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간장 ( 肝臟 ) , 담도 ( 膽道 ) 및 췌장 ( 膵臟 ) : Expandable Metallic Stent를 이용한 담도 협착의 치료
민영일(Young Il Min),이성구(Sung Koo Lee),김명환(Myung Hwan Kim),이승규(Sung Gyu Lee),전용철(Yong Cheol Jeon),성규보(Kyu Bo Seong),민병철(Pyung Cheol Min) 대한소화기학회 1991 대한소화기학회지 Vol.23 No.3
N/A Expandable metallic stents were implanted in 9 patients with malignant (4 patients) or benign (5 patients) biliary stenoses. Five patients with benign strictures (intrahepatic stones with intrahepatic strictures, n=4; intrahepatic and extrahepatic stones with common bile duct stricture, n= 1) and four with malignant biliary strictures (cholangiocarcinoma, n=4) were treated with expandable metallic stents via percutaneous or transpapillary route. The patients with benign disease had failed treatment with surgical reconstruction and transhepatic balloon dilatation. In the three of the four patients with cholangiocarcinoma, relief of jaundice was observed. Patients with benign strictures have done very well. Our experience shows that expandable metallic stents can be inserted with little discomfort for the patients and with relatively few complications. They will provide good palliation in patients with malignant obstructive jaundice and benign strictures.
Bismuth 1형 및 2형 간문부담관암에서의 축소간절제술식
이종남(Jong Nam Lee),이승규(Sung Gyu Lee),민병철(Pyung Chul Min),김명환(Myung Hwan Kim),민영일(Young Il Min),성규보(Gyu Bo Sung),최건무(Kun Moo Choi),최호순(Ho Soon Choi),권태원(Tae Won Kwon),박광민(Kwang Min Park),이영주(Young Joo L 대한소화기학회 1995 대한소화기학회지 Vol.27 No.5
N/A Background/Aims: Extended right lobectomy and caudate lobectomy of liver with extrahepatic bile duct resection have been recommended to achieve radicality and improve prognosis in Bismuth type I and II hilar bile duct carcinoma. However, this extended hepatectomy could cause an excessive surgical stress for patients with reduced hepatic function and those in poor general condition who have suffered from prolonged and severe jaundice. In this study, outcomes in 5 patients treated with limited liver resection were evaluated to ascertain whether similar positive results comparable to extended liver resection could be obtained. Methods: For 5 instances, we had performed limited liver resection, called central hepatectomy: caudate lobectomy in 1, central bisegmentectomy with Sl in 2, and medial segmentectomy with Sl in 2(1 of them underwent left portal vein resection and reconstruction using external iliac vein interposition graft). Results: In all instances, curative resections defined with cancer-negative resection margins were achieved. Their postoperative course and long-term survival were comparable to those of extended hepatectomy, and the longest survivor of the five patients has been alive for 46 months without recurrence. Conclusions: Central hepatectomy can be carried out with similar positive results to extended hepatectomy, especially in high-risk patients with limited functional liver reserve. (Korean J Gastroenterol 1995;27: 573 - 580)
민영일(Young Il Min),이성구(Sung Koo Lee),김명환(Myung Hwan Kim),이승규(Sung Gyu Lee),김태형(Tae Hyeoung Kim),서동완(Dong Wan Seo),명승재(Seung Jae Myung),박광민(Kwang Min Park),이영주(Young Joo Lee),성규보(Gyu Bo Sung),이미화(Mee Hw 대한소화기학회 1997 대한소화기학회지 Vol.30 No.1
A case of prirnary pure cholesterol hepatolithiasis is reported. A 30-year-old man with right upper quadrant pain and fever turned out to have intrahepatic stones. Stone composition was documented by infrared spectroscopy and the presence of cholesterol crystal in hepatic bile was demonstrated using polarized microscope. The patient was treated with choledochoscopic stone extraction and oral dissolution therapy. The cholangioscopic finding showed only mild inflammation and no remarkable stricture in stone-bearing duct. We advocate biochemical analyses of both stone and. bile for the optimal therapy of primary hepatolithiasis. (Korean J Gastroenterol 1997; 30:136- 139)
양성간외담도협착증에서 중재적 방사선치료와 고식적 외과치료의 비교고찰
이종남(Jong Nam Lee),이승규(Sung Gyu Lee),권태원(Tae Won Kwon),최건무(Kun Moo Choi),성규보(Kyu Bo Seong),김명환(Myeong Hwan Kim),이성구(Sung Koo Lee),민병철(Pyung Chul Min) 대한소화기학회 1994 대한소화기학회지 Vol.26 No.4
N/A Benign biliary stricture represents a significant clinical problem, despite of the technological development that has facilitated diagnosis and management. Without proper treatment, it could cause recurrent cholangitis, biliary cirrhosis, liver failure, and death. There are several e- tiologic factors in benign biliary strictures but almost all cases are related to biliary operation, especially cholecystectomy. At Asan Medical Center, from July 1989 through June 1993, nineteen patients were man- aged for post-operative biliary strictures with surgery and radiologic intervention. Nine pa- tients were treated with surgical repair (Roux-en-Y choledocho- or hepaticojejunostomy); ten patients were treated with radiologic and endoscopic intervention (9 endoscopic or tran- shepatic balloon dilatation with stent placement and 1 balloon dilatation only). All patients had the history of previous biliary scrgery, 15 cholecystectomy or CBD explo- ration, 2 choledochoenterostomy, and 2 endoscopic papillostomy. There was no motality after any proce- dure and mean period of follow-up was 10.2 months (3 36 months) for both groups. In sur- gery group, 8 patients (89%) showed successful outcome but in radiologic intervention group, only 4 patients (40%) showed successful outcome. Minor complications after procedure were 4 cases in surgery group and 3 cases in radiologic intervention group but there was no major complication in both groups. Mean period of hospital stay was 6 days (1 16 days) in radiolog- ic intervention group and 23.1 days (19&5 days) in surgery group. Five patients required retreatment because of recurrent strictures after endobiliary stenting. In these patients, 3 Roux-en-Y hepaticojejunostomy was performed, 1 pancreaticduodenectomy was done because of a possibility of malignancy and 1 PTBD was done because the patient refused the surgery. In conclusion, Radiologic intervention for benign biliary strictures provides temporary relief of symptom and might be an alternative treatment, especially in poor risk patients. However, open surgery (mucosa-to-mucosa anastomosis) is superior to radiologic intervention for definite treatrnent of postoperative biliary strictures because of fewer problems that require fur- ther therapy and excellent outcome. (Korean J Gastroenterol 1994; 26: 697 705)
확대간엽 및 문맥합병절제를 시행한 간문부 담관암의 치료
민영일(Young Il Min),이영상(Yung Sang Lee),김명환(Myung Hwan Kim),이승규(Sung Gyu Lee),민병철(Pyung Chul Min),이문규(Moon Gyu Lee),최건무(Kun Moo Choi),이성구(Sung Goo Lee),성규보(Gyu Bo Sung),오영호(Young Ho Oh) 대한소화기학회 1993 대한소화기학회지 Vol.25 No.5
Although carcinoma of hepatic hilus is generally a slow-growing tumor, the results of treatment continue to be poor, mainly, because of the low resectability rates. A case of resected carcinoma of hepatic hilus with portal vein bifurcation and proper hepatic artery invasion is presented. Preoperatively 3 seperate percutaneous transhepatic biliary drainage was made to right anterior, right posterior segment and left lobe of the liver to control cholangitis and alleviate jaundice. Curative surgery, which included extended right hepatic lobectomy with total caudate lobectomy, and combined resection of hepatoduodenal ligament and regional lymphatic tissue was performed, while an autogenous external iliac vein was interposed between root of portal vein trunk and umbilical portion of left portal vein. The use of hepatectomy with combined resection of portal vein and/or hepatic artery using vascular reconstruction allows curative surgery in the treatment of advanced carcinoma of the hepatic hilus which was previously thought to be inoperable
간장 ( 肝臟 ) , 담도 ( 膽道 ) 및 췌장 ( 膵臟 ) : 급성 담낭염의 치료에 있어서 경피적 담낭루 설치술의 이용
민영일(Young Il Min),이성구(Sung Koo Lee),안세현(Sei Hyun Ahn),김명환(Myung Hwan Kim),이승규(Sung Gyu Lee),전용철(Yong Cheol Jeon),성규보(Kyu Bo Seong),조경식(Kyung Sik Cho),이문규(Mun Gyu Lee) 대한소화기학회 1991 대한소화기학회지 Vol.23 No.3
N/A Percutaneous cholecystostomy is a techniue to obviate cholestectomy or surgical cholecystostomy in high risk patients. We evaluated 12 relatively high risk patients who underwent percutaneous cholecystostomy in recent 1 year. Overall success rate of percutaneous cholecystostomy was 92%(12/ 13). Relief of pain and defervescence could be observed promptly in almost all patients. In 4 cases of acalculous cholecytstitis, the catheters were removed successfully after resolution of acute inflammation. 3 cases of calculous cholecystitis were treated with elective cholecystectomy after resolution of septic condition. Percutaneous stone removal was performed via the enlarged tract with stone basket or other mechanical devices in 3 cases of calculous cholecystitis. Two cases of tube dislodge and 1 case of mild bile leakage were the complications of this procedure without significant mortality or morbidity. Percutaneous cholecystostomy is a fast, low risk and effective treatment of acute cholecystitis in poor surgical risk patients.