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혈역학적으로 불안정한 골반 골절에서 진공 폐쇄 드레싱을 병용한 후복막 거즈 충전법 치료
김성집 ( Sung Jeep Kim ),김지훈 ( Ji Hoon T Kim ) 대한외상학회 2014 大韓外傷學會誌 Vol.27 No.2
Pelvic bone fracture with hemodynamic instability is fatal and the mortality rate can range up to 40%. Despite the big advances in the treatment of massive bleeding and hemorrhagic shock, the mortality associated with hemodynamically unstable pelvic bone fractures remains high. The gold standard of treatment for pelvic bone fracture with hemodynamic instability has not yet been determined and is an issue of main discussion among many doctors. Retroperitoneal packing is not yet wide spread in Korea, but is a good modality for managing of massive bleeding from pelvic bone fractures when an angiography suite or an expert surgeon is not available. A vacuum-assisted closure (VAC) system can also be applied with retroperitoneal packing in the manner of damage control surgery and open abdomen surgery. We present the case of a 51-year-old male who had a pelvic bone fracture with massive bleeding. We performed retroperitoneal gauze packing with a VAC system for the first time. The postoperative vital signs of patient were immediately stable, the massive bleeding was easily and quickly controlled, and the amount of transfusion of blood components was reduced.
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서혜부 탈장에서 전복막외 복강경 탈장교정술과 개방적 탈장교정술의 비교 분석
전강웅(Kang-Woong Jun),정헌(Hun Jung),김성집(Sung-Jeep Kim),전경화(Kyong-Hwa Jun),진형민(Hyung-Min Chin),김준기(Jun-Gi Kim),박우배(Woo-Bae Park) 대한외과학회 2009 Annals of Surgical Treatment and Research(ASRT) Vol.77 No.4
Purpose: Laparoscopic herniorrhaphy has been recognized as one of the treatment options for inguinal hernia. This study compared the short-term results of two methods of repair: totally extraperitoneal (TEP) repair and open tissue based repair. Methods: A retrospective review was conducted on all patients who underwent laparoscopic TEP repair (LH, 105 cases) and open repair (OH, 57 cases) at our hospital between September 2007 and December 2008. Posterior wall repairs in open technique follow as McVay (25 cases) and Bassini (32 cases). Demographic data, operation time, perioperative complications, consumption of analgesics, and hospital stay were compared. Results: There was no significant difference in relation to patient characteristics; age, gender, BMI, medical and surgical history and hernia type. Also, there was no difference of operation time for both groups. Patients in the LH group consumed fewer analgesics (P=0.002). Intraoperative complications occurred more frequently in the LH group (P=0.036) but postoperative complications were similar. Hospital stay was shorter in LH (P<0.001). There was no difference of recurrence between LH group and OH group for 16 months. Conclusion: Laparoscopic TEP repair shows similar postoperative complications and recurrences and with less postoperative pain and hospital stay, compared with open tissue based hernia repair. However, further study with longer follow up data is necessary.
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전예원(Ye-Won Jun),정헌(Hun Jung),김성집(Sung-Jeep Kim),전경화(Kyong Hwa Jun),진형민(Hyung Min Chin),박우배(Woo Bae Park) 대한외과학회 2009 Annals of Surgical Treatment and Research(ASRT) Vol.77 No.5
Purpose: Despite the reported advantages of laparoscopic appendectomy (LA), there is debate about the postoperative complication rates. Our study attempts to determine if laparoscopic appendectomy is safe and feasible compared with open appendectomy (OA). Methods: A retrospective review was conducted of all patients who underwent open appendectomy (OA, 2,109 cases) and laparoscopic appendectomy (LA, 500 cases) at our hospital between 1997 and 2007. Incidental and interval appendectomies were excluded from this study. Demographic data, pathology, operation time, length of hospital stay, days to regular diet, and in hospital complication rate were identified. Results: The peak age was 27 years. Seven of the 500 were converted to OA, yielding a conversion rate of 1.2%. The presence of non-visualized appendix, adhesion and technical failures were reasons for conversion. The distribution of histological stages of inflammation was comparable in both groups. The mean operating time was longer for the laparoscopic (64 min) than for the open procedure (58 min) (P<0.001). The complication rate after OA (7%) was significantly higher than that following LA (2.8%) (P=0.001). Hospital stay and frequency of analgesic administration were significantly lower in LA group than in OA group. Conclusion: Laparoscopic appendectomy is a safe and clinically beneficial operating procedure even in patients with appendicitis with peritonitis, perforation and abscess, resulting in shorter hospital stays and lower complication rates.
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