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간장 ( 肝臟 ) , 담도 ( 膽道 ) 및 췌장 ( 膵臟 ) : 체외 충격파 쇄석술을 이용한 간내 담관결석의 치료
이성구(Sung Koo Lee),김명환(Myung Hwan Kim),이승규(Sung Kyu Lee),민영일(Yong Il Min),이문규(Moon Kyu Lee),성규보(Kyu Bo Seong),조경식(Kyung Sik Cho),안세현(Se Hyun Ahn),민병철(Byung Chul Min) 대한소화기학회 1991 대한소화기학회지 Vol.23 No.3
N/A Extracorporeal shockwave lithothripsy was performed in the intrahepatic stone patients (n = 18) by Dornier MPL 9,000 with ultrasound guidance. The patients had T-tube (n=9) or percutaneous transhepatic biliary drainge tube (n =9). Average treatment session was four and shock wave numbers were in the range of 3,604 to 12,000 (average 6,288 shocks). Intrahepatic stones were removed completely in 16 patients over a 3 month period by ESWL and combined stone extraction maneuver such as cholangioscopic or interventional radiologic method. Extracorporeal shock wave lithothripsy was very helpful in facilitating extraction of stones in unfavorable location or located above the severe stricture. In summary, extracorporeal shockwave lithotripsy followed by percutaneous stone extraction will provide an improvement in the success rate and duration of treatment required for complete removal of primary hepatolithiasis.
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)
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.
원발성 간내 담석 환자에서 간내담도협착의 교정을 위한 팽창성 금속스텐트 ( Expandable Metallic Stent ) 의 이용
민영일(Young Il Min),이성구(Sung Koo Lee),김병식(Byung Sik Kim),김명환(Myung Hwan Kim),이승규(Sung Gyu Lee),성규보(Kyu Bo Seong),이선영(Sun Young Yi),박홍동(Hung Dong Park) 대한소화기학회 1993 대한소화기학회지 Vol.25 No.3
N/A We inserted self-expandable metallic stents in 16 patients with primary intrahepatic stones for the correction of intrahepatic strictures after complete rensoval of intrahepatic stones. All the patients had previous history of abdominal operations for removal of intrahepatic stones. The criteria from insertion of expandable metallic stents was recurrent stenosis after successful balloon dilatation. Inserted metallic stents were Gianturco-Rosch stents (24F) and the stents were inserted via T-tube or percutaneous transhepatic biliary drainage (PTBD) track, In the fallow-up period of average 12 months (9-15 months), 14 patients (88%) out of 16 patients had relief of pruritus and improvement of liver function. But two patients with secondary biliary cirrhosis showed no improvement of clinical symptoms and signs. In conclusion, these findings suggest that expandable metallic stents will be useful in the management of intrahepatic stricutures, which recurred after successful balloon dilatation, in the patients with primary intrahepatic stones.
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.
간세포암에 대한 화학 색전요법에 있어서 Cisplatin과 Adriamycin의 효과
이정신,정영화,민영일,양석균,성규보,이문규,오용호 대한소화기학회 1992 대한소화기학회지 Vol.24 No.4
A prospective and randomized trial was carried out from June 1989 to December 1991 to evaluate the effects of cisplatin and adriamycin in the chemoembolization therapy for the patients with unresectable hepatocellular carcinoma (HCC). A total of 56 cases became the subjects of this study, including 14 patients with HCC less than 5 cm in diameter, 33 patients 5 to 10 cm, and 9 patients larger than 10 cm. We used cisplatin (Group A), adriamycin (Group B) and both (Group C) in 23, 20 and 13 cases, respectively, to compare the effects of chemotherapeutic agents. The therapeutic effects of chemoembolization were assessed by the changes of tumor size in initial and follow-up computed tomography, serum alpha-fetoprotein level in cases with elevated initial value, and duration of survival. The partial response rates of group A and C were 52% and 54%, respectively, whieh were significantly higher than that of group B (35%). Chemoembolization using cisplatin or cisplatin combined with adriamycin could prolong the 1-year-survival rate (65% and 53%) compared with treatment using adriamycin (26%). But the partial response rate and 1-year-survival rate of group A and C were not different. In conclusion, it was suggested that cisplatin is more effective and significant than adriamycin as a chemotherapeutic agent in the chemoembolization therapy for patients with unresectable HCC.
Three-Headed 99mTc-RBC SPECT를 이용한 간혈관종의 진단
이승규,정영화,민영일,이영상,문대혁,이문규,이명혜,양석균,성규보 대한소화기학회 1992 대한소화기학회지 Vol.24 No.6
We evaluated the role of three-headed single-photon emission computed tomography (SPECT) in ^(99m)Tc-RBC scintigraphy for the diagnesis of cavernous hemangioma of the liver. A total of 76 patients, including 55 patients with 62 hemangiomas and 21 patients with 27 non- hemangiomas (20 hepatocellular carcinomas, 5 hepatic metastases, 2 other benign lesions), underwent planar RBC imaging followed by blood-pool SPECT scanning. The sensitivity of RBC scintigraphy for detecting hemengiomas was improved with the addition of SPECT; from 0% to 16.7% for hemangiomas smaller than 1.0 cm in diameter (n=6), from 20.0% to 76.0% for lesions between 1.0-1.9 cm (n =25), from 64.3% to 100% for lesions between 2.0-2.9 cm (n=14), and from 94.1% to 100% for lesions ≥3.0 cm (n = 17). None of 27 non-hemangiomas showed increase in delayed blood-pool with either planar or SPECT image. In conclusion, ^(99m)Tc-RBC scintigraphy is highly specific in the diagnosis of hepatic hemangiomas and, with the addition of three-headed SPECT, the sensitivity of RBC scintigraphy for the detection of small hemangiomas is considerably improved.