자동봉합기를 이용한 위·장관 手術의 臨床的 考察

張一成 충남대학교 의과대학 지역사회의학연구소 1985 충남의대잡지 Vol.12 No.1

The principle of stapling of the gastrointestinal tract was best known to surgeons by way of the von Petz instrument, which was presented on September 1921. The American staplers, which became available in 1967 with disposable sterilely packed preloaded cartridges, and with the radical tranfer of the fine staple drivers and knives to the, disposable element, have revolutionized surgical stapling. The instrument used are represented by a family of seven staplers; the TA 30, TA 55, TA 90, and the GIA, EEA, LDS, and skin and fascia staplers. 27 cases of the gastrointestinal surgery with the Auto-Suture Staplers have been studied during the period of Jan. 1983, to Feb. 1985. at the Department of Surgery, College of Medicine, Chung Nam National University and the clinical analysis and review of literatures were carried out on these cases. The results were as follows; 1) In 27 cases, 16 were stomach cancer, 6 were congenital megacolon, 3 were rectosigmoid cancer. 2) In 27 cases, 19 were males and 8 were females and the most common age distribution was in the 5th decade. 3) Specific surgery of the 27 cases were as follows; Total gastrectomy with esophagojejunostomy in 8 cases, partial gastrectomy with gastrojejunostomy (B-II) in 8 cases, Duhamel's procedure for congenital megacolon in 6 cases, low anterior resection of rectosigmoid colon in 2 cases, colostomy repair in 1 case, gastrostomy in 1 case and transverse colectomy in 1 case. 4) Postoperative specific complication developed in 1 case stenosis and there was no mortality in these series. 5) The advantages of the Auto-Suture Staplers are a) reduction of operating time b) reduction of blood loss c) lesser tissue manipulation d) technical simplicity e) relatively lower operative mortality f) more secure and cosmetic closure Of course, the Auto-Suture stapling technic cannot completely substitute the conventional suturing method, but with the above mentioned many advantages the use of stapling instrument is well recommended and will contribute more for the development of surgical science.

여성유방의 외과적 질환에 대한 임상적 고찰

장일성,김경헌 충남대학교 의과대학 지역사회의학연구소 1995 충남의대잡지 Vol.22 No.2

615 surgical breast diseases were clinically analyzed, which were performed at the Department of General Surgery, Chungnam National University Hospital during the past 5 years from January 1990 until December 1994, and the results were as follows. 1) The incidence of surgical breast diseases was 13.7% (615 cases) of total cases operated during the same period. 2) The incidences of 3 major surgical breast diseases, fibroadenoma, fibrocystic change and cancer were 38.2% (235 cases), 19.7% (121 cases), and 33.7% (207 cases), respectively, and fibroadenoma was most frequent. 3) The most frequent age group of surgical breast diseases was 4th decade in 33.7% (207 cases). 4) The most frequent age of breast cancer was 6th decade in 36.2% (75 cases), but the incidence of breast cancer of 4th decade surgical breast diseases 20.3% (42 cases). So, the age of breast cancer was younger than past. 5) Recently, breast conservative surgery has been increased and the incidence was 39.6% (82 cases) of operation on the breast cancer.

일반외과 영역에서 Ticarcillin 효과에 대한 임상적 고찰

장일성,박인근,김종철 충남대학교 의과대학 지역사회의학연구소 1987 충남의대잡지 Vol.14 No.1

The clinical study for ticarcillin effect on prophylactic and therapeutic use has been perfomed in 53 patients in Department of Surgery .and the results as follows 1. In prophylactic use, the efficacy of the ticarcillin was 94%(33/35). 2. In therapeutic use, efficacy of theticarcillin was 89%(16/18). 3. There was no significant systemic or local complication after ticarcillin therapy. As shown above, ticarcillin was effective and safe for prophylactic and therapeutic use in surgical patients.

일반외과 영역에서 동통에 대한 Meclofenamate sodium의 치료효과

장일성,박인근,임철 충남대학교 의과대학 지역사회의학연구소 1987 충남의대잡지 Vol.14 No.1

The therapeutic efficacy of meclofenamate sodium was evaluated in 50 patients with pain in Department of Surgery. In this study, 100mg meclofenamate sodium(1 capsule) was given orally 3 times a day for 1-10 days. The results obtained were summarized as follows; 1. Females predominated over males by 3 : 2 and as to the age distribution, patients between 30 and 59 age occupied 78%. 2. Duration of drug administration was between 1 day and 10 days. 3. Prompt to moderate improvement of pain was obtained in 96% of patients. 4. There was no significant untoward reaction either subjective or objective to the administration of meclofenamate sodium.

조기 위암의 임상적 고찰

장일성,김영일 충남대학교 의과대학 지역사회의학연구소 1990 충남의대잡지 Vol.17 No.2

This report is a clinical review of 50 cases of early gastric cancer that were treated and followed during 6 years from June. 1985 to June 1990. 1. The peak incidence age was 50 decade(38%), the mean age was 50 years, the ratio of male to female was 3:2. 2. The preoperative diagnostic rate was 52% by double conrast and 60% by endoscopy and biopsy. 3. The most common size of lesions was 1.1-2cm(32%) the smaller of lesion, the greater incidence of invasion rate to submucosa but no relation to lymph node matastasis rate. 4. The most common type of lesion was IIc(28%), the depressed type(III, IIb+c, IIc) was lymph node metastasis, but the elevated type and flat type was not lymph node matastasis. 5. The most common histological type was moderate differentiated and signet-ring cell types(32.5%) the most common type of metastatic rate was moderate differentiated type (30.7%), the badder of differentiated type, the greater incidence of metastatic rate to lymph node. 6. The common sites were lower third and lesser curvature(50%). The greater incidence of metastatic rate and invasion rate to submucosa the site of posterior wall was. 7. The rate of lymph node matastasis was 6.3% in mucosa, 26.4% in submucosa and 20% in total. 8. Follow up studies were possible in 45 cases, in these 1 case was died, 1 case was recurred but alive.

유암에 대한 임상적 연구

장일성 충남대학교 의과대학 지역사회의학연구소 1984 충남의대잡지 Vol.11 No.2

This is clinical analysis and review of 34 cases of breast cancer patients which treated at this department of Chungnam National University Hospital during 5 years from July, 1979 to June, 1984. 1) Most cases of breast cancer were female (97.6%), high incidence of age group was between 40 and 59 years old. 2) All cases were complaint of breast mass, the most frequent period of interval between symptom and arrival to hospital was within 3 months (18 case, 52.9%). 3) Predominent group in size of mass was 2-5cm. in diameter (18 cases, 52.9%). 4) Left breast cancer was more frequent than right breast cancer (1. 2 : 1), and the highest incidence of site was upper outer quadrant (47%) 5) 20 cases (58.8%) had axillarv lymph node metastasis, most frequent group of number of metastatic lymph node was 1-3 (44.1%). 6) In T. N. M. classification: most frequent group was stage II (50%). 7) In pathologic classification: most breast cancer wvas infiltrating ductal cancer (94. 1%). 8) The most frequent method of operation was radical mastectomy (55. 9%). and then modified radical mastectomy (32.4%). 9) 12 cases (35.4%) was noted systemic metastasis. 10) The complication of operation were skin edge necrosis(29. 4%), seroma (26. 5%), arm edema (14.7%) and motion limitation (5.9%)

여성형유방(Gynecomastia)에 대한 임상적 고찰

장일성,이희만,홍은표 충남대학교 의과대학 지역사회의학연구소 1994 충남의대잡지 Vol.21 No.2

A Clinical Study was made in 94 cases of the gynecomastia at the department of General Surgery. Chungnam National University Hospital from January, 1986 to August, 1994. The results were as follows : 1) The most frequent age group in gynecomastia was sixties, 27 cases(28.7 %). 2) The most common duration from symptom onset to the first visit was within 6 months, 73 cases (77.7%). 3) The breast masses were located at the left breast in 45 cases (47.9%), at the right breast in 35 cases (37.2%), and bilateral in 14 cases (14.9%). 4) The most prominent symptom was palpable mass in 62 cases (66.0%), followed by palpable mass and pain in 30 cases(31.9%), palpable mass and nipple discharge in 2 cases(2.1%). 5) The etiology of gynecomastia was as follows : Association with other systemic diseases in 25 cases(26.5%), pubertal gynecomastia in 20 cases(21.3%), senescent gynecomastia in 17 cases(18.1%), idiopathic gynecomastia in 19 cases(20.2%), drug related gynecomastia in 12 cases(12.8%), and chromosomal abnormality in one case(1.1%). 6) The results of laboratory test were as follows : Liver function test was performed in 67 cases(71.3%), ultrasonography of liver in 26 cases(27.6%), liver scan in 10 cases(10.6%), and hormonal assay in 13 cases(13.5%). The results of liver function test were reported as abnormal in 12 cases(12.8%), the results of ultrasonography as abnormal in 8 cases(8.6%), the results of liver scan as abnormal in one case(1.1%), and the resutls of hormonal assay as normal in all cases. 7) Excision was performed in 16 cases(17.0%), pathological diagnosis of all cases were gynecomastia and one case was gynecomastia with intraductal papillomatosis.

외과환자에 있어서 지방유제 "Intralipos"의 임상적 응용

장일성,장재구 충남대학교 의과대학 지역사회의학연구소 1985 충남의대잡지 Vol.12 No.2

An intravenous fat emulsion "intralipos" were given to 27 patients with surgical disease and following results were obtained. 1. Adverse effect by intravenous drip infusion of fat emulsions such as allergic symptoms, colloid shock, vascular pain or thrombophlebitis were not observed. 2. Hematologic, biochemistry change such as anemia, liver dysfunction and blood coagulation disturbance were not observed. These facts indicates that "intralipos" can be used safely in clinical patients.

갑상선 항진증에 관한 외과적 치료의 임상적 연구

장일성,최길돈,하기정 충남대학교 의과대학 지역사회의학연구소 1987 충남의대잡지 Vol.14 No.2

A clinical study of hyperthyroidism was performed for 20 patient who received operation at the department of surgery of C. N. U. H. from March, 1973 to July, 1987. The results were as follows: 1) In clinical classification, 14 cases (80%) were diffuse toxic goiter and 6 cases (20%) were nodular toxic goiter. 2) Male to female ratio was 1 : 19 and the highest incidence in the 3rd decade. 3) Main symptoms and signs were, in the order of decreasing frequency, neck mass (95%), palpitation (85%), fatigability (80%), heat intolerance (75%), weight loss (65%), tremor (60%) headache (50%). 4) Pulse rate changed from 130 per minute preoperatively to 60 postoperatively. 5) Thyroid function test revealed high level above the normal in 16 (80%) and the mean value of T_3RI_4 4.06mg/ml, T_3RI_4 10.48mg/ml, free T_4 4.65/ug/dl, postoperatively all cases showed teuthyroid function. 6) Electro-cardiographic findings were sinus tachycardia 9 cases (45%), normal 6 cases (30%). sinus bradycardia 5 cases (25%). 7) In preoperative preparation, Lugol solution was more frequently used 8 cases (40%) and others prophylthiouracil plus lugol solution 4 cases (20%), Inderal plus lugol solution 4 cases (20%) Methimazole plus lugol solution 2 cases (10%), prophylthiouracil plus Inderal plus comthyroid plus lugol solution 2 cases (10%). Average mean duration of preoperative preparation was 12.8 days. 8) The types of operation were in the order of decreasing frequency near total thyroidectomy 9 cases (45%), subtotal thyroidectomy 6 cases (30%), Lobectomy 4 cases (20%) and total thyroide ctomy 1 case (5%), 9) Early postoperative complication were transient tremor 3 cases (15%) transient hoarseness 1 case (5%), hypothyroidism 1 case (5%), recurrent hyperthyrodism 1 case (53%), hypoparathyroidism l. case (53%) but there was no case of operative motality.

Fibroadenoma에 대한 임상적 고찰

장일성,김지연,이희만 충남대학교 의과대학 지역사회의학연구소 1993 충남의대잡지 Vol.20 No.2

Fibroadenoma is the most common benign tumor of breast in human female between the age of 20 and 35 years. The great majority of patients should be treated by excisional biopsy to remove the tumor and establish the diagnosis. Authors have reviewed 110 case of fibroadenoma who underwent surgical operation during the period from Jaunary 1990 to Jaunary 1993 at the department of General Surgery in Chungnam National University Hospital. The circumareolar skin incision was selected if the tumor was compatible with benign fibroadenoma on the finding of preoperative mammogram and sonogram. But, the diagnosis was uncertain and the distance from the mass to nipple was over 3 cm, the skin incision was made on the just above the palpable mass. In order to minimize the seroma, hemostasis was taken completely, the use of electrocautery was restricted as possible, a close suction drain was kept to surgical dead space via the main wound by vaccum tube in case of leaving large dead space, and compressive dressing was applied on the defected wound site after the operation. The major complication after the excision of suspicious fibroadenoma was seroma, and its complication rate was about 8% (9/110 cases). But, another complication was not found. The rate of discharge at the first postoperative day was calculated to 73.2 % among the total patients and the remaining of all patients could be discharged at the second postoperative day. In conclusion, the young female who was under suspicion of fibroadenoma must be treated with excision and the excised specimen should undergo histologic examination to rule out carcinoma or to confirm the diagnosis. The associated major complications were revealed to minimal.