132예의 유방보존술식 분석

형우진(Woo Jin Hyung),구자윤(Ja Yun Koo),서창옥(Chang Ok Suh),정우희(Woo Hee Jung),오기근(Ki Keun Oh),이희대(Hy De Lee) 대한외과학회 1997 Annals of Surgical Treatment and Research Vol.53 No.1

조기위암 환자의 예후인자와 위암 특이 사망률의 분석과 그 임상적 의의

형우진(Woo Jin Hyung),김준억(Junuk Kim),첸지안(Jian Chen),정재호(Jae Ho Cheong),노성훈(Sung Hoon Noh),최승호(Seung Ho Choi) 대한외과학회 2003 Annals of Surgical Treatment and Research Vol.65 No.4

점액성 위선암의 임상병리학적 특성 및 예후

형우진(Woo-Jin Hyung),노성훈(Sung-Hoon Noh),김용일(Yong-Il Kim),류창학(Chang-Hak Ryu),김충배(Choong-Bai Kim),민진식(Jin-Sik Min),이경식(Kyong-Sik Lee) 대한외과학회 1997 Annals of Surgical Treatment and Research Vol.52 No.6

자궁내피임장치와 동반된 골반방선균증 4예

형우진 ( Woo Jin Hyung ),김민우 ( Min Woo Kim ),김민경 ( Min Kyung Kim ),장두영 ( Doo Young Chang ),전명권 ( Myung Kwon Jeon ),이응수 ( Eung Soo Lee ) 대한산부인과학회 2005 Obstetrics & Gynecology Science Vol.48 No.2

Pelvic actinomycosis is a rare chronic anaerobic infectious disease, which occurs most commonly in association with an IUD. It is difficult to diagnose the disease initially. In most cases, the diagnosis is made postoperatively because of its diverse clin

소화기 영역의 로봇 수술

형우진 ( Woo Jin Hyung ) 대한소화기학회 2007 대한소화기학회지 Vol.50 No.4

Robotic surgery is an emerging technology. After adoption of robotic surgery for cholecystectomy in 1997, various general surgical procedures have been performed using surgical robot. In general surgery, robotic surgery is applied to wide range of procedures, however, it is still in its early years. Cholecystectomy, Nissen fundoplication, Heller myotomy, and Roux-en-Y gastric bypass are the most frequently performed robotic operations. Most reports proved that application of robotic technology for general surgery is technically feasible and safe with the help of improved dexterity, better visualization, and high level of precision. However, still the absence of tactile sense and extremely high costs are the problems to be solved. Although robotic surgery has demonstrated some clear benefits compared to conventional surgeries including laparoscopy, it remains to be seen whether these benefits will outweigh the associated disadvantages or problems of robot surgery. Therefore, more prospective randomized study comparing the shot-term and long-term surgical outcomes between robotic and conventional laparoscopic surgery is needed to further define the impact of robotic surgical technology in general surgery. (Korean J Gastroenterol 2007;50:256-259)

종격동 종괴로 발현된 잠재성 갑상선암

형우진(Woo Jin Hyung),정웅윤(Woung Yoon Chung),박정수(Cheong Soo Park) 대한두경부종양학회 1997 대한두경부 종양학회지 Vol.13 No.1

We have experienced a case of occult papillary thyroid carcinoma presenting as an anterior mediastinal mass in a 40-year-old man. The CT scan revealed a huge mass behind the manubrium of the sternum but the ultrasound examination failed to detect any lesion and developmental defect in the thyroid. Excision of the mediastinal mass and total thyroidectomy were carried out. Histologically, the mediastinal mass turned out to be papillary carcinoma without any portion of the normal thyroid tissue or normal lymph node tissue and the thyroid gland showed a tiny papillary carcinoma with the diameter of 0.3cm. Although a mediastinal mass as the sole presentation of the thyroid carcinoma is very rare, we suggest that a mediastinal mass should be added to the list of possible metastatic thyroid carcinoma.

위암 환자의 생존율 분석에 근거한 새로운 병기분류법의 제안

형우진(Woo Jin Hyung),정재호(Jae Ho Cheong),첸지안(Jian Chen),김준억(Junuk Kim),최승호(Seung Ho Choi),노성훈(Sung Hoon Noh) 대한외과학회 2004 Annals of Surgical Treatment and Research(ASRT) Vol.66 No.1

특발성 양수과다증 및 양수과소증이 주산기 예후에 미치는 영향

형우진 ( Woo Jin Hyung ),최형민 ( Hyung Min Choi ) 대한주산의학회 2006 Perinatology Vol.17 No.3

목적: 양수량의 이상은 불량한 주산기 예후와 연관되어 있음은 널리 알려진 사실이나, 다른 특이소견이 없는 특발성 양수과다증 및 양수과소증은 주산기 예후와 어떤 관계가 있는지를 알아보고자 하였다. 방법: 1999년 12월부터 2005년 12월까지 인제대학교 의과대학 일산백병원 산부인과에 내원하여 임신 26주 이후에 최소 2회 이상의 산전 초음파검사를 통해 양수과다증 및 양수과소증으로 진단된 임신부 중에서 68명의 양수과다증 임신부 중에서 태아기형, 당뇨병, 다태임신, 동종면역이나 태반기형이 동반된 경우를 제외하고 원인을 알 수 없었던 특발성 양수과다증은 27명과 양수과소증 임신부73명 중, 조기 양막파수, 당뇨, 고혈압, 태아 기형, 지연임신 등 임신부나 태아에 문제점이 있거나 본원에서 최종 분만을 하지 않은 경우를 제외한 특발성 양수과소증 임신부 31명을 후향적으로 조사하였다. 대조군은 같은 기간 동안 산전 관리를 받은 단태 임신부 중에서 임신 주수, 임신력, 나이가 비슷하며 정상 양수량을 가진 임신부를 대상으로 비교하였다. 결과: 특발성 양수과다증은 과체중아를 제외한 대부분의 주산기 예후인자와는 무관하였으나, 특발성 양수과소증의 경우에는 출생시 체중(저체중아 빈도), Apgar 점수, 태아 곤란증으로 제왕 절개술을 시행한 빈도 그리고, 신생아 중환자실 입원 빈도에 있어서 의미있는 상관관계를 보였다. 결론: 본 연구에서 원인을 알 수 없는 특발성 양수과다증은 거대아 출산과 관련이 있었고, 특발성양수과소증은 좀 더 불량한 주산기 예후를 반영하였다. 따라서 저위험 산모에서의 독립된 양수과소증이 발견된 경우에 좀 더 주의깊은 태아감시와 주기적인 산전 초음파검사를 통한 태아발육이나 양수량을 추적 관찰하는 것이 중요할 것으로 생각된다. Objective: Ultrasound estimation of amniotic fluid volume (AFI) is a critical component of antenatal surveillance. Alterations in AFI have classically been considered an indication of fetal compromise. Thus, this study was undertaken to determine whether there is any association between idiopathic polyhydramnios or oligohydramnios and adverse perinatal outcome. Methods: Women delivered between December 1999 and November 2005, and who underwent ultrasonography from 26 to 41 weeks gestation were analyzed. Twenty-seven consecutive women with singleton pregnancies complicated by idiopathic polyhydramnios (amniotic fluid index>25) and 31 women complicated by oligohydraminos (amniotic fluid index<5) were included in this study. We reviewed the perinatal outcomes including preterm delivery, birth weight, primary cesarean section rate and indication, Apgar score (1-min and 5-min), and admission to NICU (neonatal intensive care unit). These findings were compared with those of 50 matched control patients with normal amniotic fluid volume. Results: We observed that idiopathic oligohydramnios was significantly associated with primary perinatal outcome (Cesarean delivery for fetal distress) as well as secondary outcome variables such as birthweight, SGA (small for gestational age), Apgar score<7 at 1-min, 5-min, and NICU admission rates. On the other hand, idiopathic polyhydramnios did not correlate with any other perinatal outcome, except for rates of LGA (large for gestational age). Conclusion: The present study suggests that AFI is a weak predictor of perinatal outcome than has been classically suggested. But we demonstrated that the AFI identification of polyhydramnios was helpful in identifying LGA, and idiopathic oligohydramnios was a significant predictor of poor perinatal outcome.

조기 위암의 근치적 절제술 후 재발예측인자

신동우,형우진,노성훈,민진식,Shin Dong Woo,Hyung Woo Jin,Noh Sung Hoon,Min Jin Sik 대한위암학회 2001 대한위암학회지 Vol.1 No.2

Purpose: Even with excellent surgical outcome, recurrence of early gastric cancer (EGC) after a curative resection is not declining because the incidence of EGC is increasing. The aim of this study was to propose an appropriate treatment strategy by assessing the risk factors for recurrence of curatively resected early gastric cancer. Materials and Methods: Of 3662 patients who had undergone gastric resections for gastric cancer from 1987 to 1996, the cases of 1050 curatively resected EGC patients were reviewed retrospectively. Among those 1050 patients, 50 patients ($4.8\%$) were diagnosed as having recurrent cancer, which was confirmed by clinico-radiological examination or re-operation. The risk factors that determined the recurrence patterns were investigated by using univariate and multivariate analyses. Results: The mean time to recurrence was 30.9 months, and hematogenous recurrence was the most frequent type ($32.0\%$). Among the 50 recurred patients, peritoneal recurrence showed the shortest mean time to recurrence ($18.5\pm17.7$months). Between the recurred and the non-recurred patients, there was no statistically significant difference with respect to age, sex, operation type, tumor size, tumor location, gross appearance, or histological differentiation. However, depth of invasion (submucosal invasion) and nodal involvement were significantly different (P<0.001) between the two groups. Using logistic regression analyses, nodal involvement was the only significant risk factor for recurrence in early gastric cancer (P<0.001). The median survival after the recurrence had been diagnosed was 4 months. Conclusion: Although the prognosis for EGC patients is excellent and recurrence of EGC after a curative resection is rare, the time to recurrence and the patterns of recurrence in EGC patients were diverse and unpredictable, and the result after recurrence is dismal. Considering the impact of lymph node metastasis on recurrence of EGC, a systematic lymphadenectomy, rather than limited surgery, should be performed if lymph node involvement is confirmed pre- or intraoperatively. Also if the postoperative pathologic findings reveal lymph node involvement, adjuvant chemotherapy is recommended.

위암 환자에서 감시 림프절 및 고립 림프절 전이에 근거한 최소 림프절 절제에 대한 재고

황호경,형우진,최승호,노성훈,Hwang Ho Kyoung,Hyung Woo Jin,Choi Seung Ho,Noh Sung Hoon 대한위암학회 2004 대한위암학회지 Vol.4 No.4

목적: 조기 위암의 경우 림프절 정이의 빈도가 $2\∼20\%$로 낮고 따라서 수술 범위를 최소화하려는 경향이 있다. 게다가 조기 위암의 경우 림프절 절제술의 적절한 범위 선택에 여러 의견들이 있는 상황이다. 본 연구는 위암의 경우 감시 림프절 및 하나의 림프절 전이가 있는 증례를 분석하여 림프절 절제술의 최소 범위를 찾고자 하는데에 있다. 대상 및 방법: 연세대학교 의과대학 외과학교실에서 2000년부터 2002년까지 치료적 위절제술 및 D2 림프절 절제술을 시행받은 78명의 환자를 대상으로 감시 림프절을 평가 하였다. 개복술후 25 mg의 indocyanine green을 5 ml의 생리 식염수에 혼합하여 원발 종양부위의 장막하층에 주입하여 5분 이내에 염색된 모든 림프절을 표시하였다. 또한 연세대학교 의과대학 외과학 교실에서 1997년부터 2001년까지 치료적 위절제술을 시행받은 환자중 하나의 림프절 전이를 보인 141명을 분석하였다. 결과: 감시 림프절을 평가한 78명의 환자 중 69명($88.5\%$)에서 감시 림프절이 확인되었고, 그중 60명($87\%$)의 환자에서 감시 림프절은 위주위 제1군 림프절에서 발견 되었으나 9명($13\%$)의 경우에서는 제2군 림프절에서 감시 림프절이 확인 되었다. 하나의 림프절 전이를 보인 141명의 전이 림프절의 해부학적 위치를 분석한 결과 125명($88.6\%$)에서는 위주위 제1군 림프절로 전이가 있었고 16명($11.4\%$)에서는 제2군 림프절로 전이를 하였다. 결론: 따라서 D1 림프절 절제술을 시행할 경우 위암에 있어서 조기 전이를 놓칠 수 있으며, 만약 림프절 절제술이 필요한 경우에 있어서는 D2 림프절 절제술이 최소 수술 범위라 할수 있겠다. Purpose: The incidence of nodal metastases is as low as 2 to $20\%$ in early gastric cancer, so there is a trend to lessen the extent of surgery. In addition, the adequate range for a lymphadenectomy is controversial, especially in early gastric cancer. In this study, we tried to find the minimal range for a lymphadenectomy by analyzing sentinel-node and solitary lymph-node metastases in gastric cancer. Materials and Methods: The total of 78 patients who underwent a curative gastrectomy with a D2 lymphadenectomy for early gastric cancer between 2000 and 2002 in the Department of Surgery, Yonsei University, Seoul, Korea, were included for the evaluation of sentinel-node metastases.. After a laparotomy, 25 mg of indocyanine green was mixed in 5 ml of normal saline, and all the dye was injected into the subserosal layer around the primary tumor. All nodes stained within 5 minutes were marked. In addition, a total of 141 patients, who underwent a curative gastrectomy between 1997 and 2001 at the Department of Surgery, Yonsei University, Seoul, Korea, were analyzed for solitary lymph- node metastases. Results: Among the 78 patients, sentinel nodes were detected in 69 patients ($88.5\%$). The sentinel nodes in 60 cases ($87.0\%$) were located in the perigastric area. However, 9 cases ($13.0\%$) had sentinel nodes in the N2 group. In the 141 cases that had a solitary metastatic node, 125 cases ($88.6\%$) demonstrated the metastatic lymph node in the perigastric area, and 16 cases ($11.4\%$) showed that the metastatic node in the N2 group. Conclusion: Taken together, removal of a perigastric lymph node could miss early metastases in gastric cancer, so a D1 lymphadenectomy should not be the minimal range of dissection if a lymphadenectomy is necessary. (J Korean Gastric Cancer Assoc 2004;4:272-276)