4공을 이용한 담낭 절제술과 2공을 이용한 담낭 절제술의 비교

김세준(Say June Kim),이상철(Sang Chul Lee),이관주(Kwan Ju Lee) 한국간담췌외과학회 2009 한국간담췌외과학회지 Vol.13 No.4

Purpose: In spite of its safety and fesibility, it is not completely certain whether two-port laparoscopic cholecystectomy can be applied for the same indications as four-port cholecystectomy. Methods: We retrospectively analyzed the prospectively collected data of the patients who had undergone either two-port or four-port laparoscopic cholecystectomy at the Department of Surgery, Daejeon St. Mary’s Hospital between March 2007 and August 2009. A total of 341 patients were included. For our two-port cholecystectomy, combining a transumbilical wound retractor with a surgical glove on which there was a 11 mm trocar and two pipes were attached comprised an umbilical common channel, and another port was inserted through the epigastrium. The overall procedure was similar to four-port laparoscopic cholecystectomy. Results: The patients were classified into the four-port group (n=261) and the two-port group (n=80) according to the operative method. All the two-port cholecystectomies were followed by four-port procedures. The operative indications for these two procedures were identical. No significant difference was observed for the mean operation time, the conversion rate, the postoperative hospital stay and the complications between each group. Multivariate analysis revealed that the factors making two-port surgery longer than the 75 percentile of the overall operation time were the development of intraoperative complications (RR 14.3; p=0.005; C.I. 2.255-90.853), a operation for the patients who visited the emergency room (RR 10.4; p=0.012; C.I. 1.684-63.798), open conversion or making additional port(s) (RR 9.9; p=0.032; C.I. 1.219-80.958) and a body-mass index greater than 25 (RR 5.5; p=0.025; C.I. 1.244-24.731). Conclusion: This study documents that our two-port laparoscopic cholecystectomy seems to have the potential to replace the conventional four-port laparoscopic cholecystectomy.

악성 위장관 간질종양의 간전이로 오인된 위·간결핵

김세준(Say June Kim),김욱(Wook Kim) 대한외과학회 2002 Annals of Surgical Treatment and Research(ASRT) Vol.63 No.5

간문부 담관암 환자의 임상양상 및 예후 분석

김세준(Say June Kim),이채영(Chae Young Lee),김동구(Dong Goo Kim) 대한외과학회 2007 Annals of Surgical Treatment and Research(ASRT) Vol.73 No.2

Purpose: The aim of the present study was to find the proper treatment for improving the survival of patients with hilar cholangiocarcinoma by analyzing many factors affecting the patients’ survival. Methods: Between January 1991 and April 2006, 152 patients with hilar cholangiocarcinoma and who underwent surgery were reviewed. One hundred fifteen patients underwent attempted curative resections, and 37 patients had findings that precluded any further intervention. Of the 115 patients who underwent curative resection, 38 patients underwent resection of the extrahepatic bile duct only and 77 patients underwent concomitant hepatectomy. The clinicopathogical data of these patients was analyzed. Results: The 3 year overall survival and disease-free survival rates were 41.2% and 52.5%, respectively. The overall recurrence rate was 40.9% (47/115) and of patients with recurrence, those who had been treated aggressively survived longer than those who had been treated conservatively (P=.039). Of the patients’ factors that affected survival, only preoperative weight loss was meaningful (P=.024). Of the histologic factors, tumor cell differentiation (P=.048) and the presence of lymph node metastasis (P=.028) were associated with survival. Of the perioperative factors, only achievement of complete tumor resection affected survival. On comparing between resection of the extrahepatic bile duct only and concomitant partial hepatectomy, the latter achieved more definitely negative histologic margins (63.6% vs 39.5%, respectively, P=.037) at the expense of a more prolonged operation time and hospital stay and greater complications. Conclusion: Preoperative weight loss, poor differentiation, lymph node metastasis and a positive histologic margin could be included in the poor prognostic factors affecting survival. Concomitant liver resection could be rationalized in that it could attain a more negative histologic margin for treating resectable hilar cholangiocarcinoma, but it could increase mortality and morbidity rates.

담낭암 환자의 임상양상 및 예후 분석

김세준(Say June Kim),김동구(Dong Goo Kim) 한국간담췌외과학회 2008 한국간담췌외과학회지 Vol.12 No.1

Purpose: The aim of the present study was to determine proper treatment strategies to improve the outcome of patients with gallbladder cancer by an analysis of multiple factors affecting tumor recurrence and patient survival. Methods: Between January 1991 and April 2006, surgery with curative intent was performed on 120 patients with gallbladder cancer. Of 120 cases, 35 patients had findings that precluded any further intervention, and the remaining 85 patients underwent curative resections that included a simple cholecystectomy in 43 cases, a radical cholecystectomy in 32 cases and an extended cholecystectomy in 10 cases. Clinicopathogical data was analyzed. Results: The presence of jaundice at presentation, gross morphology of the tumor, tumor cell differentiation, presence of a lymph node metastasis, lymphatic invasion and direct invasion to other contagious organ(s) and achievement of a tumor-free resection margin were associated with survival. For stage I gallbladder cancer, in only T2 lesions, patients that undergone a simple cholecystectomy had double the rate of recurrence as compared to patients that undergone a radical cholecystectomy (12.5% versus 26.1%; p = .119). For stage II gallbladder cancer, survival and disease-free survival for patients that undergone a radical cholecystectomy were improved as compared to patients that undergone a simple cholecystectomy; survival and disease-free survival was poor for patients that had undergone an extended cholecystectomy, especially in patients that had bile duct invasion (4/5; 80%). For stage III/IV gallbladder cancer, all patients (n = 6) underwent an extended cholecystectomy and half of the patients survived longer than one year. Conclusion: Radical cholecystectomy could be a standard procedure for gallbladder cancer in addition to just stage II cancer. An aggressive approach including resecting contagious organ(s) in locally advanced gallbladder cancer could provide a survival benefit without an increase in complications.

Binding 췌공장문합술의 초기 경험 및 Dunking 췌공장문합술과의 비교

김세준(Say June Kim),이동호(Dong Ho Lee),김정구(Jeong Goo Kim),이광진(Kwang Jin Lee) 한국간담췌외과학회 2009 한국간담췌외과학회지 Vol.13 No.4

Purpose: Pancreatic fistulas are a leading cause of mortality and morbidity following pancreaticoduodenectomy. The objective of this study was to evaluate the possibility of controlling pancreatic fistula formation by binding pancreaticojejunostomy into the operative procedure, as proposed by Peng, which results in a 3 cm invagination of the pancreatic remnant by the jejunal segment bearing electrically-destroyed mucosa reinforced by inner and outer sutures. Methods: Prospectively collected data of patients undergoing pancreaticoduodenectomy in the Department of Surgery of Daejeon St. Mary’s hospital between April 2007 and May 2009 were analyzed retrospectively. Thirty-one patients were included in the study; 16 patients underwent dunking pancreaticojejunostomy and 15 patients underwent binding pancreaticojejunostomy. Results: The two groups were comparable with respect to demographic data, pre-operative characteristics, underlying pathologies, pancreatic textures, and duct diameters. The mean operative time did not differ between the two groups (388±29 min vs. 459±21 min, p=0.060). No difference existed in the post-operative course except for the degree of complications. In contrast to the dunking group, in which 2 cases of grade III/V pancreatic fistulas occurred, the binding group had no severe complications. In addition, transformation of amylase data measured from Jackson-Pratt drains into a natural logarithm demonstrated significant differences on post-operative (POD) days 1, 3, and 7 between the dunking and binding groups (POD1, 6.97±0.41 vs. 6.10±0.44 [p=0.037]; POD3, 6.97±0.41 vs. 6.10±0.44 [p=0.032]; POD7, 4.69±0.35 vs. 3.88±0.25 [p=0.034], respectively). Conclusion: Bindning pancreaticojejunostomy is equivalent to dunking pancreaticojejunostomy with respect to operative difficulties, and more effective in preventing complications related to pancreatic fistulas.

외과의사로서의 기초 연구 주제 찾기

김세준(Say-June Kim) 대한외과학회 2022 대한외과학회 학술대회 초록집 Vol.2022 No.11

외상성 단독 쓸개 파열

김수홍(Soo Hong Kim),이관주(Kwan Ju Lee),김형래(Hyung Rae Kim),김세준(Say June Kim),이상철(Sang Chul Lee),김정구(Jung Goo Kim),이동호(Dong Ho Lee),안창준(Chang Joon Ahn),유영경(Young Kyoung You) 대한외과학회 2008 Annals of Surgical Treatment and Research(ASRT) Vol.75 No.2

Gallbladder (GB) injuries after blunt abdominal trauma are uncommon. An isolated blunt GB injury is extremely rare, due to the anatomic location of the GB that is protected by the liver, intestines, omentum and ribs. A GB injury follows a vague and insidious clinical course, and therefore GB injuries are commonly undiagnosed until an exploratory laparotomy is performed. Early diagnosis is important, as trauma to the GB should be treated surgically and a delay in treatment can result in considerable mortality and morbidity. We encountered a patient who was diagnosed with a GB rupture based on computed tomography that showed a hemoperitoneum, high-density material in the GB lumen and a leakage of contrast material. The patient underwent an exploratory laparotomy. We report a case of isolated GB rupture after blunt abdominal trauma.

신장경을 이용한 간내담석제거술

김두배(Doo Bae Kim),김세준(Say June Kim) 한국간담췌외과학회 2010 한국간담췌외과학회지 Vol.14 No.1

Hepatolithiasis is characterized by its frequent recurrence, and its requirement for multiple interventions which can be performed radiologically, endoscopically or surgically. Although hepatic resection - concomitant removal of hepatic stones and its provocative pathology as well ? has remained the definitive treatment of hepatolithiasis, the burden of the surgery limits its widespread application. In a certain proportion of patients, those for whom hepatic resection and endoscopic/percutaneous approaches are not indicated, surgical removal of intrahepatic stones can be attempted. In those circumstances, hepatic stones located outside the direct visual field can make the stone-extracting procedure cumbersome. We experienced an operation of a 66-year-old patient who had already received left lateral sectionectomy, cholecystectomy and choledochojejunostomy. His condition was due to impacted, recurrent stones packed between the hepatic hilum and the second confluence of the hepatic duct. Instead of revising the prior choledochojejunostomy site, after entering the jejunum 4 cm below the choledochojejunostomy site, we inserted a rigid nephroscope into the hepatic duct. Under the magnified view presented by a telescope inside the nephroscope, stone extracting was easily done using forceps inserted into the nephroscope. We think a nephroscope is useful in extracting intrahepatic stones, especially for large impacted stones located below the second confluence of the hepatic duct.

간세포암에서 종양 크기의 임상적 의의

이상명(Sang Myung Lee),김세준(Say June Kim),이경근(Kyung Keun Lee),김동구(Dong Goo Kim) 대한외과학회 2008 Annals of Surgical Treatment and Research(ASRT) Vol.75 No.1

Purpose: The aim of this study is to evaluate the significance of tumor size as a predictor of biological tumor behavior and to get some information to decide on the proper operative modality by assessing the survival rate for HCC patients. Methods: Between January 1995 and September 2006, 278 patients with hepatocellular carcinoma (HCC) underwent liver surgery at our hospital. Of the 278 cases, 176 cases (63.3%) underwent liver resection and 102 cases (36.4%) underwent liver transplantation (LT). All the patients were divided into 4 groups according to their tumor size; <2 ㎝, 2∼5 ㎝, 5∼10 ㎝ and >10 ㎝. We analyzed the pathologic outcomes, survival rates and the outcome of each operative modality, as related to the tumor size. Results: The incidence of vascular invasion increased with the tumor size (<2 ㎝: 4.6%, 2∼5 ㎝: 23.3%, 5∼10 ㎝: 32.6%, >10 ㎝: 50.0%)(P<0.005). For the less than 2 ㎝ sized tumor group, the Edmonson-Steiner (E-S) grade III or IV was present in 40.7% of the patients, as compared with 78.9% in the group of patients with a tumor larger than 10 ㎝ (P=0.005). The patients with a larger tumor showed a poorer survival rate. Liver transplantation showed the longer disease free survival compared to liver resection, though there was no significant benefit in the survival rate. Patients with a small sized tumor showed a better outcome when they underwent liver transplantation and patients with a large sized tumor did better when they underwent liver resection. Conclusion: Tumor size can be used as a preoperative predictor of the pathologic outcome when considering that the larger size of tumor the patients had, the more prevalent was vascular invasion, the tumor cell grade was more advanced and the survival rate was poorer. For patients with small sized HCC, liver transplantation can be considered the appropriate treatment modality.

전이성 림프절 종대와 동반된 내경정맥 혈전증

이관주(Kwan Ju Lee),김세준(Say June Kim),이상철(Sang Chul Lee),이동호(Dong Ho Lee),유영경(Young Kyoung You),안창준(Chang Joon Ahn),김종옥(Jong Ok Kim),김정구(Jeong Goo Kim) 대한외과학회 2008 Annals of Surgical Treatment and Research(ASRT) Vol.74 No.1

Spontaneous venous thrombosis developing in the internal jugular vein is very unusual. The common causes usually include intravenous drug abuse, jugular vein catheterization, neck dissection, a hypercoagulable state associated with malignancies, neck injury or ovarian overstimulation syndrome. A 30-year-old woman with no remarkable past medical history visited our outpatient office due to neck swelling with pain. She underwent CT scan, Doppler sonogram and fine needle aspiration biopsy. We could confirm metastatic lymphadenopathy and internal jugular vein thrombosis. We present here the case of internal jugular vein thrombosis associated with metastatic malignancy.