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김진복(Jin Pok Kim),송인성(In Sung Song),최규완(Kyoo Wan Choi),최병인(Byung Ihn Choi),박재갑(Jae Gahb Park),김영우(Young Woo Kim),김용일(Yong Il Kim),정현채(Hyun Chae Jung),홍성국(Song Cook Hong),이건욱(Kuhn Uk Lee),최국진(Kuk Jin Ch 대한소화기학회 1990 대한소화기학회지 Vol.22 No.3
N/A To increase the survival rate of colorectal cancer, which represents 6% of all malignancies in Korea, early diagnosis is most important. We analyzed the 31 cases of early colorectal cancer who were admitted to Department of Surgery, Seoul National University Hospital from January 1970 to December 1989. The results were follows; 1) The incidence of early colorectal cancer among surgically treated colorectal cancer was 1.9% (31 cases out of 1615 cases). 2) The common symptoms were anal bleeding (81%), constipation (41%), and small caliber stool (26%). 3) The 17 cases out of 18 cases (95%) which were located within 12cm from anal verge were palpated as mass by digital examination, and 24 cases out of 27 cases (82%) were detected as mass by colon study, and 25 cases out of 28 cases (90%) were diagnosed as malignancy by sigmoidoscopic biopsy. 4) In early colorectal cancer with polyp remnant, 8 cases out of 27 cases (30%) were confined to mucosa and 18 cases out of 27 cases (70%) were confined to submucosa. In early colorectal cancer without polyp remnant all 4 cases (100%) were confined to submucosa. 5) In early colorectal cancer with polyp remnant, histologic type of polyp were tubular polyp in 9 cases (33%), villotubular polyp in 6 cases (22%), and villous polyp in 12 cases (45%). 6) The size of tumor were 1.4 cm (1 case), from 1 cm to 2 cm (5 cases), from 2 cm to 4 cm (14 cases) from 4 cm to 6 cm (5 cases), 7 cm (1 case), 8 cm (2 cases) and 13 cm (1 case). 7) Thirteen patients were operated more than 5 years ago and two of them died. One died of pulmonary metastasis of cervix cancer, and the other of unknown cause. 8) Eighteen patients were operated during recent 5 years and one of them died of chronic renal failure.
김진복(Jin Pok Kim),송인성(In Sung Song),최규완(Kyoo Wan Choi),박재갑(Jae Gahb Park),이건욱(Kuhn Uk Lee),최국진(Kuk Jin Choe),정승용(Seung Yong Jeong) 대한소화기학회 1993 대한소화기학회지 Vol.25 No.5
N/A There were 158 cases of ulcerative colitis, which were computerized in Seou1 National University Hospital Medical Record Room, from January 1980 to February 1993. We reviewed 122 r,ases, which medical records were available, and treated at our hospital. The mast prevalent age groups of these patients were fourth and fifth decades and a male t.o femalc ratio was 1:2.1. Among l22 patients, 16 patients (13.19:) had undergone operations, and their most common indica tions of operations were medical intractability (12 cases). The initial procedures for 16 patients were 8 total proctocolectomies (including 6 Kock's pouche. and 2 Bronke ileostomies), a total colectomy with ileorectal anastomosis, a total colectomy with ileostomy, a total colectomy and rectal mucosectomy virith ileal pouch-anal anastomosis, a right hemicolectomy, a left hemicolectomy with transverse collostomy, a segmental resection of colon, a colostomy, a terminal ileostomy. After the initial procedures, l0 operations were performed additionally in 7 patient.;, 2 cases of total proctocolectomies (1 Korks pouch, 1 Brooke ileostomy), 1. case of rectal mucosectomy with ileal pouch-anal anastomosis, 4 cases of conversion to Brooke ileostomy, 3 cases of revision of nipplc valve, pouch, ileostomy. Total proctocolectomy with Kocks pouch was performed most commonly (in 7 patients), but 6 of them sufferred from complications, most of which were related to pouches and nipple valves. Nowadays, total colectomy, rectal mucosectomy and ileal pouch-anal anastomosis is regarded a. the standard operation for patients of ulcerative colitis, but we have performed this procedure in only two patients, ecently. Although their results are unknown due to short duraticn of follow up adoption of this procedure in the surgical management af alcerative colitis will be required.
위장관 ( 胃腸管 ) : 고유근층 대장암의 임상적 고찰
김진복(Jin Pok Kim),송인성(In Sung Song),최규완(Kyoo Wan Choi),최병인(Byung Ihn Choi),박재갑(Jae Gahb Park),김용일(Yong Il Kim),김영우(Young Woo Kim),정현채(Hyun Chae Jung),홍성국(Song Cook Hong),이건욱(Kuhn Uk Lee),최국진(Kuk Jin Ch 대한소화기학회 1991 대한소화기학회지 Vol.23 No.2
N/A If detected in early stage and appropriate treatment ensued immediately, the cure rate of colorectal cancer would be increased. But, the proportion of early colorectal cancer in Seoul National Uneversity Hospital was only 1.9% of operated cases. We reviewed the medical records of 192 patients underwent curative resection for proper muscle (PM) colorectal cancer between 1970 and 1989 retrospectively speculating that these lesions are more advanced than early colorectal cancer but earlier than advanced colorectal cancer. Follow-up information for survival data was available for 151 patients (93%) among 163 patients between 1980 and 1989. The results for the PM colorectal cancer are followings. 1) The proportion was not increasing. Mean proportion between 1970 and 1989 was 12%. 2) The tumor smaller than 2 cm occupied 10% of PM colorectal cancer comparing to 0.86% in total colorectal cancer in the same duration. 3) Node negative lesion comprised 77% comparing to 52%. in total colorectal cancer. 4) Five year survival rate was 84% overall (n=163, 1980-1989), 88% in node negative group (n= 125), 69% in node positive group (n =38) (p value<0.05). 5) The overall recurrence rate was 13.5%(26/192). The recurrence rate as to tumor size was 6.7% in the group which had the lesion smaller than 2 cm, 11% in the group with 2 to 5 cm, 199. in the group larger than 5 cm. Node negative group had recurrence rate of 9.5% (14/148), on the contrary, 27% in node positive group (12/44). 6) In node negative group, the subgroup with the lesion smaller than 2 cm had no recurrence and had 92%: five year survival rate but, the subgroup with larger than 2 cm had 10%: recurrence rate and 85%, five year survival rate. As a conclusion, PM colorectal cancer without lymph node metastasis and smaller than 2 cm size had no recurrence and survived well above 90%. And it is reasonable to consider the possibility of systemic spread even in lymph node negative PM colorectal cancer if the trmor size exceeds 2 cm.
위전절제후의 식도공장문합술에 관한 고찰 - 원위 공장낭 형성술에 대하여 -
김진복(Jin Pok Kim),최상경(Sang Kyung Choi),박재갑(Jae Gahb Park),오승근(Seung Keun Oh),최국진(Kuk Jin Choi) 대한소화기학회 1984 대한소화기학회지 Vol.16 No.1
N/A There are many complications after total gastrectomy such as reflux esophagitis, dumping syndrome, malnutrition, weight loss, leakage from the esophagojejunostomy site. For the purpose of reducing the complications, variable methods of gastrointestinal reconstruction are reported. Distal jejunal pouch construction was first reported by Paulino F and Roselli A in 1973 with excellent results compared to proximal jejunal pouch construction. From Nov. 1981 to Apr. 1983, total gastrectomy with distal jejunal pouch construction was performed in 15 patients, 10 gastric Ca., 4 lymphoma, 1 chronic peptic ulcer, at the Department of Surgery, College of Medicine, Seoul National University Hospital. The results were 1) In five patients, six complications occurred which were, one subphrenic abscess, one pneumonia, one immediate postoperative ileus and one postoperative bleeding and two late ileus. There was no specific complication related to distal jejunal pouch except the postoperative bleeding in 46 year old female with liver cirrhosis. Bleeding from the Levin tube was found immediate postoperatively and she was managed conservatively for 2 days. On 3rd day, exploration was done. The bleeding site was found in the jejunal pouch. We thought that the causes of bleeding was due to faulty operative technique plus bleeding tendency from the coagulation factors deficiency and portal hypertension. The jejunal pouch was reveiwed and replaced by Reux-en-Y esophagojejunostomy. She recovered well. 2)Mean operative time was 3.9 hours and mean postoperative hospital stay was 15 days. Comparing to the previous data of our hospital between 1975 and 1980, operative time was shortened from 4.9 hours to 3.9 hours and hospital stay was reduced from 18 days to 15 days. It was due to the fact that operative technique of distal jejunal pouch was simple
김진복(Jin Pok Kim),송인성(In Sung Song),최규완(Kyoo Wan Choi),최병인(Byung Ihn Choi),박재갑(Jae Gahb Park),김용일(Yong Il Kim),정현채(Hyun Chae Jung),최국진(Kuk Jin Choe),서정민(Jeong Meen Seo),한상욱(Sang Uok Han),이기형(Kee Hyung 대한소화기학회 1993 대한소화기학회지 Vol.25 No.5
N/A Hereditary nonpolyposis colorectal cancer (HNPCC) is characterized by the development of colorectal cancer at an early age, a preponderance of tumors in the proximal colon and an excess of synchronous and metachronous colorectal cancer. When HNPCC is confirmed, a subtotal colectomy is indicated at the time of initial colon cancer treatment. To study the current status of Korean HNPCC patients and the appropriate treatment for the Korean HNPCC patients, we investigated the 10 HNPCC families registered in Korean Hereditary Colorectal Cancer Registry. Ten HNPCC families included 41 (31 males and 10 females) colorectal cancer patients. Operative and pathologic records are available from 25 HNPCC patients. Twenty five patients received 30 operations: 8 cases of right hernicolectomy, 8 cases of left hemicolectmoy, 4 cases of anterior resection, 5 cases of low anterior resection, 2 cases of abdominoperineal resection, 2 cases of subtotal colectomy and 1 case of total colectomy. Eleven patients (44%) of those 25 HNPCC patients had the synchronous, metachronous colorectal cancer or combined colorectal polyps. Because 10 patients of those eleven patients with cornbined colorectal tumors had the lesions in both side of large bowel, we recommended that the resection of colon for Korean HNPCC patients should be more than subtotal colectomy.