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근치적 위아전절제술 후 원형문합기를 이용한 위공장문합술 - 문합부 출혈과 예방 -
인명훈,강길호,조규석,김용진,김형수,한선욱,배상호,김성용,백무준,이문수,Ihn, Myung-Hoon,Kang, Gil-Ho,Cho, Gyu-Seok,Kim, Yong-Jin,Kim, Hyung-Soo,Han, Sun-Uk,Bae, Sang-Ho,Kim, Sung-Yong,Baek, Moo-Joon,Lee, Moon-Soo 대한위암학회 2009 대한위암학회지 Vol.9 No.4
목적: 원형문합기를 이용한 기계 문합술은 여러 가지 장점들로 인해 선호도가 증가하는 반면 수술 후 합병증 또한 지적되고 있다. 이에 저자들은 원형문합기를 이용한 위공장문합술을 시행할 때 발생할 수 있는 합병증을 분석하고, 기계문합술시 합병증을 감소시킬 수 있는 보완 술식을 제시하고자 하였다. 대상 및 방법: 1998년 1월부터 2007년 12월까지 순천향대학교 의과대학 외과학교실에서 근치적 위아전절제술 후 위공장문합술을 시행한 1,391명을 대상으로 하였으며, 수기 문합군을 I군, 선형문합기군을 II군, 원형문합기군을 III군으로 하였다. III군은 수술 중 직접 육안으로 출혈여부를 확인 했던 2001년 1월을 기점으로 III-A군, III-B군으로 세분하였으며, 임상적 특징과 문합부와 관련된 수술 후 합병증을 비교분석하였다. 결과: 문합부 누출은 I군에서 7예(1.5%), II군에서 1예(2.0%), III군에서 10예(1.2%)가 발생하였고, 문합부 협착은 I군에서 4예(0.8%), II군에서 1예(2.0%), III군에서 5예(0.6%)가 발생하였다. 문합부 출혈은 I군에서 32예(6.7%), II군에서 5예(10.4%), III군에서 67예(7.7%)가 발생하였으며, III-A군에서는 57예 (28.8%), III-B군에서는 10예(1.5%)가 발생하여 두 군 간에 통계적으로 유의한 차이가 있었다(P=0.037). 결론: 위아전절제술 후 원형문합기를 이용한 위공장문합술은 간편하고 안전하며 효율적인 술식이나 수술 시 세심한 주의가 요구되며, 문합부의 출혈 유무를 술 중 육안적으로 확인한 후 수술을 종료하는 보완된 술식으로 문합부출혈을 예방함으로써 기계문합법의 안전성이 더욱 향상될 것이다. Purpose: Circular stapled gastrectomy has been the favored procedure with its feasibility and the shortened operative time, but anastomotic leakage, stenosis and bleeding have been reported as problems. The aim of this study was to identify what can be done to supplement the safety of this technique by examining the potential complications of performing circular stapled gastrojejunosomy after radical subtotal gastrectomy. Materials and Methods: As subjects, this study selected 1,391 patients who underwent gastrojejunostomy after radical subtotal gastrectomy because of gastric cancer at our Department of Surgery from Jan. 1998 to Dec. 2007. The patients were divided into Group I (n=479) who underwent hand-sewn gastrojejunostomy, Group II (n=48) who underwent linear stapled gastrojejunostomy and Group III (n=864) who underwent circular stapled gastrojejunostomy. Group III was re-divided into two subgroups on the basis of the point of time that a visual check was intraoperatively performed at the anastomotic site: Group III-A (n=198) before and Group III-B (n=666) after. The characteristics and complications of the patients were then compared. Results: For the comparison of the complications between Group I, Group II and Group III, anastomotic leakage was found in 7 cases (1.5%) in Group I, in 1 case (2.0%) in Group II and in 10 case (1.2%) in Group III, and anastomotic stenosis were found in 4 cases (0.8%) in Group I, 1 case (2.0%) in Group II and 5 case (0.6%) in Group III. Anastomotic bleeding was found in 32 cases (6.7%) in Group I, in 5 cases (10.4%) in Group II and in 67 cases (7.7%) in Group III. For the comparison of complications between Group III-A and Group III-B, anastomotic bleeding was found in 57 cases (28.8%) in Group III-A and 10 cases (1.5%) in Group III-B and the difference was statistically significant (P=0.037). Conclusion: Circular stapled gastrojejunostomy after radical subtotal gastrectomy is recommended because of the safety and feasibility of this technique, but bleeding at the anastomotic site may be the critical issue. In conclusion, direct inspection for bleeding at the anastomotic site during the operation will improve the safety of performing circular stapler anastomosis.
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Dukes’ B 병기의 대장암 환자에서 Cytokeratin-19 항체를 이용한 림프절 미세전이의 발견
신응진(Eung Jin Shin),김형철(Hyung Chul Kim),임철완(Chul Wan Lim),조규석(Gyu Seok Cho),주종우(Chong Woo Chu),백무준(Moo Joon Baek),박내경(Nae Gyung Park),장용석(Yong Seok Jang),김재준(Jae Joon Kim),송옥평(Ok Pyung Song),이민혁(Min Hy 대한외과학회 2004 Annals of Surgical Treatment and Research(ASRT) Vol.66 No.5
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김태윤,백무준,김성용,신응진,박내경,이문수,김창호,송옥평 순천향의학연구소 2004 Journal of Soonchunhyang Medical Science Vol.10 No.1
Locally recurrent rectal cancer is a difficult clinical problem. Local recurrence following treatment for rectal cancer is a major cause of morbidity and mortality. The reported range of local recurrence rates following surgical treatment for rectal cancer has varied from 4% to 50%. We retrospectively reviewed the charts of 142 rectal cancer patients from January 1991 to December 1999. Analysis of patients factors included age, gender, type of surgery, and adjuvant therapy. Tumors were assessed for level, stage, and grade. Local recurrence and distant metastases were also documented. Variables influencing local recurrence in this group were identified and disease-free survival is determined. Of the 142 patients(74 males, 68 females; mean age 62.6 years), 137 consecutive patients operated on for rectal cancer and followed up to December 2000 (range 23-118months) were analyzed. Local recurrence rate was 18.3%. Age and sex of patients, type of surgery, location of tumor in the rectum, size, morphology and grading of the tumor were all unrelated to the event under investigation. At Cox regression, the Dukes stage and the postoperative radiotherapy were the only independent prognostic factors for local recurrence, and Dukes stage (Hazard ratio=2.89, p<0.001) and local recurrence (Hazard ratio=3.31, p<0.01) were the only independent factors associated with improved survival.
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김창호,임훈,백무준,이문수,김형철,이민철,송옥평,조무식,박희주 대한외상학회 1998 大韓外傷學會誌 Vol.11 No.2
Background: The pancreas may be injured as a result of either blunt or penetrating trauma. In spite of the advanees in diagnostic tools, operative method and perioperative care, the morbidity and mortality rates of the trau tic pancreatic injuries remain high. Those are due to the retroperitoneal location of the pancreas and the frequent aasociate injuries of adjacent important organs and major vessels. This study aimed to assess a clinical course and the prognostic factor of pancreatic injury. Method: A retrospective analysis of 43 patients who were sustained from traumatic pancreatic injuries was camed out. All the injuries were diagnosed by an operation during the past seven years at the Soon Chun Hyang University Chun An Hospital from January 1991 to December 1997. Results: Ninty-one percent(39) of injuries was a result of blunt trauma. Seventy%(30) had associate injuries; the gastrointestinal traet, spleen, liver, and retroperitoneal hematoma in arder of frequency. The panereatic complications were developed in 41%(16) who survived more than 48 hours or more. The over-all mortality rate was 27%(12). Among those patients survived 48 hours or more, the mortality rate was20.5%(8). Conclusions: Death after pancreatic injury is almost always due ta the degree of associate injuries and preoperative shock state rather than that of the pancreatic injury itself.
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