Reconstruction of a Large Cricotracheal Defect Using a Sternocleidomastoid Myoperiosteal Flap : A Case of Locally Aggressive Papillary Thyroid Carcinoma with Tracheal Invasion

김상민,김미라,김용완,백무진,박준욱,Kim, Sang Min,Kim, Mi Ra,Kim, Yong-Wan,Baek, Moo Jin,Park, Jun-Ook 대한두경부종양학회 2015 대한두경부 종양학회지 Vol.31 No.1

기관을 침범한 갑상선 악성종양을 제거한 후에 성문하부에 비교적 큰 기관 결손이 발생할 수 있다. 단단문합술은 넓은 부위의 결손부를 재건하는 방법으로 널리 받아들여지고 있지만, 문합부 파열, 반회후두신경마비, 재협착 등의 합병증이 발생할 수 있다. 본 증례는 기도를 침범한 갑상선 유두암종을 제거한 후 윤상연골과 기관연골의 비교적 큰 결손부를 흉쇄유돌근 근골막피판을 사용하여 안전하게 재건한 사례이다. 55세 남자 환자가 기도를 침범한 갑상선 유두상암으로 내원하였으며 기도침범은 윤상연골(둘레의 약 30%)과 4개의 기관연골(둘레의 약 50%)을 해당하는 넓은 부위였다. 수술 전 기관절개술을 시행하여 주위 기관연골의 상태가 좋지 않아 단단문합술 시행 후 문합부 파열 가능성이 있다고 판단하여 흉쇄유돌근 근골막피판을 이용하여 재건하기로 계획하였다. 갑상선 절제술, 경부림프절 절제술, 흉쇄유돌근 근골막피판을 이용한 재건술을 시행하였으며 수술 후 12일째 별다른 문제없이 퇴원하였다. 환자는 수술 후 현재 22개월 간 기도 협착 등의 별다른 합병증 없이 지내고 있다. 흉쇄유돌근 근골막피판은 성문하부나 기관지 전외측벽의 비교적 큰 결손부를 재건하는 데 유용하게 사용될 수 있다.

국소 침범한 갑상선암에서 부분 인후두부분절제술을 통한 후두 보존 2예

국진호 ( Jin-ho Kook ),박준욱 ( Jun-ook Park ),주영훈 ( Young-hoon Joo ),선동일 ( Dong-il Sun ),김민식 ( Min-sik Kim ) 대한갑상선학회 2010 International Journal of Thyroidology Vol.3 No.2

The surgical treatment of advanced hypopharynx or thyroid cancer with infiltration of the laryngeal skeleton often needs total laryngectomy for oncologic safety and functional reasons, although tumor infiltration is limited to the half of the larynx. We have performed partial pharyngolaryngectomy in locally advanced laryngopharyngeal cancer to preserve the laryngeal function by the reconstruction of radial forearm free flap with tendon. We have applied the partial pharyngolaryngectomy in locally advanced thyroid cancer with laryngeal invasion in two cases which are needs to take a total laryngectomy. In the cases, we had completely resection of the tumor with sufficient margin including supraglottis and paraglottic space, and reconstructed the defect by using the radial forearm free flap. The oncological and functional results were satisfactory.

Relationship between High Risk Human Papillomavirus and Young Patients and Nonsmokers in Squamous Cell Carcinoma of the Tonsil in Korea

주영훈,정찬권,조광재,선동일,박준욱,김민식,Joo, Young-Hoon,Jung, Chan-Kwon,Cho, Kwang-Jae,Sun, Dong-Il,Park, Jun-Ook,Kim, Min-Sik The Korean Society for Head and Neck Oncology 2011 대한두경부 종양학회지 Vol.27 No.1

연구 및 목적 : 이번 연구의 목적은 한국인에서 편도 편평세포암종의 발생에 고위험 인간유두종 바이러스(high risk human pap-illomavirus)의 역할 및 관여 인자에 대해 밝히고자 한다. 재료 및 방법 : 연구는 편도 편평상피세포암종으로 진단받은 54명을 대상으로 하였다. 고위험 인간유두종 바이러스의 감염을 알기위해 in situ hybridization 방법을 이용하였다. 고위험 인간유두종 바이러스의 감염과 나이, 성별, 흡연, 음주, 병기, 병리학적 특징 등과의 관계를 분석하였다. 결 과 : 고위험 인간유두종 바이러스의 양성율은 31.5%(17/54)였다. 고위험 인간유두종 바이러스 감염은 젊은 연령(50세 미만), 비흡연자, 림프절 전이와 유의한 상관관계가 있었다(각각 p=0.008, p=0.042, p=0.027). 하지만 성별, 음주, 원발부위 병기, 종양분화도, 피막외침범, 혈관 및 신경 침범과 고위험 인간유두종 바이러스와의 관계는 통계적으로 유의하지 않았다. 6개월 이상 추적 관찰이 가능한 환자를 대상으로 조사한 5년 전체 생존율 및 질병 특이 생존율은 각각 60%와 62%였다. 고위험 인간유두종 바이러스의 양성율은 질병 특이 생존율과 유의한 상관관계가 있었다(p=0.019). 결 론 : 한국인의 고위험 인간유두종 바이러스 감염은 젊은 연령 및 비흡연자의 편도 편평세포암종의 발생에 관련이 있고 예후 인자로 중요한 역할을 한다.

양성자펌프억제제에 반응하지 않는 인두이물감 환자에서 "뮤코미스트Mucomyst^®" 객담제거 및 상기도 염증치료를 통한 증상개선효과 평가 다기관, 단일군, 전향적 관찰 연구

박한나,박일석,이상혁,이승원,이상준,이병주,천용일,박준욱,오경호,신유섭,Park, Hannah,Park, Il-Seok,Lee, Sang Hyuk,Lee, Seung-Won,Lee, Sang Joon,Lee, Byung-Joo,Cheon, Yong-Il,Park, Jun-Ook,Oh, Kyoung Ho,Shin, Yoo Seob 대한후두음성언어의학회 2022 대한후두음성언어의학회지 Vol.33 No.1

Background and Objectives Globus pharyngeus is one of the most common symptoms of patients visiting otorhinolaryngology out-patient clinic, and usually long-lasting, difficult to treat, and frequently recurrent. Mucomyst^®, N-acetyl cysteine is an inhalation agent mainly used for mucolysis and reducing inflammation in airway via antioxidative effect. The purpose of this study was to evaluate the efficacy of inhaled Mucomyst^® treatment in patients with globus pharyngeus refractory to proton pump inhibitor (PPI). Materials and Method We prospectively evaluated the efficacy of Mucomyst^® in relieving symptoms of globus pharyngeus refractory to PPI in nine medical centers. Three hundred and three patients enrolled and finally 229 patients finished the inhaled Mucomyst^® therapy for 8 weeks. We analyzed the change of Reflux Symptom Index (RSI), Reflux Finding Score (RFS), Visual Analogue Scale (VAS) for globus, and Globus Pharyngeus Symptom Scale (GPS) after use of Mucomyst^® for 4 and 8 weeks. Results The GPS, RSI, RFS, and VAS score significantly decreased serially in patients who finished 8 week-inhalation treatment. The GPS improvement gap was significantly correlated with initial GPS (p<0.001) in multiple regression analysis. Conclusion Inhaled Mucomyst^® therapy was effective for the reduction of both subjective and objective findings in refractory globus patients. This study might suggest new treatment option for patients with globus. However, further thorough studies would be needed to assess the real effect of inhaled Mucomyst^® treatment as a standard treatment for globus.

두경부암 수술 후 발생한 합병증에서 대흉근피판의 임상적 유용성

주영훈(Young-Hoon Joo),조광재(Kwang-Jae Cho),박준욱(Jun-Ook Park),남인철(In-Chul Nam),선동일(Dong-Il Sun),김민식(Min-Sik Kim) 대한두경부종양학회 2011 대한두경부 종양학회지 Vol.27 No.1

Background and Objectives:The pectoralis major myocutaneous flap(PMMCF) has been considered to be the “workhorse” of pedicled flaps in head and neck reconstruction. Even with the worldwide use of free flaps, the PMMCF is still considered the mainstay in head and neck reconstruction. The aim of the study is to evaluate the application and reliability of the PMMCF in selected cases of head and neck complication. Materials and Methods:We conducted a retrospective review of 14 patients who underwent the surgical reconstruction us-ing the PMMCF due to the complications after head and neck ablative surgery between 1997 and 2007. Out-come measures included the indications of PMMCF, complications and post-operative functional result. Re-sults:PMMCFs were used to reconstruct defects in the following series; wound dehiscence(7 patients), flap failure(4 patients), pharyngocutaneous fistula(3 patients). Flap survival was 100 percent and mean flap size was 67.2cm 2 . Five patients had complications such as pharyngocutaneous fistula, marginal necrosis, carotid blowout. Conclusions:The PMMCF is a safe and convenient method for reconstruction of the surgical com-plications after resection of advanced tumors and can be still used as a salvage procedure after free flaps failure.

갑상선유두암종의 측경부 림프절 전이 인자 분석

서재현 ( Jae-hyun Seo ),주영훈 ( Young-hoon Joo ),박준욱 ( Jun-ook Park ),선동일 ( Dong-il Sun ),김민식 ( Min-sik Kim ) 대한갑상선학회 2010 International Journal of Thyroidology Vol.3 No.1

Background and Objectives: The aim of this study was to evaluate the incidence and risk factors of lateral cervical lymph node metastasis in papillary thyroid carcinoma (PTC). Materials and Methods: A retrospective review of the 47 patients who were diagnosed as PTC and initially treated by total thyroidectomy, central and lateral neck dissection was performed from January 2000 to July 2009. Twenty-nine patients had simultaneous unilateral lateral neck dissection, while 18 had bilateral lateral neck dissection. Results: The median age was 52.3 years (range, 19∼80 years); there were 13 males and 34 females. The rate of ipsilateral cervical lymph node metastasis was 91.5% (43 out of 47). Contralateral cervical lymph node metastasis was present in 12 out of the 18 cases (66.7%). The most frequent sites for ipsilateral positive neck nodes were level IV (74.4%), level III (65.1%), level II (51.2%), level V (23.3%), and level I (2.3%). Contralateral positive lymph nodes were found in level IV (50%), levels II (50%), and level III (41.6%). There was a significant correlation of lateral lymph node metastasis with primary tumor size (more than 2 cm) (p<0.001), lymphatic invasion (p<0.001), capsular invasion (p=0.032), muscle invasion (p<0.001), and level VI metastasis (p<0.001). The multivariate analysis showed that primary tumor size, lymphatic invasion and muscle invasion were significantly correlated with cervical lymph node metastasis (p=0.006, p=0.028 and p=0.007, respectively). Conclusion: In our series, lateral cervical metastases from PTC were commonly present at level IV, III, and II. Large primary tumor size, lymphatic invasion and muscle invasion are associated with lateral cervical lymph node metastasis.

구강 및 구인두 편평상피암종의 림프절 전이에 대한 PET-CT 영상의 유용성

주영훈(Young-Hoon Joo),선동일(Dong-Il Sun),박준욱(Jun-Ook Park),유이령(Ie-Ryung Yoo),김민식(Min-Sik Kim) 대한두경부종양학회 2010 대한두경부 종양학회지 Vol.26 No.1

Objectives :We evaluated the use of FDG PET/CT for the identification of cervical nodal metastases of SCC of the oral cavity and oropharynx with histological correlation. Material and Methods :We reviewed 46 medical records, from January 2004 to July 2007, of patients who underwent FDG PET/CT and CT/MRI for SCC of the oral cavity and oropharynx before surgery. We recorded the lymph node metastases according to the neck level affected and the system used for the imaging-based nodal classification. Results :The FDG PET/ CT had a sensitivity of 75.6% and a specificity of 96.7%;it had a higher sensitivity than the CT/MRI for identi-fication of cervical metastases on the side of the neck(26/28 vs. 20/28, p=0.031) and at each of the cervical levels(34/45 vs. 26/45, p=0.008). There was a significant difference in the SUV max between the benign and malignant cervical lymph nodes(3.31±3.23 vs. 4.22±2.57, p=0.028). The receiver-operating-characteristic (ROC) curve analysis for differentiating the benign from the malignant cervical lymph nodes, showed that the area under the curve(AUC) of the FDG PET/CT was 0.775. The cut-off value for the SUV max was 2.23 based on the ROC curve. There was a significant correlation between the SUV max and the size of the cervical lymph nodes(Spearman r=0.353, p=0.048). Conclusion :FDG PET/CT images were more accurate than the CT/MRI images. In addition, the SUV max cut-off values were important for evaluating cervical the cervical nodes in the patients with SCC of the oral cavity and oropharynx.

Relationship between High Risk Human Papillomavirus and Young Patients and Nonsmokers in Squamous Cell Carcinoma of the Tonsil in Korea

Young-Hoon Joo(주영훈),Chan-Kwon Jung(정찬권),Kwang-Jae Cho(조광재),Dong-Il Sun(선동일),Jun-Ook Park(박준욱),Min-Sik Kim(김민식) 대한두경부종양학회 2011 대한두경부 종양학회지 Vol.27 No.1

연구 및 목적 이번 연구의 목적은 한국인에서 편도 편평세포암종의 발생에 고위험 인간유두종 바이러스(high risk human pap-illomavirus)의 역할 및 관여 인자에 대해 밝히고자 한다. 재료 및 방법 연구는 편도 편평상피세포암종으로 진단받은 54명을 대상으로 하였다. 고위험 인간유두종 바이러스의 감염을 알기위해 in situ hybridization 방법을 이용하였다. 고위험 인간유두종 바이러스의 감염과 나이, 성별, 흡연, 음주, 병기, 병리학적 특징 등과의 관계를 분석하였다. 결 과 고위험 인간유두종 바이러스의 양성율은 31.5%(17/54)였다. 고위험 인간유두종 바이러스 감염은 젊은 연령(50세 미만), 비흡연자, 림프절 전이와 유의한 상관관계가 있었다(각각 p=0.008, p=0.042, p=0.027). 하지만 성별, 음주, 원발부위 병기, 종양분화도, 피막외침범, 혈관 및 신경 침범과 고위험 인간유두종 바이러스와의 관계는 통계적으 로 유의하지 않았다. 6개월 이상 추적 관찰이 가능한 환자를 대상으로 조사한 5년 전체 생존율 및 질병 특이 생존율 은 각각 60%와 62%였다. 고위험 인간유두종 바이러스의 양성율은 질병 특이 생존율과 유의한 상관관계가 있었다 (p=0.019). 결 론 한국인의 고위험 인간유두종 바이러스 감염은 젊은 연령 및 비흡연자의 편도 편평세포암종의 발생에 관련이 있고 예후 인자로 중요한 역할을 한다.