선천성 식도 폐쇄증의 예후 판정

김현학,정현아,김경헌,김정한,이석구,Kim, Hyun-Hahk,Jeong, Hyeon-A,Kim, Kyung-Hun,Kim, Jung-Han,Lee, Suk-Koo 대한소아외과학회 2001 소아외과 Vol.7 No.1

The aims of this study were to evaluate the prognostic predictabilities of the risk classifications (Waterston, Montreal, and Spitz), preoperative treatment of pneumonia and the length of esophageal gap in esophageal atresia. Twenty-five cases of esophageal atresia were reviewed retrospectively. The data was analyzed with Likelihood ratio test for trend and Fisher's exact test. Survival rates were 100.0 % in group A and B, and 60.0 % in group C according to Waters ton classification (p=0.027). By Montreal classification, 95.7 % in group I and 50.0 % in group II (p=0.086). By Spitz classification, 95.5 % in group I and 66.7% in group II (p=0.159). The survival rate was 85.7 % in the patients with pneumonia preoperatively treated and 94.4% in the patients without pneumonia. The difference was not significant (p=0.490). Survival rate in the patients with long gap (${\geq}$3cm) was 50.0 % and 100.0 % in patients with short gap (<3cm) with significant difference (p=0.020). The Waterston classification could be modified into two groups because the prognosis of both group A and B were the same. Preoperative pneumonia does not seem to be a risk factor. The length of the esophageal gap showed prognostic value.

위염전 1예

김현학,이석구,김경헌,Kim, Hyun-Hahk,Lee, Suk-Koo,Kim, Kyung-Hun 대한소아외과학회 2000 소아외과 Vol.6 No.2

Gastric volvulus is a rare surgical disorder in the pediatric population. We experienced a case of gastric volvulus. A 2-year-old boy was admitted to hospital with abdominal distension. An upper gastrointestinal series showed reversal of the greater and lesser curvatures. Surgical exploration revealed an organoaxial volvulus of the stomach, and anterior gastropexy was performed.

선천성 횡격막 탈장증 교정 후 발견된 활주형 탈장 1예

남석진,김현학,이석구,Nam, Seck-Jin,Kim, Hyun-Hahk,Lee, Suk-Koo 대한소아외과학회 1996 소아외과 Vol.2 No.2

This is a case report of a sliding hiatal hernia with severe gastroesophageal reflux(GER) after repair of congenital diaphragmatic hernia(CDH). It was not possible to determine whether the hiatal hernia is a de novo lesion which was missed at the original operation or a consequence of overzealous repair of the Bochdalek defect at the expense of weakening of the diaphragmatic crura. This case demonstrates that a sliding hiatal hernia can be a cause of severe gastroesophageal reflux that should be managed surgically.

선천성 횡격막 탈장의 지연수술 결과

이석구,김현학,김경헌,장윤실,박원순,Lee, Suk-Koo,Kim, Hyun-Hahk,Kim, Kyung-Hun,Chang, Yun-Sil,Park, Won-Soon 대한소아외과학회 2001 소아외과 Vol.7 No.1

Congenital diaphragmatic hernia (CDH) in the past was considered a surgical emergency requiring immediate operation. Several groups now advocate preoperative stabilization and delayed surgery. The treatment strategy for CDH in this institution is delayed surgery after preoperative stabilization. The aim of this study was to evaluate the results of delayed surgery. A retrospective review of 16 neonates with CDH was performed. Surfactant. conventional mechanical ventilation. high frequency oscillation. and nitric oxide were utilized for preoperative stabilization as necessary. The difference in outcome between two groups differentiated by the duration of the preoperative stabilization periods with mechanical ventilation (${\leq}$ 8 hours and > 8 hours) was determined. Chi-square test was used to analyze the data. There were 7 right-sided hernias and 9 left. The average duration of stabilization was 32.4 hours. Hepatic herniation through the defect was found in 6 cases and all died. The most common postoperative complication was pneumothorax. The mortality rate of the right side hernia was higher than the left (85.7% vs. 33.3%. p=0.036). Mortality rate of the group (N=8) whose preoperative stabilization period was 8 hours or less was better than that (N=6) whose preoperative stabilization period was more than 8 hours (25.0% vs. 83.3%. p=0.031). The overall mortality rate was 56.3%. The better prognosis was noticed in left side hernia. no liver herniation, or shorter preoperative stabilization period.

소아 림프관종의 OK-432 병변내 주사요법

김경헌,김현학,이석구,서정민,장원영,이병붕,Kim, Kyung-Hun,Kim, Hyun-Hahk,Lee, Suk-Koo,Seo, Jeong-Meen,Chang, Weon-Young,Lee, Byung-Boong 대한소아외과학회 2001 소아외과 Vol.7 No.2

Lymphangioma is a congenital malformation of the lymphatic system, commonly seen in the neck. Operation was the treatment of choice but it is difficult to resect the lymphangiomas completely. The aim of this study is to evaluate the result of intralesional injection of OK-432 as a treatment strategy of lymphangioma in children. Medical records of 51 cases of lymphangioma from March 1996 to February 2001 were reviewed retrospectively. Intralesional injection of 0.1mg OK-432 in 10ml normal saline was performed after the aspiration of as much fluid as possible. The location of the lesion was the face and neck in 26 patients, the chest wall in 14, the extremities in 9, and the abdominal wall in 2. The cystic type was present in 45 patients and the cavernous type in 6. Four postoperative recurrent cases were included. Fluid aspiration from the lesion was impossible in 5 patients. Development of fever after injection was observed in 27 patients and local inflammatory reaction was in 5 patients. There was no scar formation at injection sites. Complete shrinkage was observed in 20 patients, remarkable shrinkage in 23, slight shrinkage in 3, and no response in 5. Cystic type or aspiration-possible cases showed better outcome than cavernous type or aspiration-impossible cases. All of four recurrent cases after surgical excision showed at least remarkable shrinkage. These results indicate that intralesional injection of OK-432 is a safe and satisfactory treatment modality of lymphangiomas in children and might be considered as a treatment of choice, even in recurrent cases.

"Skip Area"가 있는 선천성 거대결장

이석구,이우용,김현학,Lee, Suk-Koo,Lee, Woo-Yong,Kim, Hyun-Hahk 대한소아외과학회 1998 소아외과 Vol.4 No.1

Early recognition and surgical treatment of Hirschsprung's disease prevents serious mortality and morbidity from enterocolitis and obstruction. Usually this disease is characterized by a single aganglionic segment of the colon extending distally to the anal margin. In surgical treatment, the surgeon performs a frozen section biopsy to confirm whether there are ganglion cells. If there are intervening ganglionic sites in aganglionic bowel, there may be confusion in diagnosis and treatment. The authors experienced one case of total colonic aganglionosis with skip area. A transverse loop colostomy was performed on a 7 day-old male baby with colon perforation due to Hirschsprung's disease. But intestinal obstruction persisted and required two more operations to find the true nature of the disease. There were aganglionic segments from the anal margin to the terminal ileum 3.7cm proximal to the ileocecal valve. The entire transverse colon and appendix were normally ganglionated.

Congenital, Cystic Adenomatoid Malformation을 보이는 복강내 폐분리증

이석구,이우용,김현학,Lee, Suk-Koo,Lee, Woo-Yong,Kim, Hyun-Hahk 대한소아외과학회 1996 소아외과 Vol.2 No.2

Pulmonary sequestration is a complex anomaly involving the pulmonary parenchymal tissue and its vasculature. It presents as a cystic mass of nonfunctional lung tissue without communication with the tracheobronchial system. Usually, it receives blood supply from anomalous systemic vessels. Therefore, preoperative diagnosis of the pulmonary sequestration is difficult, especially when it is located in the abdomen and combined with congenital cystic adenomatoid malformation(CCAM). We encountered such a mass(CCAM type 2) detected prenatally by ultrasonography. It was a kidney bean shaped, pinkish mass straddling the thorax and abdomen on the right side. Because of the sonographic appearance, neuroblastoma was diagnosed preoperatively. The mass was completely extirpated without difficulty.

개방성 제장간막관 기형4예 보고

이우용,이석구,김현학,Lee, Woo-Yong,Lee, Suk-Koo,Kim, Hyun-Hahk 대한소아외과학회 1997 소아외과 Vol.3 No.2

The omphalomesenteric duct normally obliterates by the sixth week of intrauterine life. Incomplete obliteration results in various abnormalities which may be apparent in the newborn infant. These include fistula resembling ileum, a prolapsed loop of intestine through the umblicus and a fistula draining intestinal contents. The tract may contain ectopic tissue of stomach, colon or pancreas. Although this malformation should be recognizable at birth, 40 % of patients are not treated until after the first month of life. In the past 28 months since the Samsung Medical Center opened its doors to public, the authors have treated 4 cases of patent omphalomesenteric duct remnant including one case of T-shaped total prolapse of the duct and adjacent ileum. These cases will be discussed and the literature reviewed.

소아의 담관낭종

임세웅,이석구,김현학,Lim, Sae-Woung,Lee, Suk-Koo,Kim, Hyun-Hahk 대한소아외과학회 1999 소아외과 Vol.5 No.2

To study the role of anomalous pancreatico-biliary ductal union (APBDU) in the development of choledochal cyst, we reviewed 23 cases. APBDU is defined as a long common channel(>0.4 mm). The patients ages ranged from 1 week to 112 months and the mean age was 22.5 months. Right upper quadrant pain was the most prevalent symptom. The diagnosis was made by ultrasonography and operative cholangiography in most patient. The preoperative diagnosis was made in 100 % of the cases. Gallstones were found in 5 cases. Todani type I and type IV were prevalent. A long common channel was found in all cases. The operative treatment consisted of cyst excision and Reux-en-Y hepaticojejunostomy or choledochojejunosotmy. One patient had postoperative pancreatitis. There was no mortality. We conclude that detection of choledochal cyst is occurring at a younger age and APBDU seems to play an important role in the pathogenesis of type I and IV cysts. Cyst excision is the treatment of choice to eliminate repeated cholangitis and malignant transformation.

미숙아와 만삭아에서의 비후성 유문 협착증의 임상적 차이

이석구,김성환,이우용,김현학,Lee, Suk-Koo,Kim, Seong-Hwan,Lee, Woo-Yong,Kim, Hyun-Hahk 대한소아외과학회 1998 소아외과 Vol.4 No.1

Infantile hypertrophic pyloric stenosis(IHPS) is common in full-term babies, and relatively rare in prematures. The diagnosis of IHPS in premature infants may be obscured because of the lack of classic symptoms and signs and the absence of the standard criteria for ultrasonic diagnosis. The purpose of this study is to discover the clinical differences between premature and full-term infants with pyloric stenosis, and determine the appropriate diagnostic methods for early diagnosis in premature infants. The clinical records of 52 IHPS patients who had been operated upon from October, 1994 to April, 1997 were reviewed. The incidence of IHPS in premature infants was 25 %. The onset of symptom was 4.7 weeks of age in premature, and 2.9 weeks in full-term babies. Diagnosis was established by typical symptoms. signs. and diagnostic imaging studies. In two premature infants, diagnosis was confirmed by upper gastrointestinal(GI) series, because ultrasonography did not meet the diagnostic criteria. Two premature infants initially diagnosed as gastroesophageal reflux by esophagography. were found to have IHPS by upper GI series. For the diagnosis of IHPS, a new set of criteria for premature babies has to be developed.