담낭관(Cytic Duct)을 이용한 Type Ⅲ Mirrizi Syndrome의 교정 1예 보고

한규담,김우영 대한외과학회 2006 대한외과학회 학술대회 초록집 Vol.2006 No.5

갑상선 결절의 감별에서 외과 의사에 의한 초음파의 진단적 유용성

한규담,성치원,박영삼,김철승,Kyu Dam Han,Chi Won Sung,Young Sam Park and Cheol Seung Kim 대한갑상선-내분비외과학회 2008 The Koreran journal of Endocrine Surgery Vol.8 No.3

<B>Purpose: </B>High resolution ultrasonography has recently become a useful tool to differentiate malignant thyroid nodules from benign thyroid nodules. We performed this study in order to determine the usefulness of an ultrasonography examination that's performed by endocrinologic surgeons through the analysis of the sonographic characteristics. <P><B>Methods: </B>A retrospective review was undertaken for 312 patients who underwent surgery and a US examination by the operator before surgery due to thyroid nodules at Jesus Hospital from February 2006 to March 2008. The review consisted of the characteristics of the sonographic parameters, such as the margin, structure, shape, echogenicity, homogeneity, calcification, sponge sign and the width/height ratio. <P><B>Results:</B> On univariate analysis of the non-follicular neoplasm, the significant parameters were the margin, structure, shape, echogeneity, homogeneity, calcification and the width/height ratio. On the logistic regression analysis, the margin, structure, shape and echogenecity were significant parameters. On a univariateanalysis of the follicular neoplasm, the significant parameters were the shape, echogenecity, homogeneity and calcification. On the logistic regression analysis of the total thyroid nodules, the margin, structure, shape and echogenecity were significant para</B>meters. Especially, hypoechoic and solid structures are the most potent malignant characteristics. <P><B>Conclusion:</B> Among the ultrasonographic characteristics checked by surgeons before surgery, the hypoechogenecity and solid structures are the most useful ones when planning operative management of thyroid nodules.<B> (Ko</B><B></B><B>rean J Endocrine Surg 2008;8:171-176)</B>

충수돌기에 발생한 악성 신경내분비 종양 1예 보고

오부희,한규담,이종근,박세염 대한외과학회 2006 대한외과학회 학술대회 초록집 Vol.2006 No.11

Clinical Experience with a Hybrid Procedure Using the Adherent Clot Catheter for Salvage of Thrombosed Hemodialysis Access: A Comparison with the Standard Fogarty Balloon Catheter

양유성,한규담,최은혜,박영삼,서연호,김철승 대한혈관외과학회 2015 Vascular Specialist International Vol.31 No.1

Purpose: This study aimed to compare the efficacy of two different catheters in hybrid surgery for salvage of thrombosed hemodialysis accesses. Materials and Methods: The hybrid salvage procedure (surgical thrombectomy followed by endovascular angioplasty) of the thrombosed hemodialysis access, was performed using adherent clot (AC) catheter in 140 cases and Fogarty balloon catheter in 68 cases. Procedure-related outcomes such as the clot removal status, clinical success, complications, and primary patency rates were analyzed retrospectively. Results: The proportion of cases with good clot removal scores in the AC catheter and Fogarty balloon catheter groups was 77.9% and 91.2%, respectively (P=0.018). Clinical success was achieved in 90.7% of the cases in the AC catheter group and in 98.5% of the cases in the balloon catheter group (P=0.035). The mean patency rates of the two groups were 50.7% and 63.2% at 3 months, 40.7% and 47.1% at 6 months, and 17.9% and 19.1% at 12 months. The complication rates (12.1% and 5.9%) and primary patency rates between the two catheters were not statistically different (P=0.328). On the analysis of the patency rate on access type of autologous (P=0.169) and prothetic graft (P=0.423), there was no significant difference between the two catheter groups. Conclusion: In terms of clot removal and clinical success, the AC catheter did not demonstrate better outcomes than the Fogarty balloon catheter. However, primary patency was not related to the type of catheter. Adherent clot catheter can be a useful alternative to Fogarty balloon catheter for thrombosed hemodialysis access.

투석접근로의 기능실조 개선을 위한 구난술로서의 수술적 혈전제거술과 하이브리드치료 간 비교분석

강한샘,한규담,최은혜,박영삼,서연호,김철승 대한혈관외과학회 2012 Vascular Specialist International Vol.28 No.4

Purpose: Salvage operation is performed to improve the functional deficit of vascular access. This study is planned to evaluate the utility of the hybrid surgery through a comparative analysis between the results of surgical thrombectomy and those of hybrid surgery, combining surgical methods and endovascular treatments. Methods: From January 2007 to December 2008, surgical thrombectomy had been done to 55 patients,whereas hybrid surgery had been done to 111 patients from January 2009 to December 2011. We have done a comparative analysis on the patency rate after the salvage operation for each group, retrospectively. Medical records were reviewed for patient information and radiographic data was used for checking the stenosis site in the hybrid surgery group. Results: There were no statistically significant differences between the two groups, including age, gender,diabetes status, hypertension, and vascular access site or type. The primary patency rate was significantly higher in arteriovenous fistulas (65%) compared with arteriovenous grafts group (55%), at 12 months (P<0.01). At one year after the salvage operation, the secondary patency rate was higher in the hybrid surgery group compared to the surgical thrombectomy group (43.8% vs. 23.7%, P<0.01). Conclusion: This study shows that hybrid surgery combining surgical methods and endovascular treatments can be more useful for the salvaging of thrombosed vascular access than performing only surgical thrombectomy.

유방보존술 후 흡수성 메쉬 삽입에 대한 결과와 환자의 만족도

권의영,양유성,최은혜,한규담,박영삼,김철승 한국유방암학회 2017 Journal of Breast Disease Vol.5 No.2

Purpose: Breast-conserving surgery (BCS) is a standard treatment for breast cancer. Occasionally, patients may be dissatisfied with the breast shape due to deformity after BCS. To ensure satisfactory cosmetic results, a procedure with absorbable mesh after BCS was introduced in 2005. The purpose of this study was to identify the safety and effectiveness of this procedure. Methods: From November 2013 to December 2015, patients who underwent BCS for a malignant breast mass at Jeonju Presbyterian Medical Center were reviewed, and 63 patients were included in this study. Based on data collected from medical records and telephone interviews, the subjects were divided into two groups as follows and retrospectively compared and analyzed: BCS with absorbable mesh (n=31) and BCS without absorbable mesh (n=32). Patient data included age, body mass index, underlying disease, tumor location and size, specimen size, operative time, axillary dissection based on frozen biopsy results, postoperative wound infection, postoperative radiotherapy, adjuvant chemotherapy, and follow-up period. To compare patient satisfaction between the two groups, a brief questionnaire consisting of four items was administered. Results: Infection occurred in six patients (19.4%) in the absorbable mesh group and one (3.1%) in the BCS only group; however, the difference was not significant (p=0.053). Overall satisfaction, postoperative pain and postoperative motion limitation between the two groups were also not statistically significantly different. However, patients who underwent BCS with absorbable mesh insertion were better satisfied with the breast shape than those who underwent BCS without mesh from 1 year after operation (p=0.011). Conclusion: BCS with absorbable mesh is a simple and easy method to improve patient satisfaction for breast shape.

Submucosal Esophageal Metastasis in a Patient with Poorly Differentiated Thyroid Carcinoma: a Case Report

김미진,김철승,박영삼,최은혜,한규담 대한갑상선-내분비외과학회 2017 The Koreran journal of Endocrine Surgery Vol.17 No.3

We report an unusual case of esophageal metastasis protruding through the submucosa from a poorly differentiated thyroid carcinoma (PDTC). A PDTC is a very rare thyroid carcinoma subtype. A 68-year-old woman with PDTC exhibited recurrence at the thyroidectomy site and esophageal metastatic mass despite finishing the first treatment and undergoing regular follow-up. She received additional resective treatment with modified radical neck dissection for the recurrent neck nodes and endoscopic submucosal resection for the esophageal protruding mass. To our knowledge, no case of esophageal metastasis protruding through the submucosa from a PDTC has been previously reported.

조기 유방암에서 수술 전 유방초음파 및 유방 자기공명영상검사와 수술 후 병리학적 종양 크기에 대한 비교 연구

김은혁,박찬균,최은혜,김예정,김미진,한규담,박영삼,김철승,노경희,유은애,나경균 한국유방암학회 2020 Journal of Breast Disease Vol.8 No.1

Purpose: Preoperative tumor size is associated with clinical stage, treatment plan and even survival rate of patient. We investigated the accuracy of tumor size estimation between magnetic resonance imaging (MRI) and ultrasonography (US) findings, comparing these with pathologic tumor size in the diagnosis of early breast carcinoma. Methods: Between 2011 and 2016, 136 patients with early breast cancer were analyzed and their tumor size on US and MRI findings were compared with their pathologic tumor size retrospectively. The background parenchymal enhancement of MRI was categorized as minimal, mild, moderate, and extreme. The patients who underwent neoadjuvant chemotherapy, had positive resection margins, underwent excisional biopsy for cancer diagnosis, and had non-mass lesions on MRI scans, were excluded. Results: In all, 83.1% of the cases showed concordance between MRI findings and pathologic tumor size within 0.5cm. MRI overestimated the findings by 10.3% and underestimated them by 6.6%; 78.7% showed concordance between US findings and pathologic tumor size within 0.5cm. US overestimated the findings by 5.9% and underestimated them by 15.4%. The tumor size on MRI (r=0.87) showed a stronger correlation to the pathologic tumor size than that on US (r=0.64) in early breast cancer patients. US had a tendency to underestimate the tumor size. The degree of breast parenchyma did not affect the accuracy of the measurement of preoperative tumor size. Conclusion: MRI is relatively more accurate than US for assessing preoperative tumor size in breast cancer patients. US tends to underestimate tumor size.

외과의사에 의해 시행된 양성 갑상선 결절의 고주파 절제

오래영,최은혜,성치원,박영삼,김철승,한규담,Rae Young Oh,Eun Hye Choi,Chi Won Sung,Young Sam Park,Cheol Seung Kim and Kyu Dam Han 대한갑상선-내분비외과학회 2012 The Koreran journal of Endocrine Surgery Vol.12 No.4

Purpose: The ability to apply radiofrequency ablation (RFA) has provided for a greater diversity of approaches for treatment of benign thyroid nodules. This study evaluated the efficacy and safety of RFA performed by a surgeon. Methods: From January 2009 to November 2010, a total of 47 benign thyroid nodules were treated with RFA performed by one surgeon. Nodular patterns were divided into mainly cystic, mixed, and mainly solid (soft solid, hard solid) nodules, and ultrasonography was performed for assessment of the volume-reduction radio (VRR) of each nodule. Follow-up ultrasonography was performed three to 19 months after ablation. And complication was observed. One session of RFA was performed. Results: The median volume before ablation was 7.8 cm<SUP>3</SUP> (range 1.3∼43.2 cm<SUP>3</SUP>). After ablation, the median volume was 0.9 cm<SUP>3</SUP> (range 0.0-21.6 cm<SUP>3</SUP>) and VRR was 81.5±17.3%. RFA in mainly cystic nodules resulted in significant decreases in VRR (93.7±5.0%, P=0.009). It was the largest among the nodular types. VRR was 81.4±13.1% in mixed nodules, 77.2±19.2% in mainly solid nodules, 85.9±11.0% in soft solid nodules, and 54.2±17.3% in hard solid nodules 95.7% of nodules (45 nodules) showed more than 50% reduction, while the two remaining nodules, which were hard solid nodules, showed less than 50% reduction. Complications included pain, voice change, nausea, and transient voice change. Conclusion: Results of this study demonstrated the safety and effectiveness of RFA performed by a surgeon for reducing nodule volume.

말초동맥 혈관 질환의 치료 결과에 요추부 척추관 협착증이 미치는 영향

신충식(Chung-Shik Shin),최병열(Byeong-Yeol Choi),박승범(Seung-Bum Park),김경태(Kyung-Tae Kim),김태호(Tae-Ho Kim),김철승(Chul-Seung Kim),한규담(Kyu-Dam Han) 대한정형외과학회 2016 대한정형외과학회지 Vol.51 No.5

목적: 요추부 척추관 협착증(lumbar spinal stenosis, LSS)이 동반된 말초동맥 질환(peripheral arterial disease, PAD) 환자의 경피 경관 혈관 성형술(percutaneous transluminal angioplasty, PTA)의 결과에 대하여 알아보고자 하였다. 대상 및 방법: 간헐적 파행에 대하여 PTA를 시행 받은 PAD 환자를 대상으로 후향적으로 조사하였다. 이 중 심한 LSS가 동반된 22명을 A군으로, LSS가 없거나 경미한 23명을 B군으로 정의한 후 PAT 시행 후 증상의 호전 정도에 대하여 비교 연구하였다. 결과: PTA 후 visual analogue scale (VAS) 및 Walking Impairment Questionnaire (WIQ) 점수는 양 군에서 의미 있는 호전을 보였다(p<0.001, <0.001). 하지만 VAS, WIQ 및 변형된 MacNab 점수에 따른 결과는 A군에서 덜 만족스러웠다(p<0.001, <0.001, p=0.03). 추가적인 척추 수술을 받았던 경우는 2예에 불과하였다. 결론: PAD와 LSS가 동반된 군이 PAD만 있는 군에 비하여 PTA 결과가 덜 만족스러웠으나 대부분의 환자는 보존적 치료로 증상의 호전을 보였다. Purpose: The purpose of this study was to evaluate the result of percutaneous transluminal angioplasty (PTA) in patients with concurrent lumbar spinal stenosis (LSS) and peripheral arterial disease (PAD). Materials and Methods: Patients who underwent PTA for intermittent claudication were evaluated retrospectively. Twenty-two patients with severe LSS were included in group A and 23 patients with no or mild LSS in group B. The symptomatic improvement after PTA was comparatively evaluated. Results: Visual analogue scale (VAS) and Walking Impairment Questionnaire (WIQ) scores showed significant improvement after PTA in both groups (p<0.001, <0.001). However, according to VAS, WIQ and modified MacNab scores, results of group A were less satisfactory (p<0.001, <0.001, p=0.03). Only 2 patients underwent additional spine surgery. Conclusion: In results of PTA, the PAD associated LSS group showed less improvement than the PAD only group, but most patients showed symptomatic improvement with conservative treatment.