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갑상선 결절 환자에서 혈청 갑상선자극호르몬 수치와 고분화 갑상선암과의 연관성에 관한 분석
정성엽,김훈엽,류우상,우상욱,손길수,이재복,배정원,Sung Yup Joung,Hoon Yub Kim,Woo Sang Ryu,Sang Uk Woo,Gil Soo Son,Jae Bok Lee and Jeoung Won Bae 대한갑상선-내분비외과학회 2010 The Koreran journal of Endocrine Surgery Vol.10 No.4
Purpose: This study investigated the effects of serum thyroid-stimulating hormone (TSH) levels in predicting malignancy-associated differentiated thyroid cancer (DTC) and benign thyroid nodules. Methods: Between January 2005 and December 2007, 346 patients underwent thyroid surgery at one hospital. Their records were retrospectively reviewed. Results: Sixty-nine percent (237 of 346) of the patients had DTC. The mean preoperative TSH level was higher than in the malignant group (5 uIU/ml vs 0.4 uIU/ml). The rate of malignancy was the 71% in patients with TSH levels >5 uIU/ml. The TSH level of DTC with metastasis of the lymph node was higher than that with non-metastasis (3.08 uIU/ml vs 2.09 uIU/ml, P<0.01) Conclusion: The likelihood of DTC increases with higher serum TSH concentration. Serum TSH level might be useful in predicting malignant nodular thyroid lesion. (Korean J Endocrine Surg 2010;10:220-223)
갑상선 유두암 환자에서 경부 림프절 재발에 대한 최소 갑상선외 침습의 임상적 중요성
황성배(Seong-Bae Hwang),류우상(Woo-Sang Ryu),서우형(U-Hyoung Seo),이재복(Jea-Bok Lee),배정원(Jung-Won Bae),구범환(Bum-Hwan Koo) 대한외과학회 2007 Annals of Surgical Treatment and Research(ASRT) Vol.73 No.5
Purpose: Extra-thyroidal extension has been recognized as a poor prognostic factor for increased regional recurrence risk in papillary thyroid carcinoma, and is known to require treatment that is more aggressive. In the recent UICC TNM 6th Classification, an extra-thyroidal extension was divided into a minimal extra-thyroidal extension (T3) and a massive extra-thyroidal extension (T4). The aim of this study was to investigate the clinical effect of a minimal extra-thyroidal extension of a papillary carcinoma for the recurrence of regional cervical lymph nodes. Methods: We retrospectively studied 154 patients with papillary thyroid carcinoma where a thyroidectomy was performed from Feb. 2003 to May. 2006 at the Department of Surgery, with the exclusion of 6 patients with a massive extra-thyroidal extension. We divided the cases into a no extra-thyroidal extension group and a minimal extra-thyroidal extension group according to the grading of the extra-thyroidal extension. The grading of the extra-thyroidal extension was based on both pathological findings and intraoperative surgical findings. Clinicopathological factors associated with each group were analyzed by univariate and multivariate analysis. We divided the cases into two groups according to age (<45 yrs, ≥45 yrs) and lymph node status (positive, negative), and compared each group with regards to disease free survival according to the grading of the extra-thyroidal extension. Results: By univariate analysis, a minimal extra-thyroidal extension was related to lymph node metastasis, tumor size, mutifocality (P<0.05), and was not related to cervical lymph node recurrence statistically (P=0.108). Cervical lymph node recurrence was related to being male, lymph node metastasis and tumor size (P<0.05). By multivariate analysis, a minimal extra-thyroidal extension was independently related to tumor size, multifocality, and lymph node metastasis (P<0.05). In both groups with regards to age and lymph node status, a minimal extra-thyroidal extension was not statistically related to disease free survival (P>0.05). Conclusion: We need to downstage to less than T3 for a minimal extra-thyroidal extension because there is no significant difference in disease free survival according to the grading of an extra-thyroidal extension in patients with papillary thyroid carcinoma.
갑상선 미세유두암에서 갑상선 주변 조직 침윤(Minimal Extrathyroid Extension)의 임상적 의의
이재복,김훈엽,우상욱,류우상,이정아,손길수,배정원,이유미<SUP>1<.SUP>,Jae Bok Lee,Hoon Yub Kim,Sang-Wook Woo,Woo Sang Ryu,Jung Ah Lee,Gil Soo Son,Jung-Won Bae,and Yu Mi Lee,Ph.D.<SUP>1<.SUP> 대한갑상선-내분비외과학회 2008 The Koreran journal of Endocrine Surgery Vol.8 No.4
Purpose: The prognosis of papillary thyroid carcinoma is determined by such risk factors as old age, male gender, a large tumor size and extrathyroid extension. The aim of this study was to investigate the value of extrathyroid extension for the recurrence of papillary microcarcinoma and its association with the risk factors for papillary thyroid carcinoma. Methods: We retrospectively studied 167 patients with papillary microcarcinoma and who underwent thyroidectomy from Feb. 2003 to Dec. 2008. Papillary microcarcinoma (PTMC) was defined as a tumor smaller than 1 cm and an extrathyroid extension was identified by the pathological findings. Age, gender, extrathyroid extensions, the operative methods, lymph node metastasis and the MACIS score were analyzed by the appropriate statistical methods. Results: Patients with PTMC showed a lower MACIS score, fewer lymph node metastasis and less extrathyroid extension, as compared to the patients with papillary thyroid carcinoma. Total thyroidectomy and selective lymph node dissection were less frequently done in the patients suffering with PTMC. Analysis of the risk factors showed that PTMC had a close relationship with lymph node metastasis, the extent of surgery and multifocal cancer. The disease free survival rate of the patients with PTMC was statistically related with lymph node metastasis, but not with an extrathyroid extension (P=0.001). Conclusion: The patients with PTMC showed less lymph node metastasis and extrathyroid extension as compared to the patients with PTC. Lymph node metastasis of PTMC is an independent factor for disease free survival, but minimal extrathyroid extension is not related with recurrence. PTMC with lymph node metastasis should be regarded as an aggressive large tumor and lymph node dissection should be done. (Korean J Endocrine Surg 2008;8:243-249)
미세유방재건술시 깊은 아래 배벽 동맥의 해부학적 변형에 대한 임상 보고
장서윤,김덕우,동은상,윤을식,류우상,손길수,Jang, Seo-Yoon,Kim, Deok-Woo,Dhong, Eun-Sang,Yoon, Eul-Sik,Ryu, Woo-Sang,Son, Gil-Soo 대한미세수술학회 2011 Archives of reconstructive microsurgery Vol.20 No.1
Autologous breast reconstruction after mastectomy in breast cancer patient is now increasing. The deep inferior epigastric artery (DIEA) free flap is well known as an ideal donor site for the microsurgical breast reconstruction. The branching pattern of the DIEA was well described in the literature. In that study, DIEA has three branching patterns near the arcuate line. We describe a case in which branching variation of the DIEA before entering the posterior surface of the rectus abdominis muscle. In three cases, DIEA originated from the external iliac artery ascended as a double trunk at 1cm, 2cm, and 4cm above the originating point, respectively. In one case, DIEA ascended as a single trunk along the linea alba toward to the umbilicus until it supply overlying subcutaneous tissue. Preoperative 3D computed tomographic angiography to identify the anomaly is recommended and meticulous dissection to the originating point of DIEA is needed.