갑상선 수질암에서 예방적 측경부 림프절절제술의 범위

김연선,홍석준,Yon-Seon Kim,M.D. and Suck-Joon Hong,M.D. 대한갑상선-내분비외과학회 2004 The Koreran journal of Endocrine Surgery Vol.4 No.2

Purpose: The extent of prophylactic lateral neck lymph node dissection is very controversial in medullary thyroid cancer. This retrospective study was undertaken to evaluate the efficacy of prophylactic lateral neck lymph node dissection. Methods: A total of 29 patients underwent curative operation for medullary thyroid carcinoma at our institution. Of these 29 patients, 13 patients had prophylactic lateral neck dissection and 16 patients had non-prophylactic lateral neck dissection. Among 13 patients, one-compartment prophylactic lymph node dissection was performed in 10 patients and two-compartment prophylactic lymph node dissection was performed in 3 patients. Postoperative calcitonin level was evaluated between these groups. Results: A normalized calcitonin level was detected after surgery in 74% of patients without lateral neck lymph node metastases, and in 10% of patients with lateral neck lymph node metastases. In comparison of prophylactic node dissection group and non-prophylactic node dissection group, the rate of normalized calcitonin level after surgery is 100%, 66.7% in stage 1, 100%, 50% in stage 2, 0%, 80% in stage 3, 14.3%, 0% in stage 4. In the patients who one-compartment prophylactic lymph node dissection was performed, 40% of patients had positive lymph node metastasis, and 70% had persistent hypercalcitoninemia. However, there was no postoperative hypercalcitoninemia in the patients with two- compartment prophylactic lymph node dissection although lymph node metastasis was not identified with pathologic examination. Conclusion: Prophylactic lymph node dissection was more effective in the early stage of medullary thyroid carcinoma than late stage. The two or more compartment lymph node dissection is more effective than just one-compartment dissection for the normalization of serum calcitonin level. (Korean J Endocrine Surg 2004;4:85-89)

제1형 다발성 내분비 선종의 임상양상

김연선,홍석준,Yon-Seon Kim,M.D. and Suck-Joon Hong,M.D. 대한갑상선-내분비외과학회 2004 The Koreran journal of Endocrine Surgery Vol.4 No.1

Purpose: Multiple endocrine neoplasia type I is rarely reported in Korea. The purpose of this study is to analyze the clinical features and the treatment of MEN1 which had been carried out in our institution. Methods: Eight patients underwent surgery for MEN1-related hyperparathyroidism, duodenopancreatic tumors and pituitary tumors at our institution and were reviewed retrospectively. Results: Of the eight patients, all patients had hyperparathyroidism. There were 5 total parathyroidectomy patients and 3 subtotal parathyroidectomy patients, none of them had persistent and recurrent hyperparathyroidism after operation. However, one of total parathyroidectomy patients had persistent hypoparathyroidism. Of the 8 patients, seven had duodenopancreatic tumors; four of them had pancreatic islet-cell tumors, two had malignant gastrinoma and one had Zollinger- Ellision syndrome. Pituitary tumors were observed in 6 patients among the 8; four of them had prolactinoma, and 2 had adenoma which was confirmed by magnetic resonance imaging. Of the eight patient, only one patient was confirmed to have another MEN1 family member and the mutation of MEN1 gene on chromosome 11q13 was proved on gene study.Conclusion: The clinical features of these patients were similar to those in other reports and the results of surgical treatment were relatively satisfactory. However, the detection of other MEN1 patients among the family members was relatively poor. Close follow up of family members and gene study will be required. (Korean J Endocrine Surg 2004;4: 31-35)

갑상선전절제술 후 일과성 및 영구적 저칼슘혈증의 위험인자 -일과성 저칼슘혈증의 주요인은 무엇인가?-

홍석준,이정선,김연선,Suck Joon Hong,Chung Seon Lee and Yon Seon Kim 대한갑상선-내분비외과학회 2005 The Koreran journal of Endocrine Surgery Vol.5 No.2

갑상선암으로 갑상선 전절제술 및 경부 림프절 절제술 후 합병증

노수영,고병균,김연선,Soo Young Noh,Byung Kyun Ko and Yon Seon Kim 대한갑상선-내분비외과학회 2011 The Koreran journal of Endocrine Surgery Vol.11 No.3

그레이브스병의 수술적 치료방법

성태연(Tae-Yon Sung),김연선(Yon Seon Kim),이숙현(Sook Hyun Lee),윤종호(Jong Ho Yoon),홍석준(Suk-Joon Hong) 대한외과학회 2009 Annals of Surgical Treatment and Research(ASRT) Vol.77 No.2

Purpose: Subtotal thyroidectomy has been the standard operation for Graves’ disease in achieving a favorable outcome in recovery of euthyroid state. However, the postoperative outcomes following subtotal thyroidectomy differ by surgeon and postoperative thyroid dysfunctions develop as time passes. Here, we have studied the validity of total thyroidectomy for Graves’ disease patients, with a comparison to subtotal thyroidectomy. Methods: A total of 299 patients with Graves’ disease underwent thyroid operation consecutively in Asan Medical Center, Seoul, Korea from December 1995 to December 2005. Among them, 241 cases had subtotal thyroidectomy and 43 had total thyroidectomy. The subtotal thyroidectomy cases were divided into 3 groups according to estimated remnant thyroid; <4 g, 4≤∼<6 g and ≥6 g. Also, according to postoperative thyroid function, the patients were divided into euthyroid, hypothyroidism and hyperthyroidism groups. The postoperative changes of thyroid function, postoperative complications and hospital days were analyzed. Results: In subtotal thyroidectomy, postoperative thyroid function showed euthyroid in 25 (10.4%), hypothyroidism 206 (85.5%) and hyperthyroidism 10 (4.1%). However, total thyroidectomy showed no persistent hyperthyroidism or recurrence. The postoperative thyroid function state changed in 24 patients out of 148 who had more than 2 years postoperative follow-up. Hyper-functional changes developed with higher rates (Hypo-6 vs. hyper-18). The postoperative complication rate was higher in subtotal thyroidectomy including bleeding, hoarseness and hypocalcemia. Conclusion: In our study, the patients showing normal thyroid function after subtotal thyroidectomy were very limited and thyroid dysfunction developed continuously with time lapse, especially towards hyperthyroid state. Therefore, we suggest that total thyroidectomy should be considered as a treatment option in Graves’ disease.

3차성 부갑상선 기능 항진증 환자의 수술 방법에 관한 비교

김희정(Hee Jeong Kim),김연선(Yon Seon Kim),홍석준(Suk Joon Hong) 대한외과학회 2007 Annals of Surgical Treatment and Research(ASRT) Vol.73 No.5

Purpose: Tertiary hyperparathyroidism (THPT) occurs in less than 8% of the patients with secondary hyperparathyroidism after successful kidney transplantation. Tertiary hyperparathyroidism is commonly due to parathyroid hyperplasia, but about 2.6% of the THPT cases may be due to single or double adenomas. We investigate the usefulness of limited resection of single or two-gland parathyroid by comparing the blood calcium and PTH levels with respect to operative strategy. Methods: We analyzed a total of 13 cases of tertiary hyperparathyroidism that were diagnosed and operated on at Asan Medical Center from May 1996 to April 2005. The patients were grouped according to the operative strategy: 3 and 1/2-parathyroidectomy (n=5), 3-parathyroidectomy (n=6), and 2-parathyroidectomy (n=2), and then we compared the mean blood PTH, calcium and creatinine levels. One patient in the 3-parathyroidectomy group underwent hemodialysis due to kidney transplant rejection, and this data was excluded from the analysis. Results: The mean blood calcium and PTH levels of the 2-parathyroidectomy group were higher than that of the other two groups. There were no cases of transient hypocalcemia in the 3 groups (<7.5 ㎎/㎗), and there were no cases of hypercalcemia at one year postoperative in the 3 &1/2-parathyroidectomy and 2-parathyroidectomy groups. The blood calcium and blood PTH levels were less than 9.1 ㎎/㎗ and more than 100 pg/㎖, respectively, in the one 3-parathyroidectomy patient who underwent hemodialysis due to kidney transplant rejection. Conclusion: Our preliminary conclusions, based on our small groups and the short follow-up period, are that the blood calcium and PTH levels will be higher in the limited resection group if kidney transplant rejection occurs, and tumor recurrence will be also more often found in the limited resection group. Therefore, our recommendation is that 3 and 1/2-parathyroidectomy and 2-parathyroidectomy are preferable operative strategies for tertiary hyperparathyroidism.

갑상선 유두암 T1, T2 병기 환자에서 중앙경부 림프절 전이의 빈도와 예측인자

배강호,태순영,고병균,김연선,Kang Ho Bae,Soon Young Tae,Byung Kyun Ko,Yon Seon Kim 대한갑상선-내분비외과학회 2015 The Koreran journal of Endocrine Surgery Vol.15 No.1

Purpose: Thyroidectomy without prophylactic central neck dissection may be recom-mended for small (T1 or T2) papillary thyroid carcinoma (PTC). The aim of this study was to determine the incidence and predictive factors of central cervical lymph node metastasis in T1/2 papillary thyroid carcinoma.Methods: A retrospective review of 877 patients with T1/2 PTC who underwent thyroidectomy and central lymph node dissection with or without lateral lymph node dissection from March 2007 to February 2014 was performed. The clinicopathologic results were reviewed and the incidence and predictive factors of central cervical lymph node metastasis (LNM) were analyzed.Results: The overall frequency of central LNM was 29.8%. In univariate analysis, male, younger age, bilaterality, multifocality, larger tumor size, lymphovascular invasion, and lateral lymph node metastasis were associated with central LNM. In multivariate analysis, younger age, larger tumor size, lymphovascular invasion, and lateral lymph node metastasis were independent variables of central LNM.Conclusion: Central LNM is associated with younger age, larger tumor, lymphovascular invasion, and lateral lymph node metastasis in small (T1/2) PTC patients. Prophylactic central lymph node dissection should be considered in patients with risk factors.

유방암 환자에서 내시경을 이용한 유륜부절개 부분 유방절제술에 대한 경험 및 5년 추적 관찰의 결과

강동우 ( Dong Woo Kang ),김연선 ( Yon Seon Kim ),조홍래 ( Hong Rae Jo ),고병균 ( Byung Kyun Ko ) 대한임상종양학회 2010 Korean Journal of Clinical Oncology Vol.6 No.2

목적: 유방보존술은 유방암 치료의 표준 술식으로 확립되어져 왔다. 그러나 유방보존술이 유방의 전체적인 모양을 유지시킬 수는 있으나, 수술 후 발생하는 피부 반흔은 미용적으로 해결해야 하는 문제였고 더 나은 미용 효과를 위해 내시경을 이용한 수술이 시도되었다. 저자들은 내시경을 이용한 유륜부절개 부분 유방절제술(transareolar endoscopic partial mastectomy)에 대한 임상 경험을 보고하고, 향후 유방암 수술에 대한 새로운 술식으로서의 이용 가능성에 대하여 알아 보았다. 대상 및 방법: 2005년 2월부터 2005년 6월까지 15명의 유방암 환자가 내시경을 이용한 유륜부절개 부분 유방절제술을 시행 받았다. 반달 모양의 절개창을 유륜 주위에 넣은 후 VisiportTM를 이용하여 유선조직을 피부로부터 박리하였고 preperitoneal distention balloon system (PDB)을 이용하여 유선조직을 후유방조직으로부터 박리하였다. 유선조직 상부와 하부의 충분한 박리 후에 안전한 절단면을 가진 종양조직을 제거하였다. 수술 후 경과 관찰을 위해 6개월 간격으로 5년 동안의 추적관찰을 시행하였다. 결과: 환자의 평균 나이는 47.5세였고, 종양의 평균 크기는 2.0 cm (1.3-3.0) 이었다. 유두로부터 종양까지의 거리는 평균 4.0 cm (2.5-5.0) 이었다. 15명의 환자 모두에서 안전한 절단면을 얻을 수 있었으며 수술 5년 경과 후 추적관찰에서도 국소재발은 없었다. 1명에서 흉막으로의 원격전이가 발생하였으나 국소재발은 없었다. 수술 후 미용적 만족도 평가를 위해 설문 조사를 시행하였으며 추적이 소실된 1명과 원격전이가 발생한 1명을 제외한 13명 모두에서 만족도가 높은 것으로 평가되었다. 결론: 내시경을 이용한 유륜부절개 부분 유방절제술은 미용적 측면에서 매우 효과적이고 유용한 술식으로 생각되나 향후 더 많은 환자군을 대상으로 하는 연구가 필요할 것이다. Purpose: Breast conserving surgery has been a standard surgery for breast cancers. This operation has a great cosmetic advantage over total mastectomy. Although breast conserving surgery can retain a good shape of the breast, an operation scar would be a disadvantage. Endoscopic surgery can be performed via a small and remote incision that becomes inconspicuous after surgery. We therefore designed transareolar endoscopic partial mastectomy in breast conserving surgery for breast cancer. Materials and Methods: Fifteen patients with breast cancer underwent transareolar endoscopic partial mastectomy. A semicircular incision was made around areolar and skin flap was made by using VisiportTM and deepened to the lateral edge of the mammary gland. For mobilization of the mammary gland from pectoralis muscle, we used a preperitoneal distention balloon system (PDB). The PDB allowed us to mobilize sufficiently mammary gland from the pectoralis muscle. After freeing half of the mammary gland, tumor was excised without difficulty with negative margins. Results: The mean age of patients was 47.5 years. The mean tumor size was 2.0 cm (range: 1.3-3.0 cm) and the mean tumor distance from nipple was 4.0 cm (range: 2.5-5.0 cm). In all patients, the tumor was excised with negative margins. After a mean follow up of 5 years, no patient had local recurrence, but one patient experienced distant metastasis. A patient satisfaction survey showed that all of patients evaluated the surgery as “Good”. Conclusion: Transareolar endoscopic partial mastectomy is an effective technique and feasible with a good cosmetic results. However, further study with more patients and long-term follow-up is needed.