http://chineseinput.net/에서 pinyin(병음)방식으로 중국어를 변환할 수 있습니다.
변환된 중국어를 복사하여 사용하시면 됩니다.
조기위암 및 림프절 전이에 대한 수술 중 외과적 병기판정의 정확도 및 유용성
박은규,정오,류성엽,주재균,김동의,정미란,김호군,김회원,박영규,Park, Eun-Kyu,Jeong, Oh,Ryu, Seong-Yeop,Ju, Jae-Kyun,Kim, Dong-Yi,Jeong, Mi-Ran,Kim, Ho-Goon,Kim, Hoe-Won,Park, Young-Kyu 대한위암학회 2009 대한위암학회지 Vol.9 No.3
목적: 조기위암 및 림프절 전이에 대한 수술 중 외과적 병기판정의 정확도에 대하여 분석하고, 외과적 병기에 근거한 수술 범위 판단의 유용성에 대하여 조사하고자 하였다. 대상 및 방법: 2006년에서 2007년까지 위암으로 위 절제술을 시행 받은 369명을 대상으로 조기위암 및 림프절 전이에 대한 수술 전 검사 및 외과적 병기판정의 민감도, 특이도 및 정확도를 비교 분석하였다. 결과: 조기위암에 대한 외과적 병기판정의 민감도, 특이도, 정확도는 각각 74.5%, 95.7%, 83.7%였으며 양성 예측도는 95.7%였다. 이는 수술 전 검사에 의한 조기위암의 진단에 비하여 높은 특이도와 양성 예측도를 보였다. 림프절 전이에 대한 외과적 병기판정의 민감도, 특이도 및 정확도는 73.2%, 78.1%. 76.4%였다. 127명의 림프절 전이 환자 중 수술 전 진단에서 59명(46.5%)이, 외과적 병기판정에 의해서는 34명(26.8%)만이 림프절 전이 없음으로 저 평가되었다. 조기위암의 진단에서 술 전 진단과 외과적 병기 사이에 불일치를 보인 70예 가운데, 63예(90%)는 외과적 병기판정이, 7예(10%)는 수술 전 진단이 정확하였다. 결론: 수술 중 외과의사에 의한 외과적 병기판정은 조기 위암 및 림프절 전이에 대하여 수술 전 검사에 비하여 높은 정확도를 보이고 진행위암의 조기위암으로의 저 평가를 현저히 줄인다. 따라서 위암의 수술 시 외과적 병기는 수술 범위를 결정하는데 있어서 중요한 인자로 고려되어야 한다. Purpose: The aim of this study is to evaluate the accuracy of surgically diagnosing early gastric cancer (EGC) and lymph node metastasis, and to determine its role for performing limited surgery for EGC. Materials and Methods: We reviewed 369 patients who underwent gastrectomy for primary gastric carcinoma. The surgical diagnosis was evaluated by determining its sensitivity, specificity and accuracy, and this was compared with the preoperative examinations. Results: The sensitivity, specificity, and accuracy of the intraoperative diagnosis for EGC were 74.5%, 95.7% and 83.7%, respectively. The predictive value for EGC according to the intraoperative diagnosis was 95.7%. The surgical diagnosis of EGC showed higher specificity and a higher predictive value than preoperative examinations, which significantly reduced the risk of underestimating advanced gastric cancer (AGC) to EGC. The sensitivity, specificity, and accuracy for lymph node metastasis according to the surgical diagnosis were 73.2%, 78.1% and 76.4%, respectively. For 70 patients with a discrepancy in the diagnosis of EGC between the pre- and intra-operative diagnosis, the surgical diagnosis was correct in 63 (90%) patients, but the preoperative examinations were correct in only 7 (10%) patients. Conclusion: The surgical diagnosis showed better accuracy than the preoperative examinations for detecting EGC and lymph node metastasis. Our results suggest that the decision for conducting limited surgery based on the surgical diagnosis might reduce the risk of under-treatment of AGC to EGC better than the preoperative examinations.
직장암 환자의 수술 전 병기 결정에서 경직장 초음파의 유용성
조용철(Yong Chul Cho),김호군(Ho Goon Kim),허정욱(Jung Wook Huh),주재균(Jae Kyun Ju),김형록(Hyeong Rok Kim) 대한외과학회 2008 Annals of Surgical Treatment and Research(ASRT) Vol.75 No.3
Purpose: The preoperative assessments of the depth of invasion in the rectal wall and the presence of lymph node metastasis are very important in determining the proper treatment modality for rectal cancer. The purpose of this study is to evaluate the accuracy of transrectal ultrasonography (TRUS) for preoperatively staging rectal cancer, as compared with computerized tomography (CT). Methods: 62 patients who were diagnosed with rectal cancer were staged by using TRUS and CT, preoperatively. The ultrasnonographic tumor stage (uT), the US nodal stage (uN) and the computerized tomographic tumor stage (cT) and the CT nodal (cN) stage were investigated. The accuracy, sensitivity, specificity, PPV (Positive predictive value) and NPV (Negative predictive value) were calculated and compared with the pathologic staging. Results: The accuracies of TRUS and CT in assessing the depth of rectal wall invasion were 82.2% and 79.0%, respectively. The sensitivity, specificity, PPV and NPV of TRUS were 68.1%, 81.9%, 70.4% and 85.4% and those of CT were 53.2%, 78.9%, 73.7% and 80.7%, respectively. The sensitivity of T1 was 77.8% with using TRUS and 33.3% with using CT, respectively. The incidence of over- and under-staging was 17.8% and 9.7% with using TRUS and 25.8% and 6.5% with using CT, respectively. The accuracies of TRUS and CT in assessing the involvement of lymph nodes were 62.4% and 68.8%, respectively. The incidence of over-staging for TRUS and CT was 41.9% and 21.0%, respectively. The incidence of under-staging for TRUS and CT was 20.1% and 25.8%, respectively. There was no meaningful factor influencing the accuracy of TRUS. Conclusion: TRUS is very useful tool for the preoperative assessment of the depth of rectal cancer invasion. However, the evaluation of lymph node involvement by TRUS has limitations.
복부외상환자의 예후에 영향을 미치는 인자들에 대한 분석
김희준 ( Hee Joon Kim ),김형수 ( Hyung Soo Kim ),서경원 ( Kyung Won Seo ),주재균 ( Jae Kyun Ju ),류성엽 ( Seong Yeop Ryu ),김정철 ( Jeong Cheol Kim ),김형록 ( Hyung Rok Kim ),박영규 ( Young Kyu Park ),김동의 ( Dong Yi Kim ),김영진 대한외상학회 2007 大韓外傷學會誌 Vol.20 No.1
Purpose: Recently, trauma is more frequent due to the increases in the population, the number of traffic accident, and the incidence of violence. Especially, abdominal trauma is a leading cause of morbidity and mortality. We analyzed the clinical features and the factors associated with morbidity and mortality. Methods: We analyzed 136 patients of abdominal trauma who were admitted at the Department of Surgery, Chonnam National University Hospital, from January 2003 to June 2005. We analyzed the cause of trauma, the injured organ, combined injuries, mental status, blood pressure, laboratory findings, morbidity, and mortality. The relationships between by variable were assesed by using the independent samples test and the Kruskal?Wallis test. Results: The causes of trauma were traffic accidents (98 cases, 72%), falling accidents (9 cases, 6.6%), violence (6 cases, 4.4%), and stab injuries (6 cases, 4.4%). The injured organs were the small intestines (47 cases, 34.6%), the liver (35 cases, 25.7%), the spleen (26 cases, 19.1%), the mesentery (17 cases, 12.5%), the large intestines (15 cases, 11.0%), the pancreas (14 cases, 10.3%), etc. The most common combined injury was chest injury (53 cases, 39%). Comatose or semicomatose mental status and shock on admission (<60 mmHg in systolic) were related to high mortality (85.7%). In laboratory findings, decreased hemoglobin (<8 g/dL), and platelet count (<50,000/mm3), and increased creatinine level (>1.6 mg/dL) were significant prognostic factors. The incidence of postoperative complications was 40.4%, and frequent complications were wound infection (8.1%) and re-bleeding (8.1%). The overall mortality rate was 18.4%, and most common cause was hypovolemic shock (18 cases, 13.2%), however, there was no statistical difference according to injurd organ. Conclusion: In the multivariate analysis, mental status, hemoglobin, and serum creatinine level were the most significant prognostic factors. When an abdominal trauma patient arrives at the emergency room, a rapid and accurate evaluation of the patient`s status and risk factors, and resuscitation, if necessary, have to be performed to lower the morbidity and mortality. (J Korean Soc Traumatol 2007;20:12-18)