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간좌엽 및 췌전절제 수술이 필요했던 간내담관 및 췌장관 내에 발생한 동시성 유두모양 점액선암
문덕복 ( Deok Bog Moon ),이승규 ( Sung Gyu Lee ),정동환 ( Dong Hwan Jung ),박길춘 ( Gil Chun Park ),박요한 ( Yo Han Park ),박형우 ( Hyung Woo Park ),김명환 ( Myung Hwan Kim ),이성구 ( Sung Koo Lee ),유은실 ( Eun Sil Yu ),김지훈 ( 대한소화기학회 2014 대한소화기학회지 Vol.63 No.2
Intraductal papillary mucinous neoplasm of the bile duct (IPMN-B) and intraductal papillary mucinous neoplasm of the pancreas (IPMN-P) have striking similarities and are recognized as counterparts. However, simultaneous occurrence of IPMN-B and IPMN-P is extremely rare. A 66 year-old female presented with recurrent epigastric pain and fever. During the past 9 years, she had three clinical episodes related to intrahepatic duct stones and IPMN-P in the pancreas head and was managed by medical treatment. Laboratory test results at admission revealed leukocytosis (12,600/mm3) and elevated CA 19-9 level (1,200 U/mL). Imaging study demonstrated liver abscess in the Couinaud`s segment 4, IPMN-B in the left lobe, and IPMN-P in the whole pancreas with suspicious malignant change. Liver abscess was drained preoperatively, followed by left lobectomy with bile duct resection and total pancreatectomy with splenectomy. On histologic examination, non-invasive intraductal papillary mucinous carcinoma arising from various degree of dysplastic mucosa of the liver and pancreas could be observed. However, there was no continuity between the hepatic and pancreatic lesions. This finding in our case supports the theory that double primary lesions are more likely explained by a diffuse IPMN leading to synchronous tumors arising from both biliary and pancreatic ducts rather than by a metastatic process. Herein we present a case of simultaneous IPMN of the bile duct and pancreas which was successfully treated by surgical management. (Korean J Gastroenterol 2014;63:129-133)
상간하대정맥부터 총장골정맥분지까지 연장된 하대정맥 평활근 육종의 체외절제 후 인공 하대정맥 재건 및 자가 간이식
문덕복(Deok-Bog Moon),이승규(Sung-Kyu Lee),김기훈(Ki-Hum Kim),안철수(Chul-Soo Ahn),하태용(Tae-Yong Ha),송기원(Gi-Won Song),정동환(Dong-Hwan Jung),유제호(Je-Ho Ryu),김관우(Kwan-Woo Kim),고경훈(Kyoung-Hoon Ko),최남규(Nam-Kyu Choi) 한국간담췌외과학회 2008 한국간담췌외과학회지 Vol.12 No.3
Ex situ resection and hepatic auto-transplantation as devised by Pichlmayr may be an answer for a lesion that has close proximity to or has invade the major hepatic veins. We report here on a 31-year-old female patient with a leiomyosarcoma extending from the suprahepatic vena cava to the bifurcation of the common iliac vein, and this tumor was deemed not accessible by the conventional in situ surgical techniques. The liver and retrohepatic inferior vena cava was removed en bloc and taken to the back-table where the neoplasm invading the cava wall was removed together with the inferior vena cava. The inferior vena cava was then replaced by a 26- mm Dacron graft proximally and a 20-mm ringed polytetrafluoroethylene (PTFE) graft distally, and the outflows of the liver was reconstructed to a single opening with using longitudinallyopened autogenous great saphenous vein fencing. The liver was then autotransplanted by the Piggyback technique. Both renal veins were not reconstructed because both gonadal veins were preserved during the operation. The postoperative course was uneventful and the patient is in good health until now.
비장동맥 차단술이 생체간이식 수술 수혜자의 전혈구 수치 변화에 미치는 영향
김완준(Wan-Joon Kim),문덕복(Deok-Bog Moon),박정익(Jeong-Ik Park),황신(Shin Hwang),김기훈(Ki-Hun Kim),안철수(Chul-Soo Ahn),하태용(Tae-Yong Ha),송기원(Gi-Won Song),정동환(Dong-Hwan Jung),김관우(Kwan-Woo Kim),최남규(Nam-Kyu Choi),박길춘(G 한국간담췌외과학회 2009 한국간담췌외과학회지 Vol.13 No.4
Purpose: Splenectomy during living donor liver transplantation (LDLT) in a hepatitis C virus (HCV)-related cirrhotic recipient was performed by a Tokyo group to enhance the patient’s tolerability to post-operative anti-viral treatment by improving complete blood count (CBC) profiles. At our institution, interruption of the splenic artery (SPA) by ligation or embolization in lieu of splenectomy, has been performed in LDLT to modulate portal blood flow in small-for-size graft LDLT or to prevent rupture of SPA aneurysms in recipients. We aimed to determine if interruption of the SPA can serve as an alternative management to splenectomy in LDLT recipients based on our data. Methods: Patients were classified into the splenic artery ligation group (SAL; n=26) and splenic artery embolization group (SAE; n=19), respectively. Among the recipients without SPA interruption, age-, gender-, and severity of cirrhosis-matched 25 recipients were selected as a control group. Post-operative CBC profiles and spleen size were reviewed retrospectively and compared between the groups. Results: After SAL, platelet and neutrophil counts were significantly increased at 3 and 6 months, and at 1 week and 1 month, respectively (p<0.05). After SAE, platelet and neutrophil counts were significantly increased at 3 and 6 months, and at 1 week and 3 months, respectively. There were no significant complications related to interruption of the SPA. Conclusion: Interruption of the SPA may have a role in improving neutrophil and platelet counts in LDLT recipients with severe pancytopenia or in whom antiviral treatment for HCV in anticipated.
중간부 담도암 환자에서 담도분절절제와 췌두십이지장절제에 따른 예후 비교
서석인(Seok-In Seo),황신(Shin Hwang),이영주(Young-Joo Lee),김기훈(Ki-Hun Kim),안철수(Chul-Soo Ahn),문덕복(Deok-Bog Moon),하태용(Tae-Yong Ha),송기원(Gi-Won Song),정동환(Dong-Hwan Jung),박광민(Kwang-Min Park),황대욱(Dae-Wook Hwang),이승 한국간담췌외과학회 2011 한국간담췌외과학회지 Vol.15 No.1
Purpose: This study was designed to analyze the prognosis following segmental bile duct resection (BDR) versus pancreatoduodenectomy (PD) for mid bile duct (mBD) cancer. Methods: During the 4 years between 2003 and 2006, 55 patients underwent surgical resection for mBD cancer in our institution. Medical records were reviewed retrospectively. They were divided into two groups, a BDR group (n=24) and a PD group (n=31) according to the extent of resection. Results: Median follow-up was 43 months. Overall 3- and 5-year survival rates were 56.0% and 33.8%, respectively. The BDR group had lower tumor stages than the PD group (p=0.011). R0 resection was achieved in 17 (70.8%) of the BDR group and 30 (96.8%) of the PD group. Median survival periods were 43 and 34 months after R0 and R1 resections, respectively (p=0.715). Recurrence occurred in 41 patients after a mean period of 18 months. Three- and 5-year survival rates were 62.5% and 27.2% after BDR, respectively, and 51.5% and 34% after PD, respectively (p=0.715). No significant risk factors for shorter patient survival times was identified. Aggressive treatment of recurrence did not appear to prolong patient survival. Conclusion: The extent of resection for mBD cancer did not affect the survival outcome when R0 resection was achieved. Considering the operative risk in patients with older ages or co-morbidities, PD should be considered only after obtainment of simultaneous tumor-free radial and proximal longitudinal resection margins.
간이식 수술 후 재발된 B형 간염 환자 및 de novo 감염 환자에서 Adefovir의 치료 효과에 대한 예비 보고
김건국 ( Keon Kuk Kim ),김기훈 ( Ki Hun Kim ),황신 ( Shin Hwang ),안철수 ( Chul Soo Ahn ),문덕복 ( Deok Bog Moon ),하태용 ( Tae Yong Ha ),이승규 ( Sung Gyu Lee ) 대한소화기학회 2005 대한소화기학회지 Vol.45 No.3
Background/Aims: Anti-viral therapy using hepatitis B immune globulin and lamivudine could not prevent HBV recurrence after liver transplantation (LT) completely. Adefovir dipivoxil is a acyclic nucleotide phosphate analogue and known to have potent anti-
정성민(Sung Min Jung),안철수(Chul Soo Ahn),이승규(Sung Gyu Lee),이영주(Young Joo Lee),박광민(Kwang Min Park),황신(Shin Hwang),김기훈(Ki Hun Kim),문덕복(Deok Bog Moon),하태용(Tae Yong Ha) 한국간담췌외과학회 2011 한국간담췌외과학회지 Vol.15 No.1
Purpose: Although surgical resection is the most effective treatment for hepatocellular carcinoma (HCC) accompanied by portal vein tumor thrombus (PVTT), the recurrence rate is very high and prognosis is poor. This retrospective analysis aimed to establish a surgical strategy for patients with portal vein thrombus and to identify predictors of tumor thrombus in these patients. Methods: From 2006 to 2007, 63 hepatocellular carcinoma patients with portal vein thrombus detected by preoperative imaging underwent hepatic resection, and their clinical data were retrospectively analyzed. Possible prognostic factors for survival were analyzed with postoperative survival curves, and significant factors were determined by univariate and multivariate analysis. Results: 31 patients (49.2%) with portal vein tumor thrombus were detected by pathologic reports in 63 HCC patients with portal vein thrombus. Significant prognostic factors included Serum Albumin ≤3.5 g/dl, Alkaline phosphatase (ALP)≥100 IU/L, Tumor size≥10 cm, non-expanding type, PVTT and Alpha-feto protein (AFP)≥104 IU/L by univariate analysis. Independent prognostic factors included PVTT. Conclusion: PVTT is not always detected in patients with HCC accompanied by portal vein thrombus. Although patients have a portal vein tumor thrombus, some patients have greater long-term survival. Hepatic resection should be considered for patients with portal vein thrombus.
10cm 이상의 거대 간세포암의 우엽 절제술에서의 전방 접근법
김태환(Tae-Hwan Kim),이승규(Sung-Gyu Lee),송기원(Gi-Won Song),황신(Shin Hwang),김기훈(Ki-Hun Kim),안철수(Chul-Soo Ahn),문덕복(Deok-Bog Moon),하태용(Tae-Yong Ha),정동환(Dong-Hwan Jung) 한국간담췌외과학회 2008 한국간담췌외과학회지 Vol.12 No.4
Purpose: This study was conducted to evaluate the technical feasibility and the impact on survival of the anterior approach technique for resecting a huge hepatocelluar carcinoma (HCC) as compared with the conventional approach technique. Methods: We performed a retrospective observational study on 57 patients who underwent right hemihepatectomy for a huge HCC over than 10cm in diameter. A total of 57 patients were divided into two groups; the anterior approach technique group (AA group, n=23) and the conventional approach group (CA group, n=34). The overall perioperative data was collected and analyzed. The post-hepatectomy liver function, the operative mortality and morbidity and the survival outcome were compared between the two groups. Results: The post-hepatectomy liver function profile was not significantly different between the two groups. The operative mortality and morbidity were comparable in both groups. The transfusion requirement was not significantly different in both groups (p=0.470), but the cases without transfusion were more common in the AA group (p=0.046). The tumor with an advanced stage (UICC stage III/IV) was significantly more frequent in the AA group (p=0.014). The overall patient survival and disease-free survival was not significantly different between the two groups despite of the difference of the disease stage between the 2 groups (p=0.050, p=0.822). Pulmonary metastasis was more common in the CA group (p=0.035). Conclusions: Despite of the advanced disease state, the anterior approach technique resulted in comparable operative and survival outcomes as compared with the outcomes of the conventional approach technique. In terms of the technical feasibility, the anterior approach technique may reduce the required amount of transfusion when performing hepatectomy for a huge HCC.