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김송철 ( Song Cheol Kim ) 대한소화기학회 2007 대한소화기학회지 Vol.51 No.2
Pancreatic cancer is a major problematic concern among all forms of gastrointestinal malignancies because of its poor prognosis. Although significant progress has been made in the surgical treatment in terms of increased resection rate and decreased treatment-related morbidity and mortality, the true survival rate still remains below 5% today. Surgical options for pancreatic cancer are based on the its unique anatomy and physiology, catastrophic tumor biology, experience of surgeon, and status of patients. Four main options exist for the surgical treatment of pancreatic cancer. These include standard "Whipple" pancreaticoduodenectomy (PD), pylorus preserving PD (PPPD), distal pancreatectomy (left-side pancreatectomy), and total pancreatectomy according to the location of tumor. Portal vein involvement by tumor is regarded as an anatomical extension of disease, and en bloc resection of portal vein with tumor is recommended if technically feasible, which is stated in 2002 AJCC tumor staging for pancreatic cancer. In comparison of the survival rates between standard and extended resection of pancreatic head cancer, no significant survival benefit was demonstrated from the prospective reports. PPPD may be superior to standard PD in respect to nutrition and quality of life without any deleterious effect upon long term survival or tumor recurrence. New surgical treatment modalities including modified extended pancreatectomy, neoadjuvant chemotherapy, and radical antegrade modular distal pancreatectomy have been tried to improve the patients` survival. However, early diagnosis and treatment remain as key factors for the cure of pancreatic cancer irrespective of various surgical trials. (Korean J Gastroenterol 2008;51:89-100)
김송철(Song Cheol Kim),유창식(Chang Sik Yu),허주령(Joo Ryung Hur),이문규(Moon Gyu Lee),김진천(Jin Cheon Kim) 대한소화기학회 1997 대한소화기학회지 Vol.29 No.1
Diverticulosis of the vermiform appendix is one of the rare diseases. Recently we experienced a case of diverticulosis of vermiform appendix presented with cecal diverticulitis. The patient was presented with intermittent abdomina] pain that persisted for two months and preoperative barium enema showed multiple cecal and appendiceal diverticulosis. Resection including terminal ileum and cecum was done and pathology revealed cecal diverticulitis with appendiceal diverticulosis. So, we report a case of appendiceal diverticulosis presented with cecal diverticulitis in regard to its rarity and proper managernent with literature review. (Korean J Gastroenterol 1997; 29:108-112)
신장 ; 국내 단일기관에서 시행한 췌장이식의 임상적인 결과
한덕종 ( Duck Jong Han ),김송철 ( Song Cheol Kim ),박재범 ( Jae Berm Park ),김영훈 ( Young Hoon Kim ),박관태 ( Kwan Tae Park ),홍정자 ( Jung Ja Hong ),하희선 ( Hea Seon Ha ),정주희 ( Ju Hee Jung ),김인구 ( In Koo Kim ),박건춘 ( Ku 대한내과학회 2011 대한내과학회지 Vol.80 No.2
목적: 췌장이식은 인슐린 의존형 당뇨병에서 1966년 미네소타대학 병원에서 처음 시행된 수술로써 인슐린을 끊을 수 있는 유일한 치료법으로 이식수술 후 합병증의 감소, 면역억제제 및 수술 후 관리의 개선으로 널리 시행되고 있다. 국내에서는 1992년 첫 췌장이식이 시행된 이래 점차 늘어가고 있지만 아직 활발히 이루어지고 있지는 못하다. 이에 저자들은 1992년 7월부터 2009년 12월까지 국내 단일기관에서 시행한 췌장이식의 임상 결과를 분석하여 보고하고자 한다. 방법: 본원에서는 1992년 7월 이후 2009년 12월까지 18년간 119명의 당뇨병 환자에서 췌장이식을 시행한바 이를 후향적으로 분석하여 췌장 이식의 임상적인 결과를 분석하였다. 결과: 이식수혜자의 당뇨병 분류로 총 119명 중 인슐린 의존형이 93명(78.2%)이었고, 16명(13.4%)에서는 Type II형 이었다. 기증자는 뇌사자가 107명(89.9%), 그리고 12명(10.1%)에서는 가족간 생체기증이었다. 당뇨합병증으로 신·췌장 동시 이식이 67명(56.3%)이었고, 42명(35.3%)에서는 췌장단독이식, 10명(8.4%)에서는 이미 신장이식을 받은 환자에서 췌장이식이 시행되었다. 수술 후 췌장 이식편생존율은 81.6%(1년), 63.4%(5년), 그리고 57.1%(10년)이었다. 면역억제제로 tacrolimus와 MMF를 사용한 1999년 이후(n=96) 췌장 이식편 생존율은 89.1%(1년), 72.9%(5년), 그리고 66.2%(10년)이었고, 환자의 생존율은 93.0%(1년), 86.0%(5년), 그리고 86%(10년)이었다. 결론: 최근 췌장이식 수술의 향상된 성적으로 삶의 질과 장기 환자 생존을 고려할 때, 췌장 이식은 당뇨병의 유형에 상관 없이 인슐린 투여가 필요한, 심각한 당뇨 합병증 또는 인슐린 투여 관련 합병증의 위험에 놓여 있는, 비비만형 당뇨병 환자들에게 효과적인 치료로 제시 될 수 있다. Background/Aims: Pancreas transplantation (PT) as the ultimate treatment for insulin-dependent diabetes has been the subject of debate clinically. Marked improvements in patient and graft survival, and decreases in postoperative morbidity have been achieved due to technical refinements, improved immunosuppressants, and better postoperative management. Here, we report our 18-year experience with PT performed at our institute. Methods: All recipients who underwent deceased donor or living donor PT between July 1992 and December 2009 were included. We reviewed the medical records, including operation records, progress, and laboratory findings during follow-up. Graft and patient survival were analyzed using the Kaplan-Meier method. Results: In total, 119 cases of pancreas transplantation were performed between July 1992 and December 2009 at our institute. Indications for pancreas transplantation were type I diabetes in 93 (78.2%) patients and type II diabetes in 16 (13.4%) patients. The transplanted pancreas was obtained from a deceased donor in 108 cases (90.8%) and a living donor in 11 cases (9.2%). Median follow-up duration was 39.3 months posttransplantation (range 0~176 months). Overall graft survival rates at 1, 5, and 10 years were 81.6%, 63.4%, and 57.1%, respectively. Following the introduction of tacrolimus as an immunosuppressant in 1999, graft survival at 1, 5, and 10 years was 89.1%, 72.9%, and 66.2%, and overall patient survival at 1, 5, and 10 years was 93.0%, 86.0%, and 86.%, respectively. Conclusions: Considering the quality of life and long-term patient survival, PT is an effective treatment strategy in non-obese diabetic patients requiring insulin regardless of the type of diabetes. (Korean J Med 2011;80:167-178)
장내 출혈을 수반한 췌십이지장의 동정맥기형에서 시행한 췌장 전절제술 및 췌장도세포 자가이식
한덕종(Duck Jong Han),김송철(Song Cheol Kim),김태희(Tae Hee Kim),위유미(Yu Mi We),조경민(Kyung Min Cho),홍정자(Jung Ja Hong) 대한소화기학회 2001 대한소화기학회지 Vol.38 No.1
Ascaris lumbricoides, the roundworm, is recognized as one of the most prevalent human intestinal helminths in the world, but the positive rate of its egg is markedly decreased recently in Korea. Biliary ascariasis is a relatively common complication of intestinal ascaris infestation and may cause pancreatic ductal obstruction, choledocholithiasis, cholecystitis, cholangitis, hemobilia, and liver abscess. However, there has been no report on biliary ascariasis combined with both bile duct stone and liver abscess in Korea. We experienced a case of having two worms of Ascaris lumbricoides in the bile duct combined with both bile duct stones and liver abscess. The case was managed with endoscopic removal of the worms and stone and with percutaneous drainage of the liver abscess. We report the case with a review of literatures. (Korean J Gastroenterol 2001;38:61-64)