原發性 後復膜腫瘍 28例에 對한 臨床的 考察

鄭相鳳(Sang Bong Chung),權宏保(Koing Bo Kwun),鄭在龍(Jae Ryong Jung),朴永寬(Young Kwan Park),李鐵(Chul Lee) 대한외과학회 1970 Annals of Surgical Treatment and Research Vol.12 No.8

IORT in Gastric Cancer

김명세,강철훈,김성규,송선교,권굉보,김흥대,Kim Myung Se,Kang Cheol Hoon,Kim Sung Kyu,Song Sun Kyo,Kwan Koing Bo,Kim Heung Dae The Korean Society for Radiation Oncology 1991 Radiation Oncology Journal Vol.9 No.2

영남대학병원에서는 1988년 6월 15일부터 1990년 9월 15일까지 절제가능한 국소 진행된 위암 환자중 원격 전이를 추인할 수 없었던 환자 총 28명을 prospective randomized protocol에 의한 치료를 계획하였다. 28명중, 개복후 절제가 불가능했던 환자 3명과 stage la로 판명된 환자 1명을 제외 한 24명에서 외과적 근치절제수술후 1500cGy를 giuev의 전자선을 이용하여 1회에 조사하였다. 외부 방사선 치료는 수술후 4주 이내에 시작하여 하루 180 cGy 주 5회 치료법으로 $4300\sim4500$ cGy를 조사하였다. 항암요법은 protoco떼 의하여 5-FU, Mitomycin-C, Adriamycin, Uraful을 여러 가지 조합으로 투여하였다. 3개월에서 31개월 간의 추적기간 중에 방사선 조사와 관계되는 심한 부작용은 보고되지 않았다. 짧은 추적 기간이므로 생존율을 산출할 수 없겠으나 수술중 방사선치료, 외부방사선 치료와 여러가지 항암제를 병합 투여하였음에도 불구하고 심한 부작용이 발견되지 않았을 뿐 아니라 현재까지 국소재발이 한 예에서도 발견되지 않았음으로 수술중 방사선 치료의 국소 재발의 억제 및 방지의 효과가 확실시되며 계속되는 추적 검사에서도 좋은 생존율이 기대된다. Total 28 patients with resectable, locally advanced gastric cancer were entered in our prospective randomized study from June 15, 1988 to Sep. 15, 1990 in Yeungnam University Hospital. This study consisted of curative resection, IORT, external irradiation and combination of chemotherapy. Twenty-four of 28 patients were treated with single dose of 1500 cGy with 9 MeV election intraoperatively. External irradiation of $4300\sim4500$ cGy with 180 cGy per fraction, 5 days per week was started within 4th weeks of postoperative days. Various chemotherapy with or without external irradiation were added for reducing hematogenous and/or peritoneal dissemination and determination of complication of each arm. Duration of follow up was $4\sim31$ months. No serious complication related with radiation were reported compare to resection and chemotherapy only group. Although our follow up period is too short to draw any conclusion, IORT appears to improve local control, hopely further survival. Continuous follow up should be needed for evaluation of real therapeutic gain such as complication vs. improved survival.

Intraoperative Radiotherapy (IORT) for Locally Advanced Colorectal Cancer

김명세(Myung Se Kim),김성규(Sung Kyu Kim),김재황(Jae Hwang Kim),권굉보(Koing Bo Kwan),김흥대(Heung Dae Kim) 대한방사선종양학회 1991 Radiation Oncology Journal Vol.9 No.2

대장-직장암은 한국에서 남녀 모두 4위의 비교적 높은 빈도를 보이고 있으며 점점 증가되는 추세에 있다. 근치적 수술요법이 주 치료방법으로 사용되어 왔으나 그 생존율은 20~50%에 불과하다. 국소재발은 특히 직장암에서 가장 흔히 실패의 원인으로서 근치적 복합요법의 발달에도 불구하고 40~92%의 높은 국소재발율이 보고되고 있어 생존율을 높이고 생존의 질을 높이기 위하여는 국소재발을 줄이는 노력이 필수적이다. 수술중 방사선 치료는 수술중에 원하는 부위에만 다량의 방사선을 한번에 조사하는 방법으로 최근 보고에서 국소재발율을 5%까지 줄일 수 있었다고 보고되고 있다. 영남대학병원 치료방사선과에서는 국내에서는 처음으로 91년 5월 30일 직장암 환자에 수술중 방사선 치료를 실시한 후 현재까지 6명의 대장 직장암 환자에 수술중 방사선 치료를 실시하였기에 환자선택, 치료선량, 선량분포, 수술 및 방사선치료과정등을 보고하고저 한다. Colorectal cancer is the second most frequent malignant tumor in the United States and fourth most frequent tumor in Korea. Surgery has been used as a primary treatment modality but reported overall survivals after curative resection were from 20% to 50%. Local recurrence is the most common failure in the treatment of locally advanced colorectal cancer. Once recurrence ha developed, surgery has rarely the role and the five year survival of locally advanced rectal cancer is less than 5%, in spite of massive comvination therapy. Intraoperative radiotherapy(IORT) with or without external beam irradiation has been advocated for reducing local recurrence and improving survival. The recent report of local control could be achieved. We performed 6 cases of IORT for locally advanced colorectal cancer which is the first experience in Korea. Patient's eligibility, treatment applicator, electron energy, dose distribution no the surface and depth within the treatment field and detailed skills are discussed. We hope that our IORT protocol can reduce local failure and increase the long term survival significantly.

IORT in Gastric Cancer

Myung Se Kim(김명세) , Cheol Hoon Kang(강철훈) , Sung Kyu Kim(김성규) , Sun Kyo Song(송선교) , Koing Bo Kwan(권굉보) ,Heung Dae Kim(김홍대) 대한방사선종양학회 1991 Radiation Oncology Journal Vol.9 No.1

영남대학병원에서는 1988년 6월 15일부터 1990년 9월 15일까지 절제가능한 국소 진행된 위암 환자중 원격 전이를 확인할 수 없었던 환자 총 28명을 prospective randomized protocol에 의한 치료를 계획하였다. 28명중, 개복후 절제가 불가능했던 환자 3명과 stage la로 판명된 환자 1명을 제외한 24명에서 외과적 근치절제수술후 1500 cGy를 9MeV의 전자선을 이용하여 1회에 조사하였다. 외부 방사선 치료는 수술후 4주 이내에 시작하여 하루 180 cGy 주 5회 치료법으로 4300~4500 cGy를 조사하였다. 항암요법은 protocol에 의하여 5-FU, Mitomycin-C, Adriamycin, Uraful을 여러 가지 조합으로 투여하였다. 3개월에서 31개월 간의 추적기간 중에 방사선 조사와 관계되는 심한 부작용은 보고되지 않았다. 짧은 추적 기간이므로 생존율을 산출할 수 없겠으나 수술중 방사선치료, 외부방사선치료와 여러 가지 항암제를 병합 투여하였음에도 불구하고 심한 부작용이 발견되지 않았을 뿐 아니라 현재까지 국소재발이 한 예에서도 발견되지 않았음으로 수술중 방사선 치료의 국소 재발 억제 및 방지의 효과가 확실시되며 계속되는 추적검사에서도 좋은 생존율이 기대된다. Total 28 patients with resectable, locally advanced gastric cancer were entered in our prospective randomized study from June 15, 1988 to Sep, 15, 1990 in Yeungnam University Hospital. This study consisted of curative resection, IORT, external irradiation and combination of chamotherapy. Twenty-four of 28 patients were treated with single dose of 1500 cGy with 9 MeV election intraoperatively. External irradiation of 4300~4500 cGy with 180 cGy per fraction, 5 days per week was started within 4th weeks of postoperative days. Various chemotherapy with or without external irradiation were added for reducing hematogenous and/or peritoneal dissemina-tion and determination of complication of each arm. Duration of follow up was 4~31 months. No serious complication related with radiation were reported compare to resection and chemother-apy only group. Although out follow up period is too short to draw any conclusion, IORT appears to improve local control, hopely further survival. Continuous follow up should be needed for evaluation of real therapeutic gain such as complication vs. improved survival.

Complication of Intraoperative Radiation Therapy (IORT) in Gastric Cancer

김명세(Myung Se Kim),김성규(Sung Kyu Kim),송선교(Sung Kyo Song),김홍진(Hong Jin Kim),권굉보(Koing Bo Kwan),김흥대(Heung Dae Kim) 대한방사선종양학회 1992 Radiation Oncology Journal Vol.10 No.2

영남대학교 의료원 치료방사선과에서 1988년 6월 15일에 위함 환자의 수술중 방사선치료를 시작한 이래 1992년 8월 30일까지 총 58예에서 시도하여 그중 53예에서 IORT를 실시하였으며, 정기적인 추적검사에서 한명의 국소개발 환자도 보고되지 않고 있다. 출혈(3예), 장관폐쇄(3예), 폐혈증(2예), 골수기능저차(1예)를 포함한 총 9예(17%)의 합병증이 보고되었고, 이중 6예(13%)가 사망하였다. IORT(1500cGy), 외부 방사선치료 (-4500cGy)와 강한 항암제를 병합치료 하였음에도 불구하고 주등(수술과 항암제 치료)의 25.2%, 김등(수술 불가능한 환자에서 항암제 투여)의 18%, 리등(수술)의 18.5%, Kraming등(IORT 2800-3500cGy)의 35.3%에 비해 낮은 합병증을 보여 IORT가 위암의 치료에 공헌할 수 있음을 시사하였다. 그러나 비교적 높은 치사율(11.3%)은 더욱 세심한 수술수기 및 수술 후 환자의 치료가 필요하며 외부 방사선치료와 항암제치료의 적절한 시기 조절 및 치료선량의 가감이 필요할 것으로 생각된다. Local control is the important prognostic factor in cancer treatment because local control decrease the relative risk of metastatic spread and increase distant metastasis free survival. IORT is the modality which could increase local control without increasing complication, combined with curative operation. Eventhough we could achieve significant deacreased local failure by IORT and curative resection, it should not be committed as a main treatment modality without proving acceptable complications. Therapeutic Radiology Department of Yeungnam University Medical Center have tried 58 IORT from June 15, 1988 and performed 53 IORT in patients with gastric cancer. No local failure had been reported including interstinal obstrution, hemorrhage, sepsis, and bone marrow depression. These complications could be comparable to Jo's 25.2% (chemotherapy + operation), Kim's 18% (chemotherapy only in inoperable patients), because our treatment regimen is consisted of IORT (1500cGy), external irradiation (--4500cGy) and extensive chemotherapy (FAM, 5FU + MMC, BACOP). Our data encouraged us to re-inforce further IORT in stomach cancer treatment.

술중 담도조영술이 꼭 필요한가?

김춘직(Chun Jik Kim),김상운(Sang Woon Kim),이수정(Soo Jung Lee),김홍진(Hong Jin Kim),심민철(Min Chul Shim),권굉보(Koing Bo Kwun),정문관(Moon Kwan Chung) 대한소화기학회 1994 대한소화기학회지 Vol.26 No.1

N/A Since operative cholangiography was introduced by Mirizzi in 1932, surgeons have used it routinely during cholecystectomy to find silent CBD stones. However, recent developments in preoperative evaluation techniques have led to debates regarding the routine use of operative cholangiography. The purpose of this study is to evaluate the necessity of the routine use of operative cholangiography. Of the 839 patients who underwent cholecystectomy, 625 patients underwent preexp- loratory cholangiography during the period from June 1983 to December 1991, at the Depart- rnent of Surgery, Yeungnam University Hospital. Unsuspected common duct stones were found in 5 out of 149 patients(5.9%) by preexploratoty cholangiography when emergency cholecystectomy was performed. Of the 448 cholangiography in patients without any abnor- mality in the preoperative test and no operative indication for CBD exploratiOn, the incidence of gall stones was only 1.1%. Of the 82 patients with minor abnormality of LFT or ultrasonogram, 38 cases of elective cholecystectomy were carried out without any other test. The incidence of gall stones in these patients was 28%. The ERCP was attempted on 163 pa- tients with one or more of the following abnormalities: LFT, ultrasonogram and past history of jaundice, pancreatitis or cholangitis. In 117 of these patients, CBD stones were found, in 2 of the patients, stricture were found, and in the rernaining 44, no stones were found. The ERCP performed on 35 patients with normal findings of preopeative LFT or ultrasonogram showed no evidence of CBD stone. Of the 79 whose ERCP was judged normal preoperatively, no stones were found at operative cholangiography. Therefore the following points may be concluded: First, operative cholangiography should be performed when emergency cholecystectomy is indicated. Secondly, it should also be done when the confirmatory test, such as ERCP, PTC and CT was not performed or failed in pa- tients with one or more of the following abnormalities such as LFT, ultrasonogram and past history of jaundice, pancreatitis or cholangitis. Finally, it should also be carried out on patients with dilated duct, small stones in the gallbladder and enlarged cystic duct.(Korean J Gastroenterol 1994; 26: 167-174)

복강경 및 대장내시경에 의한 비개복적 우측대장종괴 절제술

김재황,정문관,심민철,권굉보 대한대장항문학회 1994 Annals of Coloproctolgy Vol.10 No.4

거대 간혈관종 1例

김시환,이영현,이헌주,정문관,최수봉,김종설,권굉보,황미수,장재천,이태숙 영남대학교 의과대학 1984 Yeungnam University Journal of Medicine Vol.1 No.1

저자 등은 상복부종양을 주소로 영남대학병원 내과에 입원하여 거대 간혈관종으로 진단하여 성공적으로 절제해 낸 1例를 경험하였기에 문헌고찰과 함께 보고하는 바이다. Hepatic hemangioma is a benign neoplastic disease of the liver and characterized by high vascularity and accompanied with bleeding episode. We report a case of giant hepatic cavernous hemangioma and review the literature briefly. A 44-years old female patient was admitted because of palpable abdominal mass, which growing for 15 years. She was diagnosed as hepatic hemangioma by abdominal CT scan and selective celiac angiography. She was performed the left lateral segmentectomy of liver and the pathological report was cavernous hemangioma of the liver.

복강동맥 압박 증후군 1 예

김태년,조재호,김영조,이동준,김준환,최진수,김영성,권굉보,정문관,신동구 대한소화기학회 1999 대한소화기학회지 Vol.33 No.1

Celiac artery compression syndrome denotes the presence of external celiac artery compression and abdominal symptoms including abdominal pain, nausea and weight loss etc. Recently, we experienced one case of celiac artery compression syndrome comfirmed by abdominal arteriogram. A 29-year-old man presented with prolonged recurrent epigastric pain, nausea, vomiting and epigastric systolic brui for 8 years. On physical examination, laboratory studies and upper gastrointestinal studies with gastroduodenoscopy, ultrasonography and computerized tomography, there was no specific abnorma l finding related to symptoms of the patient. However, abdominal arteriogram revealed smooth narro wing of the celiac artery close to its origin with dominant splenic flow and arterial aneurysm about 12mm in size at the gastroduodenal artery. We operated the patient with decompression method including division of the constricting median arcuate ligament and neural fibrous tissues surrounding the celiac artery. However, symptoms of the patient were not relieved. On the 9th day after the operation, transfemoral intraluminal angioplasty at the remaining compressed celiac artery was peformed. After the angioplasty, the symptoms of the patient were improved. (Kor J Gastroentero 1999;33:142 - 147)