (2.3%) were detected at later exams, over a median of 7.3 years (range, 0.2∼30.8). In univariate analysis, lymph node metastasis (P<0.001) was significantly associated with distant metastasis. In multivariate analysis, lymph node metastasis (P<0.001) and locoregional recurrence (P=0.008) were significantly associated with distant metastasis. Conclusion: Distant metastasis in MIFTC patients were associated with high-risk clinicopathologic features and more aggressive clinical courses. Further study will be needed to ascertain these results with long-term surveillance.
송광섭(Kwang-Seop Song),채영준(Young Jun Chai),백세현(Se Hyun Paek),권형주(Hyungju Kwon),김수진(Su-jin Kim),최준영(June Young Choi),구도훈(Do Hoon Koo),이규언(Kyu Eun Lee),윤여규(Yeo-Kyu Youn) 대한종양외과학회 2013 Korean Journal of Clinical Oncology Vol.9 No.2
Purpose: Laparoscopic adrenalectomy has been a standard method for adrenal gland tumors. On the other hand, hand-assisted laparoscopic adrenalectomy is an operative method which enables operator to use a hand to facilitate dissection and retraction. The aim of this study was to report initial experience of hand-assisted laparoscopic adrenalectomy and to evaluate potentialities for surgical application. Methods: Seven patients who underwent hand-assisted adrenalectomy from September 2010 to July 2013 were enrolled. Clinicopathological characteristics, intraoperative hemodynamic status, and parameters associated with postoperative recovery were reviewed. Surgical indications for hand-assisted laparoscopic adrenalectomy were right side adrenal tumors larger than 4 cm on preoperative computed tomography (CT) scan. Mean age was 36.9 years (range, 23 to 51 years) and there were 3 men and 4 women. Results: The mean size of adrenal tumor was 6.1±2.4 cm. Operation time was 119.4±29.7 minutes in average and mean blood loss was 142.9±109.7 mL. There were 4 patients with pheochromocytoma, one patient for each adrenocortical neoplasm, paraganglioma and lymphoma. Intraoperative hypertensive crisis were observed in 2 patients with pheochromocytoma and there was no intraoperative tachycardia crisis. Patients had first oral intake at 1.4±0.8 days in average and mean postoperative hospital stay was 3.4±1.3 days. There was no postoperative complication and mortality. The median follow-up was 12 months and there was no case with evidence of recurrence during the periods. Conclusion: In our initial experience, hand-assisted laparoscopic adrenalectomy was performed safely and effectively. Hand-assisted laparoscopic adrenalectomy might be an alternative to laparoscopic adrenalectomy for moderate sized right side adrenal tumors.
팬데믹 상황에서 음압병실 근무 간호사의 COVID-19 환자 간호 경험
노은영(Noh, Eun-Young),채영준(Chai, Young Jun),김현정(Kim, Hyun Jeong),김은진(Kim, Eunjin),박연환(Park, Yeon-Hwan) 한국간호과학회 2021 Journal of Korean Academy of Nursing Vol.51 No.5
Purpose: The purpose of this study was to explore nurses’ experience with caring for COVID-19 patients in a negative pressure room amid the spread of the pandemic. Methods: This study was a qualitative research, and focus group interviews were used to collect data. Three focus groups comprising 19 nurses were interviewed from February 17 to 25, 2021. All interviews were recorded and transcribed verbatim with the consent of the participants. The verbatim transcripts were scrutinized using thematic analysis. Results: Two main themes emerged from the analysis: ‘Struggling in an isolated space’ and ’Limitations of nursing infrastructure and system’. The nurses caring for COVID-19 patients experienced anxiety and fear about the infection, physical exhaustion, emotional burnout, and a sense of duty as a nurse. They also acknowledged the lack of guidelines, increased task and burden, limitations of nursing care, and the demand for improving the limitations of the nursing system. Conclusion: The results of this study demonstrate that nurses caring for COVID-19 patients encounter physical and emotional problems within the limited healthcare system. The study suggests that comprehensive interventions are needed for nurses. Furthermore, detailed guidelines, strengthening of nursing personnel, and improvements to the nursing system are vital to effectively cope with the pandemic. The government and medical institutions should be aware of the needs of nurses and what they are going through, and make efforts to improve the quality of life of healthcare workers and create a safe healthcare environment.