인조혈관스텐트 삽입술용 복부대동맥류 모델의 개발$^1$

김태형,성규보,고기영,이종헌,신동익,송호영,Kim, Tae-Hyeong,Seong, Gyu-Bo,Go, Gi-Yeong,Lee, Jong-Heon,Sin, Dong-Ik,Song, Ho-Yeong 대한영상의학회 2002 대한영상의학회지 Vol.46 No.3

목적: 인조혈관스텐트삽입술용 복부대동맥류 모델의 유용성을 평가하고자 한다. 대상과 방법: 모델은 심장과 복부대동맥류 부분으로 제작하여 실리콘 튜브로 연결하였고, 혈액은 37$^{\circ}C$의 물을 사용하였다. 심장은 수중펌프(80 L/분)와 솔레노이드 밸브로 혈관의 맥류를 발생시켰다. 대동맥류는 사각형의 틀에 지점토로 제작된 형상을 넣고 액상의 실리콘을 부어 건조시킨 후 지점토를 제거하였다. 수중펌프 출력부의 개통(100%, 50%, 25%)에 따른 흉부대동맥, 대동맥류, 장골동맥의 혈압(수축기/이완기)과 인조혈관스텐트삽입술을 시행하여(5예) 시술의 재현성과 시술 후의 압력을 측정하였다. 결과: 혈압은 수중펌프 출력부가 100% 개통의 경우, 흉부대동맥이 253/252 mmHg, 대동맥류가 271/162 mmHg, 장골동맥이 264/166 mmHg, 50%의 경우, 흉부대동맥이 173/121 mmHg, 대동맥류가 145/99 mmHg, 장골동맥이 145/106 mmHg, 25%의 경우, 흉부대동맥이 35/28mmHg, 대동맥류가 61/44 mmHg, 장골동맥이 24/22 mmHg이었다. 인조혈관스텐트는 모두 성공적으로 삽입되었고, 시술 후 혈압은 50% 개통의 경우, 흉부대동맥이 170/132 mmHg, 대동맥류가 174/128 mmHg, 장골동맥이 167/128 mmHg이었다. 결론: 본 모델은 시술의 재현이 쉽고, 혈압의 조절범위가 넓어 인조혈관스텐트의 체외실험 기구로 유용할 것으로 판단된다.3.8%)와 가역적인 혈관연축(vasospasm)이 2예(7.7%) 있었으며 그 밖에 시술 후 혈종(hematoma)형성 2예(7.7%), 일시적 손목 주위 신경학적 마비 1예(3.8%)등이었다. 결론: 요골동맥 천자를 통한 동맥화학색전술은 RHA카테터를 사용하여 가능하였으며, 고식적 방법으로 인한 지혈을 위한 절대 침상 안정의 단점을 보완할 수 있는 유용하고 안전한 방법으로 고려될 수 있을 것이다.',ABE = 'Purpose: To evaluate th\ulcornerfeasibility and usefulness of the transradial approach for intra-arterial chemoembolization therapy in patients with hepatocellular carcinomas. Materials and Methods: Twenty-nine patients with hepatocellular carcinoma who underwent intra-arterial chemoembolization via the radial artery approach were involved in this study. All underwent Allen’s test to check ulnar arterial patency. In all cases, we used the radial approach hepatic artery (RHA) catheter designed by ourselves, evaluating t\ulcorner selec\ulcorneron ability of the hepatic artery using an RHA cathter, the number of punctures, the procedure time, and compression time at the puncture site as well as complications occurring during and after the procedure. Results: Except for three in which puncture failure, brachial artery variation or hepatic artery variation occurred, all procedures were successful. The mean number of punctures was 3.5, and the average duration of the whole procedure was one and half hours. This gradually decreased as the nu\ulcornerer of procedures increased. The average duration at a compression of puncture site was 12 minutes. There were no major complications. Minor complications included minimal intimal dissection of the radial artery (3.8%), reversible vasospasm of the radial artery (7.7%), hematoma at a puncture site (7.7%) and transient neurologic deficit (3.8%). Conclusion: The transradial approach using an RHA catheter for intra-arterial chemoembolization therapy in patients with hepatocellular carcinoma\ulcornerwas techni\ulcornerlly feasible, with acceptable levels of safety. It may be a good alternative to absolute bed rest with a sand bag after the femoral approach.',PY = '2002-00-00',RF = '13',BN = ',CODEN = ',URI = ',URL = ',URC = ',DOI = ',ISDB = ',PNH = '유승훈;심형진;곽병국;김기현;이화연;송인섭;김양수',PNHNUM = '20040222678;20030129880;20030129876;19930326569;20030108354;20030130 Purpose: To determine the efficacy of an abdominal aortic aneurysm model for stent-graft placement. Materials and Methods: The model consists of two parts, the eart and the vascular system. A peristaltic pump and a solenoid valve were used to simulate a pulsatile flow from the heart. A ball-shaped piece of clay was placed inside a square box and liquid silicone was poured. After the silicone was formed, the clay was removed and a silicone tube was used to connect the heart model and the aneurysm model. The silicone tube was also used to simulate the iliac arteries and one end of the artery was clamped and the other one was extended to a water bath. Water at 37$\^{C}$ was circulated through the model, and the pressure at the thoracic aorta, aneurysm and iliac artery was measured with the outlet valve opening at 25, 50, and 100% before and after stent-graft placement. Results: The liquid pressure measurements were 253/252, 271/162 and 264/166 mmHg at the thoracic aorta, aneurysm and iliac artery, respectively, when the outlet was 100% open. They were 173/121, 145/99, 145/106 mmHg when the outlet was 50% open, and 35/28, 61/44, 24/22 mmHg when it was 25% open. After lacement of the stent-graft, the pressure measurements were 170/132, 174/128, and 167/128 mmHg, respectively. Conclusion: Since it was easy to produce, the model was useful for in-vitro stent-graft testing, and a wide range of pressure could be applied.

산욕기 출혈의 경도관 동맥색전술의 유용성

고기영,성규보,윤현기,Go, Gi-Yeong,Seong, Gyu-Bo,Yun, Hyeon-Gi 대한영상의학회 2003 대한영상의학회지 Vol.48 No.6

목적: 산욕기 출혈을 치료하는 데 있어서 동맥색전술의 효용성과 안전성을 평가하고자 하였다. 대상과 방법: 고식적 치료로 지혈되지 않는 500 ml 이상의 산후 출혈로 인하여 동맥색전술을 시행받은 25명의 환자들을 대상으로 하였다.우측 대퇴동맥을 천자하여 양측 내장골동맥 조영술을 시행하여 출혈동맥을 색전한 후 측부혈류에 의한 재출혈을 방지하기 위하여 반대측 내장골동맥의 전방구역 또는 자궁동맥을 추가로 색전하였다. 출혈동맥이 보이지 않은 경우에도 제왕절개술 후의 출혈인 경우 양측 내장골동맥의 전방구역을, 그 외의 경우에는 양측 자궁동맥을 색전하였다. 사용한 색전물질은 코일, 젤폼 또는 폴리비닐알콜 입자 등이었다. 시술 후 질 출혈의 지속 여부,합병증 등을 후향적으로 분석하였다. 결과: 혈관조영술 상 출혈 부위가 확인된 경우는 13예(52%)였으며, 출혈 동맥은 일측 (n=10) 또는 양측 (n=2)자궁동맥, 일측 질동맥 (n=1)이었다. 색전술 후 12명(92%)은 질 출혈이 소실되고 회복되었으나, 1명은 질 출혈이 지속되어 자궁적출술을 시행받았다. 혈관조영술 상 출혈 부위를 찾을 수 없었던 경우는 12예(48%)였으며 색전술 후 11명(92%)은 회복되었으나, 1명은 패혈증이 악화되어 사망하였다.2명에서는 각각 색전술 12, 13일 후 재출혈이 발생하여 자궁절제술을 시행받았다. 결론: 동맥색전술은 고식적 치료로서 지혈되지 않는 산욕기 출혈의 치료방법으로서 효과적이고 안전한 치료방법으로 사료된다. Purpose: To assess the effectiveness and safety of transcatheter arterial embolization for the treatment of massive postpartum bleeding. Materials and Methods: Transcatheter arterial embolization was attempted in 25 patients with massive postpartum bleeding. After identification at bilateral internal iliac arteriography, the bleeding artery was embolized using gelfoam, polyvinyl alcohol particles or microcoils, and to prevent rebleeding through collateral pathways, the contralateral uterine artery or anterior division of the internal iliac artery was also embolized. Clinical success and complications were retrospectively assessed and documented. Results: Active bleeding foci were detected in 13 patients (52%), and involved the unilateral (n=10) or bilateral (n=2) uterine artery and unilateral vaginal artery (n=1). Twelve (92%) of the 13 patients recovered completely following embolization, but one underwent hysterectomy due to persistent bleeding. The focus of bleeding was not detected in 12 patients (48%), but 11 (92%) of these also recovered following embolization of the bilateral uterine or internal iliac arteries. One patient, however, died due to sepsis. Two of the 12 patients underwent hysterectomy due to rebleeding on the 12th and 13th day, respectively, after embolization. Conclusion: Transcatheter arterial embolization is relatively safe and effective for the treatment massive postpartum bleeding.

담도 스텐트 삽입 실험을 위한 경피 경담낭 접근법: 개에서의 동물실험

서태석,송호영,고기영,성규보,김태형,이호정,Seo, Tae-Seok,Song, Ho-Yeong,Go, Gi-Yeong,Seong, Gyu-Bo,Kim, Tae-Hyeong,Lee, Ho-Jeong 대한영상의학회 2002 대한영상의학회지 Vol.46 No.6

목적:담도 스텐트의 동물실험을 위한 경피적 담낭 천자법의 유용성과 안전성 및 새로 개발된담도 스텐트의 개통성을 평가하고자 하였다. 대상과 방법:스텐트는 나이티놀 세선을 이용하여,직경 10 mm,길이 2 cm로 제작하였다.잡견 7마리에서 초음파 유도하에 16 G의 바늘로 담낭을 천자한 후 담도조영술을 시행하고,고정 장치를 이용하여 담낭을 전복벽에 고정시킨 후 방사선 투시 유도하에 담낭 체부를 다시 천자 하였다.안내철선과 도관을 삽입하여 담낭관을 통해 총담관으로 진입시킨 후 도관을 제거하고 안내철선을 따라 8 F 삽관기에 장착된 담도 스텐트를 총담관에 설치했고,담도조영술을 시행 한 후 담낭에는 8.5 F 배액관을 설치하고 실험을 종료하였다.개는 실험 후 2일에 사망한 1예 를 제외하고,2주,4주,8주까지 2마리씩 추적 관찰하였고,담도조영술 후 희생시켜서 병리조직학적인 검사를 하였다. 결과:경피적 담낭천자를 이용한 담도 스텐트 삽입술은 모든 예에서 성공하였다.스텐트 장치후 1예에서 실험 2일 후 배액관의 일부가 복강 내로 이탈되어 복막염으로 사망하였고,6마리는 희생시까지 전신상태가 양호하였다.희생직전 시행한 담도조영상에서 8주까지 담도 스텐트의 개통성은 잘 유지되어 있었다.현미경 검사에서는 2주 표본부터 육아조직의 증식이 있었고, 8주 표본에서는 완전한 내피층을 형성하였다. 결론:개에서 경피적 담낭 천자법을 이용한 담도 스텐트 삽입술은 담도 스텐트의 평가를 위한간편하고 용이한 시술이며,새로 개발된 스텐트는 추적 관찰기간 동안 개통성이 우수하였다. Purpose: To determine, in an experimental study of biliary stent placement, the usefulness and safety of the percutaneous transcholecystic approach and the patency of a newly designed biliary stent. Materials and Methods: A stent made of 0.15-mm-thick nitinol wire, and 10 mm in diameter and 2 cm in length, was loaded in an introducer with an 8-F outer diameter. The gallbladders of seven mongrel dogs were punctured with a 16-G angiocath needle under sonographic guidance, and cholangiography was performed. After anchoring the anterior wall of the gallbladder to the abdominal wall using a T-fastener, the gallbladder body was punctured again under fluoroscopic guidance. The cystic and common bile ducts were selected using a 0.035-inch guide wire and a cobra catheter, and the stent was placed in the common bile duct. Post-stenting cholangiography was undertaken, and an 8.5-F drainage tube was inserted in the gallbladder. Two dogs were followed-up and sacrificed at 2, 4, and 8 weeks after stent placement, respectively, and the other expired 2 days after stent placement. Follow-up cholangiograms were obtained before aninmal was sacrificed, and a pathologic examination was performed. Results: Stent placement was technically successful in all cases. One dog expired 2 days after placement because of bile peritonitis due to migration of the drainage tube into the peritoneal cavity, but the other six remained healthy during the follow-up period. Cholangiography performed before the sacrifice of each dog showed that the stents were patent. Pathologic examination revealed the proliferation of granulation tissue at 2 weeks, and complete endothelialization over the stents by granulation tissue at 8 weeks. Conclusion: Percutaneous transcholecystic biliary stent placement appears to be safe, easy and useful. After placement, the stent was patent during the follow-up period.

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 ) : 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.

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.

대한간학회지 제6차 춘계학술대회 초록집 : 구연 ; 진행성 간암에서 chemoport를 통한 간동맥 내 cisplatin 및 5-fluorouracil 화학요법의 효과

송희곤 ( Song Hui Gon ),이한주 ( Lee Han Ju ),이상수 ( Lee Sang Su ),송병철 ( Song Byeong Cheol ),정영화 ( Jeong Yeong Hwa ),이영상 ( Lee Yeong Sang ),윤현기 ( Yun Hyeon Gi ),성규보 ( Seong Gyu Bo ),서동진 ( Seo Dong Jin ) 대한간학회 2000 Clinical and Molecular Hepatology(대한간학회지) Vol.6 No.1(S)

대한간학회지 제8차 춘계학술대회 초록집 : 포스터 발표 ; 소간세포암의 수술적 절제술 후 HBsAg 여부에 따른 간내 재발양상

송병철 ( Song Byeong Cheol ),서동진 ( Seo Dong Jin ),이한주 ( Lee Han Ju ),정영화 ( Jeong Yeong Hwa ),이영상 ( Lee Yeong Sang ),박원철 ( Park Won Cheol ),최국명 ( Choe Gug Myeong ),이승규 ( Lee Seung Gyu ),성규보 ( Seong Gyu Bo 대한간학회 2002 Clinical and Molecular Hepatology(대한간학회지) Vol.8 No.2(S)

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.