무기하 액와 접근법을 이용한 로봇 갑상선 절제술: 단일 술자에 의한 최초 1년간의 경험

노재형,이정훈,나국영,이잔디,정웅윤<SUP>1<.SUP>,소의영,Jae Hyung Noh,Jeong Hun Lee,Kuk Young Na,Jandee Lee,Ph.D.,Woong Youn Chung Ph.D.<SUP>1 <.SUP>and Euy Young Soh,Ph.D. 대한갑상선-내분비외과학회 2010 The Koreran journal of Endocrine Surgery Vol.10 No.3

Purpose: Various endoscopic thyroidectomy procedures have been designed to minimize visible cervical scarring. However, endoscopic thyroidectomy is a technically challenging procedure that is performed by a limited surgeon. Robotic systems aida surgeon in performing minimally invasive head and neck surgery by offering superior visualization and dexterity. This study reports the initial experience of one surgeon with robotic thyroidectomy to assess the technical feasibility and safety of the approach. Methods: One hundred four thyroid cancer patients (97 females, 7 males; mean age of 39.8±8.1 years) underwent robotic thyroidectomy using gasless transaxillary approach between November 2008 and October 2009 in Ajou University Hospital. All the procedures were completed successfully using the da Vinci surgical system without open conversion. Patient characteristics, postoperative clinical results, complications, and pathologic details were assessed. Results: Total thyroidectomy was performed in 25 (24.0%) patients, subtotal thyroidectomy in 13 (12.5%) patients, and unilateral lobectomy in 66 (63.5%) patients. All patients underwent ipsilateral central compartment neck dissection, and two patients underwent selective lymph node (LN) dissection. The mean operation time was 134.5±47.2 min (range 61∼310 min), in which the actual time for the thyroidectomy with lymphadenectomy (console time) was 56.4 min. (range 31∼270). The mean number of LN resected was 3.9 (range 0∼28). There were no serious complications. The mean hospital stay was 2.9±0.9 days (range 2∼7). Conclusion: Robotic thyroidectomy is a feasible, safe, and cosmetically excellent procedure. The application of robotic technology for thyroid surgeries could be an alternative to endoscopic or conventional open thyroidectomy. (Korean J Endocrine Surg 2010;10:157-162)

위장의 점막 연관성 림프조직 림프종(MALT Lymphoma)의 임상적 고찰

백광열,노재형,허진석,손태성,최성호,조재원,김용일,Paik Kwang Yeol,Noh Jae Hyung,Heo Jin Seok,Sohn Tae Sung,Choi Seong Ho,Joh Jae Won,Kim Yong-Il 대한위암학회 2001 대한위암학회지 Vol.1 No.1

Purpose: The aim of this study was to analyze the clinical and the histopathological characteristics of mucosa associated lymphoid tissue (MALT) lymphomas in the stomach. Materials and Methods: We retrospectively reviewed the medical records of 22 patients who had been treated at Samsung Medical Center from Jan. 1995 to Sep. 2000 and who had been pathologically proven to have a MALT lymphoma. The factors we analyzed were operative procedure, tumor stage, and histopathological characteristics. Results: Of 3658 patients with a gastric malignancy, 22 patients proved to have a MALT lymphoma ($0.6\%$). There were 7 men and 15 women whose ages ranged from 25 years to 70 years (mean, 48.8 years). Forteen cases were located in the antrum, 4 ($18\%$) in the body and 4 ($18\%$) in the fundus or the high body. Nineteen of these patients were managed with total gastrectomy and splenectomy and 3 with radical subtotal gastrectomy. Histopathologically the tumor was limited to the mucosa in 3 patients ($1.36\%$), to the submucosa in 13 ($59.1\%$) and extended to the muscularis propria in 6 ($27.3\%$). Lymph node involvement was seen in 12 patients ($54.6\%$). There was no splenic or hepatic involvement. Bone marrow involvement was not seen in any patients. H. pylori was identified in 11 patients (50$\%$). During the mean follow-up period of 32.7 months, there were no reports of tumor recurrence or death. Conclusion: MALT lymphomas rarely disseminate by the time of diagnosis and rarely involve the bone marrow. Lymph node involvement is relatively high and a total gastrectomy is effective in managing patients with a MALT lymphoma.

위절제술을 받은 위암 환자의 Helicobacter pylori 감염률 측정에 관한 연구

김성,노재형,김성,김용일,김진복,Kim Sung,Noh Jae-Hyung,Kim Sung,Kim Yong-Il,Kim Jin-Pok 대한위암학회 2003 대한위암학회지 Vol.3 No.2

Purpose: This study aims to determine the infection rate of Helicobacter pylori (H. pylori) in gastric cancer patients who received gastrectomies, and to compare the rates of H.pylori infection detected by serological test and that of histopathological test, and to evaluate its clinical meaning. Materials and Methods: Fifty two patients were selected from those who underwent gastrectomies at the Department of Surgery, Samsung Medical Center, from March 1997 to May 1997. The control group consisted of healthy 103 persons visited the center for health promotion in Samsung Medical Center. In both groups, we quantitatively checked serum level of IgG anti H. pylori antibody titer by ELISA using GAP IgG test kit (BioRad, USA) for the serological test, and we microscopically examined the surgical specimen stained by Warthin-Starry silver staining method for the histopathological test. Results: The seropositive rate of H. pylori in the patients' group was $71.2\%$ (37/52), and the control group was $65.0\%$ (67/103). The difference between two groups was statistically significant. However the histopathological study showed that the overall detection rate of H. pylori was $61.5\%$ (32/52) in the patients' group and $61.2\%$ (63/103) in the control group; nd this difference was not statistically significant Conclusion: We could confirm that H.pylori infection rate in the gastric cancer resected patients was statistically higher than in the normal healthy persons even in small population. And the detection method for the H. pylori infection by serological test was presumed to be better than that of histopathological test using surgical specimen. Further study for the larger population by well-organized multicenters will be needed.

췌담관암에서 술 전 및 술 후 CA-19-9 항원의 유용성에 대한 연구

이형근(Hyung Geun Lee),문현종(Hyun Jong Moon),허진석(Jin Seok Heo),노재형(Jae Hyung Noh),손태성(Tae Sung Sohn),최성호(Seong Ho Choi),조재원(Jae Won Joh),김용일(Yong Il Kim) 대한외과학회 2003 Annals of Surgical Treatment and Research(ASRT) Vol.65 No.2

위암조직에서 Cyclin G2 발현의 의의

최민규,홍성권,박승배,백용해,노재형,손태성,김성주,김성,Choi, Min-Gew,Hong, Seong-Kweon,Park, Sung-Bae,Paik, Yong-Hae,Noh, Jae-Hyung,Sohn, Tae-Sung,Kim, Sung-Joo,Kim, Sung 대한위암학회 2005 대한위암학회지 Vol.5 No.4

목적: cyclin G2는 여러 암종에서 세포 주기의 억제적 조절자로 알려져 있으나 위암에서의 발현 양상에 대해서는 거의 보고된 바가 없다. 본 연구에서는 위암에서 cyclin G2의 발현양상을 조사하고 이의 임상적 의의에 대해 알아보았다. 대상 및 방법: 1994년 11월부터 1997년 12월까지 위암으로 수술을 시행 받은 172명 환자의 암 조직에서 cyclin G2의 발현여부를 면역조직화학염색을 통해 조사하고 이에 따른 임상 및 병리학적 특성 비교 및 예후분석을 시행하였다. 결과: 전체 172개의 암조직 중 43예(25.0%)에서 cyclin G2의 발현이 양성이었다. cyclin G2 발현은 임상병기가 진행될수록 양성률이 더 낮게 나타났으며(P<0.001) 종양 침습 깊이가 더 진행된 경우와(P<0.05) 림프절 전이가 있거나(P<0.05) 림프관 침범이 있는 경우에 cyclin G2의 발현율이 낮았다.(P<0.05). 생존물의 비교 시 cyclin G2 양성군이 cyclin G2 음성군에 비해서 유의하게 예후가 좋았다(P<0.001). 다변량 분석 시 종양의 T 병기, 림프절 전이, 림프관 침범 여부가 독립적 예후인자로 유의하였으나 cyclin G2 발현여부는 유의하지 않았다. 결론: cyclin G2는 위암 조직의 25%에서 발현되었으며 이의 발현 음성은 보다 진행된 종양과 연관성이 있었다. cyclin G2는 위암의 증식에 억제 작용을 하는 것으로 생각되며 암 발생기전에 있어 이의 보다 정확한 역할에 대해 보다 많은 연구가 필요할 것으로 생각된다. Purpose: Cyclin G2 has been reported to be a negative cell-cycle regulator in various cancer tissues. However, the pattern of cyclin G2 expression in gastric cancer is relatively unknown. We investigated the expression of cyclin G2 in gastric cancer tissues and evaluated the clinical significance of its expression. Materials and Methods: Well-preserved gastric cancer tissues were consecutively obtained from 172 patients who underwent gastric cancer operations at Samsung Medical Center between November 1994 and December 1997. Cyclin G2 expression in the tissues was examined immunohistochemically, and the clinicopathological features and prognostic significance according to the expression were analyzed. Results: Of the 172 gastric cancer tissues, cyclin G2 expression was positive in 43 tissues (25.0%). According to the stage, cyclin G2 expression was lower in more advanced stages (P<0.001). Negative expression of cyclin G2 was positively correlated with more advanced depth of tumor invasion (P<0.05), presence of lymph-node metastasis (P<0.05) and presence of lymphatic invasion (P<0.05). The prognosis of the cyclin G2(+) group was significantly better than that of the cyclin G2(-) group (P<0.001). Multivariate analysis revealed that T stage, lymph-node metastasis, distant metastasis, and lymphatic invasion were independent prognostic factors, but the expression of cyclin G2 was not. Conclusion: Cyclin G2 was expressed in 25% of the gastric cancer tissues, and negative expression of cyclin G2 was associated with more advanced tumor progression. Cyclin G2 may be a negative cell-cycle regulator in gastric cancer, and further studies are necessary to elucidate its exact role in the mechanism of carcinogenesis.

IV기 조기위암의 임상병리학적 특성

김민국,안지영,최민규,노재형,손태성,김성,Kim, Min Kuk,An, Ji Yeong,Choi, Min Gew,Noh, Jae Hyung,Sohn, Tae Sung,Kim, Sung 대한위암학회 2008 대한위암학회지 Vol.8 No.3

목적: 조기위암이 림프절 전이에 의해 IV기로 진단되는 경우는 매우 드물어 거의 보고된 바가 없다. 이에 저자들은 수술적 치료 후 IV기로 진단된 조기위암 환자들의 임상, 병리학적 특성과 예후를 조사하였다. 대상 및 방법: 2001년 1월부터 2007년 1월까지 삼성 서울병원에서 위암으로 위 절제술을 시행 받은 뒤 IV기 조기위암으로 확진된 10명의 환자들의 임상 병리학적 소견을 분석하였다. 결과: 10명의 환자들 중 남녀 비는 5:5였고 수술 당시 평균연령은 61세였다. 8예에서 근치적 위 아전절제술을 시행하였으며 2예에서는 근치적 위 전절제술을 시행하였다. 절제된 위의 병리 검사에서 10예 모두 점막하층까지 종양이 침윤되어 있었고, 9예에서 림프관 침윤이 있었으며, 평균 45.5개의 절제된 림프절 중 평균 22.2개에서 전이가 있었다. 종양의 크기의 중간값은 5.3 cm이었고, 6예에서 암세포가 Lauren형 조직 분류로 미만형을 보였으며, 이들은 WHO 분류로 저분화형 선암과 인환세포암종을 보였다. 10명 중 9명은 수술 후 항암화학요법을 시행 받았다. 추적 관찰 기간의 중간값은 31개월이었고, 보조 항암화학요법을 시행 받지 않은 1명은 뇌혈관질환으로 사망하였다. 보조 항암화학요법을 시행받은 9명 중 한 명은 암의 재발로 사망하였으며, 추적 검사에서 골 전이를 보인 한 명을 제외한 나머지 7명의 환자들은 현재까지 재발 없이 추적 관찰 중이다. 결론: IV기 조기위암은 점막하층의 침윤 깊이를 보이고, 비교적 큰 종양의 크기, 림프관 침윤 등의 특징을 보인다. 적극적인 수술적 치료 및 보조항암 화학요법을 통해 재발을 줄이고, 향후 이들 위암의 특성에 대한 연구 및 장기적 추적 관찰이 필요하다. Purpose: Stage IV early gastric carcinoma (EGC) is a rare disease. We report here on 10 cases of EGC that showed metastasis in more than 15 lymph nodes. Materials and Methods: A total of 8354 cases of gastric carcinoma in patients who underwent surgical procedures between January 2001 and January 2007 at Samsung Medical Center were studied, and 10 cases were classified as stage IV EGC. We investigated their clinicopathologic characteristics. Results: There were 5 males and 5 females. Their ages at operation ranged from 46 to 76 years with a mean age of 61. All of the 10 patients had undergone curative resection for gastric cancer. The pathological diagnosis confirmed that all of the patients had tumor confined to the submucosa. The median size of the tumors was 5.3cm and the mean number of dissected nodes was 45.5 with a mean number of 22.2 involved nodes. Six cases were classified as the diffuse type and 4 were classified as the intestinal type by Lauren's classification. Histologically, 3 cases were signet ring cell carcinoma, 3 were poorly differentiated, 2 were moderately differentiated and 2 were well differentiated adenocarcinoma. Endolymphatic invasion was found in 9 cases. The median follow-up was 31 months. Adjuvant chemotherapy was done in 9 patients, and the patient who did not receive chemotherapy died by cerebrovascular accident. 2 patient had recurrence of gastric cancer and 7 survived without recurrence. Conclusion: More cases should be collected and further studies on the molecular and cellular tumor characteristics are required to characterize these tumors that show aggressive lymphatic spread.

만성 흉수로 내원하여 황색 조갑 증후군(Yellow Nail Syndrome)으로 진단된

노세희 ( Se Hui Noh ),박경민 ( Gyung Min Park ),천윤희 ( Yoon Hee Chun ),김선영 ( Sun Young Kim ),노재형 ( Jae Hyung Roh ),박태선 ( Tai Sun Park ),김우성 ( Woo Sung Kim ) 대한결핵 및 호흡기학회 2009 Tuberculosis and Respiratory Diseases Vol.67 No.6

Yellow nail syndrome is a rare cause of pleural effusions. This syndrome is characterized by yellow discoloration of nails, lymphedema, and respiratory disorders, including pleural effusion, chronic bronchitis, bronchiectasis, and chronic sinusitis. The etiology of this syndrome is obscure, but the pathogenesis seems to be related with impaired lymphatic drainage. We report a case of yellow nail syndrome in a 70-year-old female with the typical clinical findings (yellow discoloration of nails, lymphedema, and chronic pleural effusion) of this disorder and with proven lymphatic obstruction on lymphoscintigraphy.

전력 구조 개편에 따른 환경 영향 평가 및 경제적 분석을 위한 DECADES 데이터 베이스 구축 및 활용

오영진(Young-Jin Oh),노재형(Jae-Hyung Noh),김발호(Balho H. Kim),전영환(Yeong Han Chun),박종배(Jongbae Park) 대한전기학회 2002 대한전기학회 학술대회 논문집 Vol.2002 No.7

2기 위암환자의 수술 후 보조 항암요법 및 방사선 치료가 생존율에 미치는 영향

홍성권,최민규,백용해,노재형,손태성,김성,Hong, Seong-Kweon,Choi, Min-Gew,Baik, Yong-Hae,Noh, Jae-Hyung,Sohn, Tae-Sung,Kim, Sung 대한위암학회 2005 대한위암학회지 Vol.5 No.4

목적: UICC 분류에 의한 2기 위암환자의 임상병리학적 특징에 대하여 알아보고 수술 후 보조요법으로서의 항암, 방사선 치료가 5년 생존율에 미치는 효과에 대하여 알아보고자 하였다. 대상 및 방법: UICC에 의한 병리학적 분류로 병기2기로 판정된 954명을 대상으로 하였다. 항암치료는 수술 후 3주째부터 5-Fluorouracil $400mg/m^2/day$와 Leucovorin $20mg/m^2/day$를 사용하였으며 방사선 치료는 총 4,500 cGy를 25회로 나누어 시행하였다. 결과: 임상병리학적 인자들의 생존율분석에서 환자의 나이, 수술방법, 종양의 크기와 항암 및 방사선 치료가 의미 있는 예후 인자로 분석되었다. 수술 후 항암 방사선 치료에 따른 생존율 분석에서 보조요법을 시행하지 않은 425예의 5년 생존율은 67.9%, 항암 치료 군 187예는 79.8%, 항암방사선 치료 군 342예는 83.6%로 조사되어 통계적으로 유의한 차이를 보였으며(P<0.0001) 항암치료 군과 항암방사선 치료 군과의 생존율 비교에서는 항암방사선 치료 군에서 생존율의 향상을 보여주기는 하였으나 통계적으로 유의하지는 않았다(P=0.1264). 결론: 2기 위암환자에서 환자의 나이, 수술방법, 종양의 크기 및 수술 후 보조적인 항암 및 방사선 치료가 5년 생존율에 영향을 주는 의미 있는 예후인자로 조사되었다. 수술 후 보조요법의 시행이 통계적으로 의미 있는 생존율을 보였으나 임상병리학적 인자들을 고려한 무작위 연구를 통해 그 의미를 검증해야 할 것으로 생각된다. Purpose: This study was conducted to evaluate the effectiveness and the role of post-operative adjuvant chemoradiation therapy in a stage-II (UICC, 1997) primary gastric cancer. Materials and Methods: From September 1994 to December 2004, 954 stage-II gastric-cancer patients were seen, and all of them underwent a curative resection with extensive (D2) lymph-node dissection. The chemotherapy consisted of fluorouracil $(400mg/m^2)$ plus leucovorin $(20mg/m^2)$ for 5 days, followed by 4,500 cGy of radiotherapy for 5 weeks with fluorourcil and leucovorin on the first 4 days and the last 3 days of radiotherapy. Two five-day cycles of chemotherapy were given four weeks after the completion of radiotherapy. The Kaplan-Meier method was used to estimate the survival rates. To assess the importance of potential prognostic factors, we performed univariate and multivariate analyses using a log-rank test and Cox's proportional hazards regression model. A P value <0.05 was considered significant. Results: Univariate analysis revealed that age, tumor size, gross type, surgical method, and postoperative adjuvant therapy had statistical significance. Among these factors, age, surgical method, tumor size, surgical method, and postoperative adjuvant therapy were found to be independent prognostic factors by using a multivariate analysis. The postoperative adjuvant chemotherapy group and the chemoradiation therapy group had survival benefit compared to the surgery-only group. However the chemoradiation therapy group had no significant survival benefit compared to the chemotherapy group. Conclusion: The postoperative adjuvant therapy in stage-II gastric-cancer patients had significant benefit. Therefore, postoperative adjuvant chemoradiation therapy has an acceptable effect. A large-scale, randomized study is needed to evaluate the effectiveness and the role of postoperative radiation therapy.

위 신경초종 1예

최재혁,장원영,허진석,노재형,손태성,최성호,김성,김용일,Choi Jae Hyuck,Chang Weon Young,Huh Jin Suk,Noh Jae Hyung,Sohn Tae Sung,Choi Sung Ho,Kim Sung,Kim Yong Il 대한위암학회 2002 대한위암학회지 Vol.2 No.2

Schwannoma of the stomach is a rare controversial neoplasm which requires extensive studies to clarify its nature as a stromal tumor or leiomyoma. We describe the pathologic, immunohistochemical, and ultrastructural characteristics of schwannoma of the stomach in a 33-year-old woman. The tumor was a well-circumscribed submucosal mass located in the posterior wall of the midbody of the stomach. Microscopically, the cells were made up of fasciculating bundles of spindle cells featured with peripheral lymphoid cell cuffing. The tumor cells revealed a diffuse, strong immunoreactivity to S-100 protein and vimentin, but were negative to desmin and smooth muscle actin. They also had a focal positive reaction to glial fibrillary acidic protein. Ultrastructurally, many tumor cells showed a number of thin, elongated and interdigitating dendritic-cell-like processes, distinctly uniformed basal laminae, frequent cellular attachments, and microfilaments. These findings support the schwannian nature of the tumor.