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소아에서 발생한 장중첩증에서 수술적 치료의 필요와 관련된 위험인자
하헌탁,조자윤,박진영,Ha, Heontak,Cho, Jayun,Park, Jinyoung 대한소아외과학회 2014 소아외과 Vol.20 No.1
The aim of this study was to identify the risk factor related to the need for operative treatment and avoid unnecessary non-operative management for intussusception in children. We retrospectively reviewed medical records of patient treated for intussusception at our institution between January 2006 and January 2013. Clinical features such as gender, age, seasonal variation, symptoms and signs, treatment results were analyzed. Univariate and multivariate analyses including a chi-square test for categorical variables and logistic regression analysis were performed. During the study period, 356 patients were treated for intussusception. 328 (92.1%) was treated successfully by the non-operative pneumoreduction, and 28 (7.9%) required operative management. On univariate analysis, risk factors which were related to the need for operative treatment were age, vomiting, bloody stool, lethargy, and symptoms duration. A logistic regression analysis in order to assess for independent predictors of operative treatment was performed. Age (<6 vs ${\geq}12$ months) (OR 4.713, 95% CI 1.198~18.539, p=0.027) and symptoms duration longer than 48 hours (OR 4.534, 95% CI 1.846~11.137, p=0.001) were significantly associated with a requirement for operative treatment. We conclude that younger age and a longer duration of symptoms (${\geq}48$ hours) are the independent risk factor related to the need for operative treatment for intussusception. Early surgical intervention or transfer to a hospital with pediatric surgical capabilities should be considered for patients with these findings.
Chul Woo Jang,Hyung Jun Kwon,Horyon Kong,Heontak Ha,Young Seok Han,Jae Min Chun,Sang Geol Kim,Yun Jin Hwang 한국간담췌외과학회 2016 Annals of hepato-biliary-pancreatic surgery Vol.20 No.4
Backgrounds/Aims: The roles of portal hypertension (PHT) on the postoperative course after hepatectomy are still debated. The aim of this study was to evaluate surgical outcomes of hepatectomy in patients with PHT. Methods: Data from 152 cirrhotic patients who underwent hepatectomy for hepatocellular carcinoma (HCC) were collected retrospectively. Patients were divided into two groups according to the preoperative presence of PHT as follows: 44 patients with PHT and 108 without PHT. Propensity score matching (PSM) analysis was used to overcome selection biases. Results: There were no significant differences in morbidity (56.8% vs. 51.9%, p=0.578) and 90-days mortality (4.5% vs. 4.6%, p=0.982) between the two groups. Post-hepatectomy liver failure (PHLF) was not significantly different between the two groups (43.2% vs. 35.2%, p=0.356). Patients without PHT had a better 5-year disease-free survival than those with PHT, although the difference did not reach statistical significance (30.9% vs. 17.2%, p=0.081). Five-year overall survivals were not significantly different between the two groups (46.6% vs. 54.9%, p=0.724). Repeat analyses after PSM showed similar rates of morbidity (p=0.819), mortality (p=0.305), PHLF (p=0.648), disease-free survival (p=0.241), and overall survival (p=0.619). The presence of PHT was not associated with either short-term or long-term poor surgical outcomes. Conclusions: Child-Pugh A and B patients with PHT have surgical outcomes similar to those without PHT. Hepatectomy can be safely performed and can also be considered as a potentially curative treatment in HCC patients with PHT.
Aggressive Management for Metastatic Renal Cell Carcinoma in the Pancreas
( Hyung Jun Kwon ),( Young Seok Kim ),( Sang Geol Kim ),( Jae Min Chun ),( Heontak Ha ),( Yoon Jin Hwang ) 대한간학회 2018 춘·추계 학술대회 (KASL) Vol.2018 No.1
Aims: Metastatic cancer to the pancreas is rare and accounts for 2%~5% of all pancreatic malignancies, metastasis from renal cell carcinoma is the most frequent. Pancreatic metastasis from renal cell carcinoma (RCC) can be only site of metastasis and can be surgically resectable. In this study, we report six cases of metastatic rcc of the pancreas which underwent surgical treatment. Methods: Between March 2016 to August 2017, six patients (three men and three women of mean age 61.5±3.7 years) underwent pancreatectomy for RCC metastasis. We retrospectively reviewed clinicopathological data on those patients. Results: Pancreas metaststasis occurred metachronously in all patients, with a mean interval from primary renal cell carcinoma of 5.8±1.0 years. The mean length of hospital stay was 14.8±5.3 day. In-hospital mortality did not occur. Histological examination confirmed the location of a secondary RCC in all patients. Among the six patients, two patients have multiple lesions of the pancreas and 4 patients were a solitary lesion. Median follow-up after pancreatectomy was 8.5 months (5-35months). Four patients were alive with no evidence of disease at 2, 4, 5, and 6 months after resection. Two patients had recurrent disease but were still alive at 17 and 34 months after resection. Conclusions: Single localization of RCC metastasis to the pancreas is rare and it has a slow growing pattern. A hypervascular solid pancreatic tumor, in a patient who has previously undergone nephrectomy for RCC should be considered as suspicious metastasis. In selected patients, standard pancreatic resection might be an option an can be associated good results.
Hyemin Ham,Sang Geol Kim,Hyung Jun Kwon,Heontak Ha,Young Yeon Choi 대한외과학회 2015 Annals of Surgical Treatment and Research(ASRT) Vol.89 No.4
Purpose: Pancreatic body/tail cancer often involves the celiac axis (CA) and it is regarded as an unresectable disease. To treat the disease, we employed distal pancreatectomy with en bloc celiac axis resection (DP-CAR) and reviewed our experiences. Methods: We performed DP-CAR for seven patients with pancreatic body/tail cancer involving the CA. The indications of DP-CAR initially included tumors with definite invasion of CA and were later expanded to include borderline resectable disease. To determine the efficacy of DP-CAR, the clinico-pathological data of patients who underwent DP-CAR were compared to both distal pancreatectomy (DP) group and no resection (NR) group. Results: The R0 resection rate was 71.4% and was not statistically different compared to DP group. The operative time (P = 0.018) and length of hospital stay (P = 0.022) were significantly longer in DP-CAR group but no significant difference was found in incidence of the postoperative pancreatic fistula compared to DP group. In DP-CAR group, focal hepatic infarction and transient hepatopathy occurred in 1 patient and 3 patients, respectively. No mortality occurred in DP-CAR group. The median survival time (MST) was not statistically different compared to DP group. However, the MST of DP-CAR group was significantly longer than that of NR group (P < 0.001). Conclusion: In our experience, DP-CAR was safe and offered high R0 resection rate for patients with pancreatic body/tail cancer with involvement of CA. The effect on survival of DP-CAR is comparable to DP and better than that of NR. However, the benefits need to be verified by further studies in the future.