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강구정(Koo Jung Kan),김유사(You Sah Kim),강중신(Joong Shin Kang) 대한소화기학회 1985 대한소화기학회지 Vol.17 No.2
Patients with classical hemophilia present themselves with various bleeding episodes and most of them are diagnosed and treated by pediatricians, hematologists, and orthopedic surgeons. Surgery on these patients has become increasingly common and safe. There are three reasons for this. First, ease and specificity of diagnosis have been greatly faciliated by improved understanding of the coagulation mechanism and improved laboratory methods. Secondly, there has been increased availability of concentrated clotting materials, and increasing experience in the medical management of these patients. Thirdly, this group of patients now enjoys a longer life expectancy, and thus an incrcased probability of developing both those surgical diseases prevalent in the general population as well as the surgical problems peculiar to patients with bleeding disorders. Nevertheless, experience of general surgeons with hemophiliac patients are rather limited. Recently we have experienced a spontaneous infarction of parts of the jejunum following bleeding in the mesentery of the jejunum in a seven year old boy with known diagnosis of hemophilia A. A segmental resection of the jejunum and end-to-end anastomosis were carried out successfully. We are reporting this case with review of literature giving special emphasis on the hematological management in the perioperative period.
췌-십이지장절제술에 있어서 췌-공장문합방법에 따른 합병증 비교
박정훈(Jung Hun Park),최영일(Young Il Choi),김용훈(Yong Hoon Kim),강구정(Koo Jeong Kang),임태진(Tae Jin Lim) 한국간담췌외과학회 2009 한국간담췌외과학회지 Vol.13 No.1
Purpose: This study was designed to compare and analyze the complication rates of different anastomotic methods of pancreaticojejunostomy after performing pancreaticoduodenectomies by a single surgeon. Methods: From January 2000 to August 2007, 92 patients underwent pancreaticoduodenectomy at a single institution. According to the texture of the pancreas and pancreatic duct size (below or above 3 mm), the type of pancreaticojejunal anastomosis was selected (either duct-to-mucosa pancreaticojejunostomy or end-to-side pancreaticojejunostomy with polyethylene tube). Results: The pathologic diagnosis of the 92 patients included 81 patients with adenocarcinoma, five with chronic pancreatitis and three with GIST that developed in the duodenum. The adenocarcinomas include 33 distal CBD cancers, 18 pancreatic head cancers, 27 Ampulla of Vater cancers and 6 duodenal cancers. The pancreatic fistula rate was not significantly different between the duct-to-mucosa group and the end-to-side pancreaticojejunostomy group (nine of the 43 patients in the duct-to-mucosa group (20.9%) and six of the 46 patients in the tube insertion group (13.0%) (p=0.4). The rate of pancreatic fistula, as classified by three different consecutive periods (period I: 2000-2003; period II: 2004-2005; period III: 2006-2007), was markedly decreased and there were less complications with increasing experience (period I: 33.3%; II: 7.1%; III: 6.4%) (p=0.001). Conclusion: When performing pancreaticojejunostomy, both the duct-to-mucosa method and the tube insertion method were effective in decreasing the complication rate if the appropriate method was selected according to the texture of the pancreas and the size of pancreatic duct. The surgeon"s experience and skill can affect the occurrence of pancreatic fistula after pancreaticojejunostomy. Enough experience is the most important factor to decrease the complication rate after pancreaticoduodenectomy.