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내시경하 갑상선절제술에 있어 CO₂ 가스주입은 안전한가?
최원범(Won Beom Choi),박용래(Yong Lai Park),최준호(Jun Ho Choe),김흥대(Hung Dai Kim),배원길(Won Gil Bae) 대한외과학회 2007 Annals of Surgical Treatment and Research Vol.73 No.4
Purpose: Endoscopic thyroidectomy has recently been widely used in clinical practice. The operative method can be classified into CO₂gas insufflation and the gasless technique. This study assessed the safety of low pressure CO₂gas insufflation (up to 6 mmHg) by performing continuous measurement of the end-tidal CO₂ (ETCO₂) pressure. Methods: From March 2003 to October 2006, 95 patients (90 hemithyroidectomies and 5 total thyroidectomies) underwent endoscopic thyroidectomy. The low pressure CO₂gas insufflation technique was applied in all cases. The ETCO₂ pressure of the patients was measured by capnometry at the time of a pre-CO₂gas insufflation status (0 minutes) and at the time of post-CO₂gas insufflation (30 minutes) and then it was measured every 30 minutes with also performing capnograms. We analyzed the ETCO₂ pressure at the time of the pre-CO₂gas insufflation status (0 min) and we compared this with that of each status by using paired T-test. Results: For all 95 cases, the mean patient age was 36.2±9.1 (range: 21∼57 years), the mean tumor size was 1.7±1.1 (range: 0.1∼4.5 ㎝) and the mean operative time was 135.0±46.1 (range: 50∼340 min). The mean ETCO₂ pressure (mmHg) was 33.0±3.9 at the time of pre-CO₂gas insufflation status (0 min); the mean ETCO₂ pressure was 31.1±3.7 at 30 min (n=95), 33.5±3.7 at 60 min (n=95), 35.2±3.6 at 90 min (n=95), 34.9±3.7 at 120 min (n=90), 34.6±3.8 at 150 min (n=70), 34.1±3.4 at 180 min (n=40), 34.3±5.2 at 210 min (n=15) and 34.0±4.2 at 240 min (n=9). There was a significant difference the early post-CO₂gas insufflation status (P<0.05 at 30 min, 90 min, 120 min), but there was no significant difference in the late post-CO₂gas insufflation status (P>0.05; at 60 min, 150 min, 180 min, 210 min, 240 min). At each time point, the ETCO₂ pressures were all within the normal range. Conclusion: We successfully performed endoscopic thyroidectomy with using the low pressure CO₂gas insufflation technique and there were no significant complications. We think that performing endoscopic thyroidectomy with using the low pressure CO₂gas insufflation technique is a safe procedure.
인공지능 응용/전문가시스템 : 전문가시스템을 활용한 Class5수준의 IETM 개발제안
최원범 ( Won Beom Choi ),정만기 ( Man Ki Jung ),이동우 ( Dong Woo Lee ) 대한산업공학회 2010 대한산업공학회 추계학술대회논문집 Vol.2010 No.-
IETM is a digital technical support system providing accurate information at ease through interactive multi-media technology. Currently maintenance the specific weapon system from the army the staff for and the staff for a parts supply, width is using widely from the end-user of equipment and the maintenance supply and use unit. With development of IT techniques joins in recently and about IETM flurries of development of the form which progresses Class5 level IETM development forms from the present paper because the demand to come being high proposes.
전문가시스템을 활용한 Class5수준의 IETM 개발제안
최원범(Won-Beom Choi),정만기(Man-Ki Jung),이동우(Dong-Woo Lee) 대한산업공학회 2010 대한산업공학회 추계학술대회논문집 Vol.2010 No.11
IETM is a digital technical support system providing accurate information at ease through interactive multi-media technology. Currently maintenance the specific weapon system from the army the staff for and the staff for a parts supply, width is using widely from the end-user of equipment and the maintenance supply and use unit. With development of IT techniques joins in recently and about IETM flurries of development of the form which progresses Class5 level IETM development forms from the present paper because the demand to come being high proposes.
조기 위암 진단하에 내시경 점막절제술 시행 후, 불완전 절제로 판단되어 근치적 위절제술을 받은 환자에 대한 고찰
김형욱(Hyung Ook Kim),최원범(Won Beom Choi),신준호(Jun Ho Shin),류창학(Chang Hak Yoo) 대한외과학회 2008 Annals of Surgical Treatment and Research(ASRT) Vol.74 No.3
Purpose: Increasingly, endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) has been performed. However, yet, there is no standard therapy after incomplete EMR or ESD. The aim of this study was to evaluate the necessity of further resection after an incomplete EMR or ESD. Methods: We analyzed 24 patients who underwent curative gastrectomy due to an incomplete EMR or ESD between January 2000 and February 2007. A retrospective review was performed evaluating the clinicopathological characteristics, operating methods and presence of residual tumor. Results: After the gastrectomy, the total positive residual tumor rate was 66.7% (16/24), with a rate of 73.5% (11/15) for mucosal cancer a rate of 50.0% (4/8) for submucosal cancer, and a rate of 100% (1/1) for cancer that invaded the muscularis propria. There were no positive lymph nodes. There was no recurrence in a mean 35.5 months (range, 4∼90 months) of follow-up. Conclusion: Further resection is recommended for patients with a positive resection margin, because of the possibility of the presence of a residual tumor. Laparoscopic resection may be one of the most effective therapeutic options for these patients as a minimally invasive procedure by which curative resection can be expected.
절제 가능한 간세포암에서 수술 전 경동맥화학색전술의 효과
김인숙 ( In Sook Kim ),임영석 ( Young Suk Lim ),윤현기 ( Hyun Ki Yoon ),성규보 ( Kyu Bo Sung ),장명국 ( Myoung Kuk Jang ),최원범 ( Won Beom Choi ),김성훈 ( Sung Hoon Kim ),이한주 ( Han Chu Lee ),정영화 ( Young Hwa Chung ),이영상 ( 대한내과학회 2005 대한내과학회지 Vol.69 No.6
Background : Although hepatic resection (HR) is the mainstay for the treatment of hepatocellular carcinoma (HCC), high recurrence rate (>60%) is major serious problem. Thus preoperative transarterial chemoembolization (TACE) has been proposed as a neoadjuvant treatment before HR. However, the effect of preoperative TACE in preventing recurrence for initially resectable HCC remains controversial. This study aims at assessing the role of preoperative TACE on the early and long-term outcome following resection of HCC. Methods : Retrospective randomized analysis was performed. A total of 366 patients who had HR for HCC between January 1995 and December 2000, were included, 132 patients underwent preoperative TACE (TACE plus HR) and 234 patients did not (HR). Statistically no baseline characteristic difference in two groups. Results : HR group was significantly higher than TACE plus HR group in disease-free survival rate and overall survival rate (p<0.001, p<0.01). In subgroup analysis, the disease-free survival rate of HR group was higher than TACE plus HR group in UICC T1-2 and UICC T3 (p<0.01 for both), whereas the difference in overall survival rate was significant only in UICC T3 (p<0.01). Those who achieved tumor necrosis of more than 95% by preoperative TACE showed comparable overall survival rate with HR group, while it was significantly lower in patients who demonstrated tumor necrosis of less than 95% (p<0.001). Conclusions : Preoperative TACE for initially resectable HCC may promote early and late tumor recurrence and reduces overall survival rate after surgery particularly in patients with advanced-stage tumors.(Korean J Med 69:614-621, 2005)