부인과 암수술에 있어서 외과의사의 역할

최평화(Pyong Wha Choi),유창식(Chang Sik Yu),정상훈(Sang Hun Jung),김대동(Dae Dong Kim),홍동현(Dong Hyun Hong),김희철(Hee Cheol Kim),김진천(Jin Cheon Kim) 대한외과학회 2008 Annals of Surgical Treatment and Research(ASRT) Vol.74 No.4

Purpose: Resection of the bowel or solid organs may be required for pelvic tumor surgery. The present study was performed to assess combined surgical procedures and determine the role of the general surgeon in gynecologic oncology surgery Methods: We performed a retrospective study of 135 patients with gynecologic malignancy who underwent a combined operation with a general surgeon between January 2000 and December 2005 at Asan Medical Center. The purpose of the combined operation was categorized into 3 groups: a tumor debulking operation, a resolution of intraoperative complications by a gynecologic surgeon, or an intraoperative diagnostic change. Results: The incidence of combined operations for debulking, resolution of intraoperative complications, and intraoperative diagnostic changes were 103 cases (76.3%), 22 cases (16.3%), and 10 cases (7.4%), respectively. Ovarian cancer was the most common gynecologic malignancy (74.1%) and the rate of a combined operation with a general surgeon in ovarian cancer was 18.5% during the time period. Colorectal resection was the most common procedure by a colorectal surgeon (61.5%). Twenty four patients (17.8%) experienced postoperative complications, including ileus, wound infection, pancreas leakage, and stomal necrosis, with no significant differences according to the purpose of combined operation, pathologic diagnosis, or bowel preparation. The rate of a preoperative consultation to a general surgeon by gynecologic surgeons in cases with colorectal or solid organ invasion preoperatively was 53.2%. Conclusion: A general surgeon is an important consultant in a debulking operation of gynecologic malignancies, especially ovarian cancer, or treatment of complications. Thorough preoperative evaluation, bowel preparation, and preoperative consultation to a general surgeon is important in gynecologic oncology surgery.

개복술로 제거한 직장이물질(유리잔)

최평화(Pyong Wha Choi),이정민(Jung Min Lee),허태길(Tae Gil Heo),박제훈(Je Hoon Park),이명수(Myung Soo Lee),김철남(Chul Nam Kim),장석효(Surk Hyo Chang) 대한외과학회 2008 Annals of Surgical Treatment and Research(ASRT) Vol.74 No.6

Anorectal trauma associated with retained rectal foreign body is an infrequent clinical problem, but presents a challenge to physicians taking care of patients with this problem. We report a case of rectal foreign body (glass cup) extracted by laparotomy. A 49-year-old male with a history of alcoholism presented to the emergency room four days after inserting a glass cup into his rectum. He complained of vague anal pain and failure to pass flatus or stool for four days. He had attempted to extract the glass cup using various methods (digital, instrumental manipulation, enema), none of which was successful. Computed tomography revealed a glass cup lodged in the rectum, without complication. The patient was brought to the operating room, administered spinal anesthesia, and placed in lithotomy position after failure of extraction in the emergency room. Although the object was palpable, it could not be extracted either manually or by the use of forceps. We decided to perform an emergent laparotomy under general anesthesia. After the abdomen was opened, an attempt was made to milk the object toward the distal rectum. However, this proved to be impossible secondary to severe rectal mucosal edema. The glass cup was eventually extracted through performing a colotomy at the rectosigmoid junction, with primary repair. The patient’s postoperative course was uneventful, and he was discharged on the eighth postoperative day.

성인 서혜부 탈장 473예 임상적 분석

정성원(Sung Won Jung),허태길(Tae Gil Heo),이정민(Jung Min Lee),최평화(Pyong Wha Choi),박제훈(Je Hoon Park),이명수(Myung Soo Lee),김철남(Chul Nam Kim),장석효(Surk Hyo Chang) 대한외과학회 2008 Annals of Surgical Treatment and Research(ASRT) Vol.75 No.2

Purpose: This article compares the results of various methods of inguinal hernia repair in adults. Methods: We retrospectively reviewed the medical records of 473 patients over 20 years of age who received an inguinal hernia repair procedure between January 2000 and June 2007. We analyzed the patients’ clinical factors and outcomes, dividing them into five groups according to method of repair: Bassini group, Lichtenstein group, mesh plug group, Prolene Hernia System (PHS) group, and laparoscopic group. Results: The mean number of used analgesics was significantly smaller in the PHS group than in other groups (P<0.05, PHS group: 0.46, Bassini group: 1.55, Lichtenstein group: 1.20, mesh plug group: 0.82, laparoscopic group: 1.44). The mean operation time was significantly shorter in the PHS group than in the other groups (P<0.05, PHS group: 45.18 min, Bassini group: 59.85 min, Lichtenstein group: 68.20 min, mesh plug group: 66.73 min, laparoscopic group: 83.33 min). Finally, the mean postoperative hospital staywas significantly shorter in the PHS group than in the other groups (P<0.05, PHS group: 2.93 day, Bassini group: 4.96 day, Lichtenstein group: 4.17 day, mesh plug group: 4.01 day, laparoscopic group: 5.11 day). Out of five groups, there was onecase of postoperative recurrence in the Bassini group. Conclusion: Mesh PHS operation is a more preferred method of inguinal hernia repair in adults because it offers a lower postoperative pain, shorter operation time, shorter postoperative hospital stay.

장관 기종의 임상적 고찰

민선영(Sun Young Min),김재일(Jae Il Kim),최평화(Pyong Wha Choi),박제훈(Je Hoon Park),허태길(Tae Gil Heo),이명수(Myung Soo Lee),김철남(Chul Nam Kim),장석효(Surk Hyo Chang),김한성(Han Seong Kim) 대한외과학회 2010 Annals of Surgical Treatment and Research(ASRT) Vol.79 No.6

Purpose: Pneumatosis intestinalis (PI) is increasingly being detected in recent years with the more frequent use of computerized tomography (CT). The present study was performed to evaluate the clinico-radiologic characteristic presentation of PI and to determine the prognostic factors for mortality. Methods: Fifteen patients who were diagnosed with PI on CT between June 2000 and May 2010 were retrospectively reviewed. Age, sex, location of PI, presence of portal vein gas, time to diagnosis, American Society of Anesthesiologists (ASA) classification, Acute Physiology And Chronic Health Evaluation Ⅱ (APACHE Ⅱ), acidosis, shock, and other associated findings were analyzed for their association with outcome. Results: Fifteen patients (7 males and 8 females, average age, 60.3 years) were diagnosed with PI. Mortality rate was 47% (7 patients). The mortality rate in patients with septic shock, APACHE Ⅱ score (18), acidosis (pH<7.36) were all 100%, 87%, 100%, respectively (P<0.05). Age, sex, location of PI, portal vein gas, time to diagnosis, ASA classification, associated findings did not show statistical difference. Conclusion: Shock, APACHE Ⅱ score (18) and acidosis were associated with high mortality in patients with PI. So, more intensive management and interest are recommended in patients with shock, APACHE Ⅱ score (18), and acidosis due to PI.

외상성 췌장 손상의 임상 결과 및 예후인자

이홍태 ( Hong Tae Lee ),김재일 ( Jae Il Kim ),최평화 ( Pyong Wha Choi ),박제훈 ( Je Hoon Park ),허태길 ( Tae Gil Heo ),이명수 ( Myung Soo Lee ),김철남 ( Chul Nam Kim ),장석효 ( Surk Hyo Chang ) 대한외상학회 2011 大韓外傷學會誌 Vol.24 No.1

Purpose: Even though traumatic pancreatic injuries occur in only 0.2% to 4% of all abdominal injuries, the morbidity and the mortality rates associated with pancreatic injuries remain high. The aim of this study was to evaluate the clinical outcomes of traumatic pancreatic injuries and to identify predictors of mortality and morbidity. Methods: We retrospectively reviewed the medical records of 26 consecutive patients with a pancreatic injury who underwent a laparotomy from January 2000 to December 2010. The data collected included demographic data, the mechanism of injury, the initial vital signs, the grade of pancreatic injury, the injury severity score (ISS), the revised trauma score (RTS), the Glasgow Coma Scale (GCS), the number of abbreviated injury scales (AIS), the number of associated injuries, the initial laboratory findings, the amount of blood transfusion, the type of operation, the mortality, the morbidity, and others. Results: The overall mortality rate in our series was 23.0%, and the morbidity rate was 76.9%. Twenty patients (76.9%) had associated injuries to either intra-abdominal organs or extra-abdominal organs. Two patients (7.7%) underwent external drainage, and 18 patients (69.3%) underwent a distal pancreatectomy. Pancreaticoduodenectomies were performed in 6 patients (23.0%). Three patients underwent a re-laparotomy due to anastomosis leakage or postoperative bleeding, and all patients died. The univariate analysis revealed 11 factors (amount of transfusion, AAST grade, re-laparotomy, associated duodenal injury, base excess, APACHE II score, type of operation, operation time, RTS, associated colon injury, GCS) to be significantly associated with mortality (p<0.05). Conclusion: Whenever a surgeon manages a patient with traumatic pancreatic injury, the surgeon needs to consider the predictive risk factors. And, if possible, the patient should undergo a proper and meticulous, less invasive surgical procedure. (J Korean Soc Traumatol 2011;24:1-6)

대장조루술 시 수술 전 장루위치 표시의 의의

최평화,유창식,조영규,홍현기,이혜옥,김미숙,김희철,김진천 대한대장항문학회 2001 Annals of Coloproctolgy Vol.17 No.6