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원발성 간세포암 환자에서 간절제술 후 예후인자에 관한 연구 - 단변량 분석 -
김수태(soo Tae Kim),이건욱(Kuhn Uk Lee),윤효영(Hyo Yung Yun),김건표(Keon Pyo Kim) 대한소화기학회 1993 대한소화기학회지 Vol.25 No.1
N/A To further define the clinicopathologic features and determinants of survival we reviewed the cases of 279 patients with primary hepatic malignancy managed surgically between 1981 and 1990. There were 279 patients who had hepatic resection due to primary hepatocellular carcinoma. Male to female ratio was 5.8 to 1 and their average age was 53 years. Ten variable were subject to univariate analysis and their survivals were calculated using the method of life table. 79.1%. of patients had chronic hepatic disease including liver cirrihosis and chronic active hepatitis and 124 patients (74.2%) were positve in HBsAg. Alpha-fetopretein was high in 67%. (normal 20ng/ml). Curative resection was done in 194 patients. Operative mortality was 11.4%, operative mortality was significantly associated with preoperative liver function and intraoperative blood loss. Median survival was 33 months, With 5 year survival of 28.3%. Univariate analysis showed that Child's classification, encapsulation, number of tumor, size of turmor and operative procedure were associated with 5 year survival rate (p<0.05) and liver cirrhosis, slpha-fetoprotein. HBsAg, preoperative transcatheter hepatic arterial embolization (TAE) and resection margin were not related with 5 year survival rate (p > 0. 05). There was no difference in survival rate between limited hepatic resection and major hepatic resection in 93 patients of small HCC (tumor size less than 5 cm). There was significant difference in survival rate in limited hepatic resection and rnajor hepatic resection in liver cirrhotic patients (n=140). So we conclude that early detection with tumor marker and sonography in high risk patients and curative resection are the best way to improve the long term result in HCC. And preoperative evaluation of liver fuction and decrease intraoperative blood loss are the best way to decrease operative mortality. In smal! HCC with liver cirrhosis, we think that limited hepatic resection is an effetive treatment.
김수태(soo Tae Kim),허윤석(Yoon Seok Hur),김건표(Keon Pyo Kim) 대한소화기학회 1993 대한소화기학회지 Vol.25 No.4
N/A The benign liver tumors have cliverse disease entities Hemangioma, nonparasitic liver cyst, liver cell adenoma, focal nodular hyperplasia, hepatobiliary cystadenoma, hamartoma etc, are included in spite of their rarity. We reviewed 36 patients with benign liver tumor from 1981 January to 1990 December operated at Department of General Surgery, Seoul National University Hospital including organizing liver abscess, and Ecchinococcai cyst because of their frequent misdiagnosis and tumor 1ike features preoperatively, Sex ratio was 1.6: 1 (22: 14) and mean age was 52 4 years. Preoperative diagnostic tools were ultrasonography, CT, antiography, radioisotope scan and peritoneoscopy, and their preoperative diagnostic accuracy was at most 50%, Their entities were hemangioma 11 cases, organizing liver abscess 9 cases, nonparasitic liver c, st 9 cases, Ecchinococcal cyst 2 cases hamartoma 1 case, adenoma 1 case, biliary cystdenoma 1 case and two cases of clouble primary lesions: livr cyst and liver abscess, hemangioma and hamartoma. The operations were performed as to preoperative diagnosis; right lobectomy 7 cases, left lobectomy 4 cases, left lateral segmentectomy 4 cases, subsegrnentectomy 12 cases, mass excision 3 cases and unroofing 5 cases in nonparasitic liver cyst. The operative complications were presented in 23 cases (62.2%); pleural effusioin 12 case, intraabdominal abscess 11 cses, and atelectasis 10 cses without mortality.
김수태(soo Tae Kim),이건욱(Kuhn Uk Lee),김건표(Keon Pyo Kim),강한성(Han Sung Kang) 대한소화기학회 1993 대한소화기학회지 Vol.25 No.6
N/A To clarify the clinical features and prognostic factors on hepatic resection of intrahepatic cholangiocarcinoma, we studied them in 27 cases during last 8 years from Jan. 1985 to Dec. 1991. Of 27 patients, the mean age was 54.8 years old, and male to female ratio was 4.4: 1. 22.2% of the patients were positive for HBsAg. and 52.1%. positive for anti HBc (IgG). Alpha-fetoprotein was elevated in 7 cases (26.9%) and CEA was increased in 71.4% of the patients. The liver cirrhosis was associated with 5 cases (18.5%) and Clonorchis sinensis infection rate was 11.1% The overall postoperative mortality and morbidity rate were 11% and 33% respectively in 27 patients with hepatic resection. The 4 prognostic factors (curative resection or not, tumor size, tumor number and preperative Child's classification) were evaluated analytically. The curative resection and Child A group survived longer than palliative resection and Child B. C group(p<0.01). But tumor size and number were not significant prognostic factors (p>0.05). The 1 year-and 3 year survival rates in curative resection group were 78% and 54%. As intrahepatic cholangiocarcinoma grows slowly and is less associated with liver cirrhosis, early detection and curative resection may be the best way to treat it.
김수태(Soo Tae Kim),김건표(Keon Pyo Kim),정승용(Seung Yong Jeong),한세환(Se Hwan Han),민승기(Seung Gee Min),정중기(Joong Ki Chung),이건욱(Kuhn Uk Lee),이효석(Hyo suk Lee),오용석(Yong Seok Oh),이상형(Sang Hyung Lee),김현집(Hyon Jip Ki 대한소화기학회 1995 대한소화기학회지 Vol.27 No.6
Partial resection of liver is the standard treatment modality in hepatocellular carcinoma(HCC). But the resection of liver is impossible in large HCC, especially with the cirrhotic liver. An alternative treatment for such patients would be orthotopic liver transplantation. We experienced a case of liver transplantation for HCC patient with far advanced disease. The patient had no clinical evidence of distant metastasis preoperatively. We did liver transplantation from a donor who was diagnosed as brain death due to traffic accident. The blood type was compatible and operation was finished successfully. Immunosuppressive treatment with cyclosporine was done and the recipient was known to have hepatitis B. Hepatitis B immune globulin was administered. Immediate postoperative recovery was uneventful but the failure in the of alpha-fetoprotein to normal level was observed. Multiple hot uptake of bone was detected on the bone scan during the follow up and the recipient was expired after 7 months. (Korean J Gastroenterol 1995;27:744 - 748)