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허경열(Kyung Yul Hur),송태건(Tae Geon Song),박경규(Kyung Kyu Park),송영식(Young Sik Song),김익수(Ik Soo Kim) 대한소화기학회 1995 대한소화기학회지 Vol.27 No.6
N/A Background/Ainis: We planed the study to evaluate the ideal procedure in surgical aspect of peptic ulcer through comparision of results in each procedure. Methnds: we reviewed l47 patients treated during l987 to 1993 at department of surgery, Socmchunhyang University Hospital. Results: The indications of operation were perforation(63.3%), obstruction(17.7%), bleeding(15.0%), intractabi- lity(2.0%) and others(2.0%) in order of frequency. Truncal vagotomy and pyloroplasty was perfor- med in 70 patients(47.6%), truncal vagotomy and antrectomy in 27 patients(18.4%), subtotal gastrectomy in 19 patients(I2.9%), truncal vagotomy and gastrojejunostomy in 15 patients(l0.2%.), primary closure in 10 patients(6.8%) and other procedures in 6 patients(4.1 fo). Perioperative morta- lity rate was l.4%(2 patients1 tha( these patients have severe and uncontrolled medical illness. Among 147 cases, follow-up evaluation was possible in 83 cases. The 66 cases(79.6%) was classified excellent and very good group according to Golighers modified Visick classification. In this study, ulcer recurrence rate was as follows: tnmcai vagotomy and antrectomy 0 il,, truncal vagotnmy and pyloroplasty 7.9%, subtotal gastrectomy 9.1Fo, truncal vagotomy and gastrojejunos- tomy 22.2%, and primary closure 60.0%. Reoperation was necessary in 4 cases after antrectomy and truncal vagotomy(14.8'7c), l patient after truncal vagotomy and pyloroplasty(1.5Fo) and 2 cases after truncal vagotomy and gastrojejunostomy(l3.3%). Conclusions: Considering postoperative complication and reoperation rate, we conclude that truncal vagotomy and pyloroplasty was more acceptable and safe procedure than truncal vagotomy and antrectomy in perforated peptic ulcer, even though its re]atively higher recurrence rate. (Korean J Gastroenterol 1995;27: 626-634)
위암에서 림프절 미세전이의 면역조직화학적 방법에 의한 측정 및 생존율과의 상관관계
문철,박경규,이문수,허경열,장용석,김재준,이민혁,진소영,이동화,Moon Chul,Park Kyung-Kyu,Lee Moon Soo,Hur Kyung Yul,Jang Yong Seog,Kim Jae Joon,Lee Min Hyuk,Jin So-Young,Lee Dong Wha 대한위암학회 2002 대한위암학회지 Vol.2 No.1
Purpose: The purpose of this study is to identify immunohistochemical evidence of lymph-node micrometastasis in histologic node-negative gastric cancer patients and to evaluate the prognostic significance of lymph-node micrometastasis.Materials and Methods: A retrospective study of 50 gastric cancer patients who underwent curative resections from October 1990 to November 1994 was performed. Two consecutive sections were prepared: one for ordinary hematoxylin and eosin staining, and the other for immunohistochemical staining with Pan cytokeratin antibody (Novocastra, UK). In the univariate analysis, the survival rate was calculated using the Life Table Method, and the multivariate analysis was determined using a Cox Proportional HazardsModel. The statistical analyses of the relationships between the clinicopathologic factors and micrometastases were performed by using a Chi-square test. Results: Of 2522 harvested lymph nodes, 81 ($4.1\%$) nodes and 19 ($38\%$) of 50 patients were identified as having lymphnode micrometastases by using immunohistochemical staining for cytokeratin. The incidence of lymph-node micrometastases was significantly higher in diffuse type carcinomas ($54\%$, P=0.024) and in patients with serosal invasion ($52.2\%$, P=0.05). For patients with lymph-node micrometastases (n=19), the 5-year survival rate was significantly decreased ($73.7\%$, P=0.015). The Lauren's classirication (P=0.021) and the depth of invasion (P=0.035) were shown by multivariate analysis to have a significant relationship with the presence of micrometastases. Multivariate analysis revealed that lymph-node micrometastasis was independently correlated with survival in histologic node-negative gastic cancer patients. Conclusion: The presence of cytokeratin detected lymphnode micrometastases correlates with the worse prognosis for patients with histologic node-negative gastric cancer.
원형 봉합기를 이용한 위십이지장연결술 시 단측연결과 단단연결의 비교
서민우,김용진,송단,강길호,조규석,이문수,허경열,김재준,Seo, Min-Woo,Kim, Yong-Jin,Song, Dan,Kang, Gil-Ho,Cho, Gyu-Seok,Lee, Moon-Soo,Hur, Kyung-Yul,Kim, Jae-Joon 대한위암학회 2009 대한위암학회지 Vol.9 No.2
목적: 원형 봉합기를 이용한 위십이지장연결술의 가장 대표적인 두 가지 방법(단측연결과 단단연결)의 수술 후 결과를 토대로 그 장단점을 확인하고자 본 연구를 고안하였다. 대상 및 방법: 2005년 3월부터 2008년 2월까지 순천향 대학병원에서 위암 진단 하 위십이지장 연결술을 시행한 134명을 대상으로 하였다. 2005년 3월부터 2006년 9월까지는 연속적으로 단측연결을(단측군, 76명), 2006년 11월부터 2008년 2월까지는 연속적으로 단단연결을 시행했다(단단군, 58명). 두 군을 대상으로 전향적 자료 수집을 통해 수술후 경과를 비교 분석하였다. 결과: 두 근간 모든 임상병리학적 요인에 차이가 없었다. 평균 수술시간은 단측군이 157분($\pm56$), 단단군이 150분($\pm49$)이었으며, 입원기간의 경우 단측군이 10.5일($\pm3.5$), 단단군이 9.4일($\pm2.9$)로 이 역시 두 군간에 차이는 없었다. 합병증과 관련해서 전체적으로 단측군이 15예(19.7%), 단단군은 8예(13.8%)에서 발생하였으며(P=0.489), 연결부위 관련해서 단측군에서 출혈이 2예 및 협착이 2예 있었으며, 단단군의 경우 출혈이 2예에서 있었다(P=0.698). 결론: 원형 봉합기를 이용한 위십이지장연결술은 두 방법 모두 기술적으로 용이하며 안전하였다. 통계적 의의는 없었지만, 연결 부위 협착과 관련해서는 단측군에서만 2예 발생하여 단단군이 더 나은 경향을 보였다. Purpose: The use of automatic circular staplers for gastroduodenostomy after distal gastrectomy is now widely accepted. We compared the clinical outcomes of two different methods. Materials and Methods: Between March 2005 and February 2008, 134 patients with gastric cancer underwent distal gastrectomies. Seventy-six consecutive patients received end-to-side gastroduodenostomies (ES) between March 2005 and September 2006. The remaining 58 consecutive patients received end-to-end gastroduodenostomies (EE) between November 2006 and February 2008. We analyzed the surgical outcomes between the two groups (ES versus EE) on the basis of prospectively collected data. Results: Among the clinical factors, there were no differences between the two groups. The overall complication rates were 19.7% in the ES group and 13.8% in the EE group (P=0.489). With respect to anastomosis-related complications, 2 cases had bleeding and 2 cases had stenoses in the ES group, while 2 cases in the EE group had bleeding. Re-operation was needed in the case of intraluminal bleeding in the ES group. There were no mortalities in our study. Conclusion: The two methods for gastroduodenostomy were safe and technically feasible. Although there was no statistical difference in the overall complications, including anastomosis-related complications, we demonstrated better outcomes with respect to anastomotic stenosis in the EE group.