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복강경 담낭절제술 시 일률적인 담관조영술을 통해 확인한 간내담관의 변이 및 무증상 담관석에 대한 고찰
김세룡 ( Se Young Kim ),김기호 ( Ki Ho Kim ),김일동 ( Il Dong Kim ),서병선 ( Byung Sun Suh ),신동우 ( Dong Woo Shin ),김상욱 ( Sang wook Kim ),박진수 ( Jin Soo Park ),임혜인 ( Hye In Lim ) 대한소화기학회 2011 대한소화기학회지 Vol.58 No.6
Background/Aims: Intraoperative cholangiogram (IOC) during laparoscopic cholecystectomy (LC) has been used to evaluate bile duct stone. But, the routine use of IOC remains controversial. With routine IOC during LC, we reviewed the variation of hepatic duct confluence and try to suggest the diagnostic criteria of asymptomatic common bile duct (CBD) stone. Methods: We reviewed the medical record of 970 consecutive patients who underwent LC with IOC from January 1999 to December 2009, retrospectively. Results: Nine hundered seventy patients were enrolled. IOC were successful in 957 (98.7%) and unsuccessful in 13 (1.3%). Eighty two of 957 patients (8.2%) were excluded because of no or poor radiologic image. According to Couinaud`s classification, 492 patients (56.2%) had type A hepatic duct confluence, 227 patients (26.1%) type B, 15 patients (17%) type C1, 43 patients (4.9%) type C2, 72 patients (8.2%) type D1, 21 patients (2.4%) type D2, 1 patient (0.1%) type E1, 1 patient (0.1%) type E2, 2 patients (0.2%) type F, and 1 patient (0.1%) no classified type. The CBD stone was found in 116 of 970 (12.2%) patients. In 281 patients, preoperative serologic and radiologic tests did not show abnormality. When preoperative findings were not remarkable, there was no difference of clinical features between patients with or without CBD stones. Conclusions: Although IOC during LC has some demerits, it is a safe and accurate method for the detection of CBD stone and the anatomic variation of intrahepatic duct. (Korean J Gastroenterol 2011;58:338-345)
제1형 신경섬유종증 환자에서 십이지장 구부의 점막하 신경섬유성 증식에 의한 위배출 장애
서병선(Byung Sun Suh),신동우(Dong Woo Shin),이정섭(Jung Seob Lee),김세룡(Se Young Kim),한은미(Eun Mee Han),장은정(Eun Jeong Jang) 대한외과학회 2010 Annals of Surgical Treatment and Research(ASRT) Vol.79 No.6
Neurofibromatosis type 1 (NF1; also known as von Recklinghausen’s neurofibromatosis) is inherited in an autosomal dominant fashion, although it can also arise due to spontaneous mutation. Gastrointestinal involvement of NF1 is seen in 10% to 25% and causes symptoms in fewer than 5%. Histologically, the gastro intestinal (GI) manifestation of NF1 occurs in three forms: hyperplasia of the gut neural tissue, stromal tumors, and duodenal or periampullary endocrine tumors. A 31-year-old female, diagnosed with NF1, presented with poor oral intake and vomiting for 10 days prior to admission. Preoperative gastrofiberscopic finding was gastric outlet obstructing polypoid duodenal bulb lesion. The patient underwent hemigastrectomy with antecolic gastrojejunostomy due to gastric outlet obstruction. The final pathologic report was submucosal neurofibromatous proliferation with Brunner’s gland hyperplasia located at the duodenal bulb in the NF1 patient. We report this case with a review of literatures.
건강검진 수진자들에서 성별, 나이 및 체질량지수에 따른 간효소치의 상세 분포 연구
최승호 ( Seung Ho Choi ),양종인 ( Jong In Yang ),이창현 ( Changhyun Lee ),변희진 ( Hee Jin Byun ),강정묵 ( Jung Mook Kang ),김세룡 ( Se Young Kim ),임정윤 ( Jeong Yoon Yim ) 대한소화기학회 2014 대한소화기학회지 Vol.64 No.4
Background/Aims: The aim of this study was to examine the distribution of range of liver enzymes according to age and BMI in each gender using large-scale data. Methods: Data were gathered from 65,715 subjects who underwent a routine health check-up and did not have HBsAg and anti-HCV. Boxplot analysis was used to examine the distribution of range of liver enzymes according to age and BMI in each gender. Multivariate linear regression analysis was performed for assessment of the association of liver enzymes with age and BMI, and to determine whether the range of liver enzymes was affected by risk factors for metabolic syndrome in each gender. Results: ALT, AST, and GGT levels showed significant association with BMI in both male and female after adjusting for age. The range of ALT, AST, and GGT levels varied more widely according to the increase in BMI in males than in females, and this finding was more prominent in younger subjects than in older subjects. All risk factors for metabolic syndrome were shown to affect liver enzyme levels in male subjects. However, although most risk factors for metabolic syndrome affected liver enzyme levels, there might be weak or no effect of fasting hyperglycemia on AST, and low serum HDL-cholesterol level on GGT in female subjects. Conclusions: Age, BMI, and other risk factors for metabolic syndrome had a significant effect on the distribution of range of liver enzymes in each gender, even in this study conducted from Korean health checkup subjects. (Korean J Gastroenterol 2014;64:213-223)