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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
이형욱(Hyung Wook Lee),안태성(Tae Sung Ahn),조성우(Sung Woo Cho),신응진(Eung Jin Shin),박내경(Nae Kyung Park),이문수(Moon Soo Lee),김창호(Chang Ho Kim),백무준(Moo Jun Baek) 대한종양외과학회 2012 Korean Journal of Clinical Oncology Vol.8 No.1
목적 : 신경주위 침윤(Perineural invasion, PNI)은 많은 악성종양에서 생존율과 좋지 않은 상관관계를 보이는 것이 알려져 있으나, 대장암에서 암 세포의 신경주위 침윤과 대장암 환자의 예후와의 관련성에 대해서는 아직 명확하게 확인되지 않았다. 이에, 저자들은 대장암 환자에서 암세포의 침윤과 다른 임상병리학적 예후인자와의 관련성을 확인하여 대장암에서 침윤이 대장암 환자의 또 다른 예후인자로서 가능한지를 알아보고자 하였다. 방법 : OO에서 2007년 1월부터 2010년 12월까지 대장암으로 수술 받은 환자 148명을 대상으로 조사하였다. 신경주위 침윤 여부와 대상 대장암 환자의 기타 임상병리학적 인자와 비교하였고, 이들의 관계에 대하여 통계학적 유의성을 검정하였다. 결과 : 신경주위 침윤은 대상 환자 148명중 31명인 20.9%에서 확인할 수 있었다. 대장암 조직에서의 신경주위 침습은 환자의 T병기와 무관하였다. (p=0.114) 반면에, 신경주위 침습이 있는 경우 대장암의 림프절 전이와 강한 상관관계를 보였고(p<0.001), 림프관 및 혈관침습이 더 많이 발견되었다(p=0.001). 그리고, 신경주위 침습 여부는 대장암 환자의 전체 병기와의 관련성을 보였다(p<0.001). 하지만 그 외, 암 세포의 분화도와는 상관관계가 없었고, 대장암의 원격전이가 있는 군과 없는 군에서는 신경주위 침습이 21%, 20%로 각각 발현되어 서로 연관성이 없었다. 결론 : 대장암에서 암 세포의 신경주위 침습은 환자의 추적 관찰기간이 충분하지 않아 환자의 예후와의 관계가 확인되지 않았지만, 다른 여러 중요 예후 인자들, 즉 림프절 전이 여부, 림프관 및 혈관 침습, 환자의 병기 등과 상관관계가 확인되었다. 이는 신경주위 침습이 대장암 환자에서 또 다른 예후인자로 기능할 수 있음을 보여주는 결과로 생각되며 이 결과가 대장암 환자의 보조 치료를 계획하는데 고려되어야 할 것으로 생각된다. Purpose : Perineural invasion (PNI) is widely known to be correlated with poor survival in many type of malignancy but the connection between perineural invasion of colorectal cancer and the prognosis has not yet been clearly confirmed. Therefore, we examined perineural invasion in colorectal cancers and investigated its relationship to clinicopathological features such as tumor staging, lymph node metastasis, vascular invasion, lymphatic invasion and patient’s prognosis in this study Methods : The subjects were 148 colorectal cancer patients who underwent surgical resection in OOO. The pathologists who were not aware of the prognosis of the patients reexamined the existing biopsy results and reevaluated the perineural invasion. The presence of perineural invasion and the other clinicopathological factors were compared and the statistical significance of the correlation between these was examined. Results : Perineural invasion was confirmed in less than 10% of the patients in the initial biopsy results. However, it was confirmed in 20.9% of the patients reevaluating the biopsy. Perineural invasion in colorectal cancer was found to be unrelated to the T stage of the patients (p=0.114). On the other hand, perineural invasion appeared to be strongly related to lymph node metastasis of colorectal cancer (p<0.001) and lymphatic and vascular invasion was more common in the patients with perineural invasion (p=0.001). Moreover, perineural invasion seemed to be related to the stage of cancer (p<0.001) and patient’s survival (p<0.05). Nevertheless, it was neither correlated to the level of differentiation nor to the distant metastasis since perineural invasion was expressed in 21% of the patients with distant metastasis and in 20% of the patients without distant metastasis. Conclusion : The correlation of perineural invasion in colorectal cancer to the clinicopathologic factors such as lymph node metastasis, lymphatic invasion, vascular invasion and the stage of disease were confirmed. And perineural invasion was significantly correlated with patient’s survival. This is thought to be that perineural invasion can be a prognostic factor of colorectal cancer and it should be utilized planning adjuvant therapy for colorectal cancer patients.
갑상선유두암에서 갑상선전절제술과 중심경부림프절절제술 후 발생하는 저칼슘혈증 예측 인자 연구
이옥주(Ok Joo Lee),김형철(Hyung Chul Kim),임철완(Cheol Wan Lim),신응진(Eung Jin Shin),조규석(Gyou Suk Cho),정준철(Jun Chul Jung),정귀애(Gui Ae Jung),김지선(Zisun Kim),정재홍(Jae Hong Jeong),최규성(Kyusung Choi),한선욱(Sun Wook Han),허 대한갑상선-내분비외과학회 2015 The Koreran journal of Endocrine Surgery Vol.15 No.3
Purpose: Total thyroidectomy with central lymph node dissection (CLND) is a treatment modality of choice for thyroid cancer. Hypocalcemia is the most common complication after total thyroidectomy. The aim of the current study was to determine the association between surgery-related clinical factors and postoperative hypocalcemia. Methods: A prospective analysis was performed for 101 patients who underwent total thyroidectomy with CLND for papillary cancer from June 2013 to June 2014. Correlation between clinicopathologic factors and postoperative hypocalcemia was analyzed. Results: Based on the postoperative day-2 calcium, 56 patients (55%) developed hypo-calcemia and 45 patients (45%) were normal. No significant differences in histopathologic (tumor size, tumor focality, histologic type, number of retrieved lymph nodes, metastatic lymph node, thyroiditis, retrieved parathyroid gland) findings were observed between the hypocalcemia group and normal calcium group. Mean value of the postoperative day-0 parathyroid hormone (PTH) was significantly lower in the hypocalcemia group (hypoca1cemia group: 14.3±9.4 pg/mL; normal group: 25.0±16.4 pg/mL; P<0.001). In logistic regression analysis, postoperative PTH was a factor significantly affecting postoperative hypocalcemia (OR 0.93; CI: 0.90-0.97; P<0.001). In ROC analysis, the cut-off value of PTH was 19.965 (sensitivity 79%, specificity 58%), and area under the curve (AUC) was 0.709 (95% CI: 0.607-0.811). Conclusion: Postoperative PTH was a factor predicting hypocalcemia after total thyroidectomy with CLND. Use of postoperative PTH as a screening tool for prediction of postoperative hypocalcemia would be useful in management of patients with hypocal-cemia.
재발성 직장암의 간전이 환자에서 시행된 전간 혈류 차단과 정맥 혈류 우회술 그리고 장기 보존액 주입 하의 ante situm 간절제술
주종우(Chong Woo Chu),김형철(Hyung Chul Kim),신응진(Eung Jin Shin),임철환(Cheol Wan Lim),조규석(Gyu Seok Cho),정준철(Jun Cheol Chung),정귀애(Gui Ae Jeong),송옥평(Ok Pyung Song),진수지(Soo Ji Jin),김희경(Hee Kyung Kim),박성진(Seong Ji 한국간담췌외과학회 2008 한국간담췌외과학회지 Vol.12 No.2
We present here a case of recurrent rectal cancer liver metastasis that was managed with ante situm liver resection under total vascular exclusion (TVE) and venovenous bypass with hypothermic perfusion. A 58-year-old man who suffered with rectal cancer liver metastasis was transferred to our hospital in January 2006. A left lateral sectionectomy had been previously performed. Recurrent lesion developed in segments I, IV and VIII one year after the first hepatectomy. The tumor was 5 cm in diameter and it involved the confluence of the hepatic veins and the retrohepatic vena cava. An incomplete tumor-free margin and massive bleeding were expected with performing a conventional liver resection, together with vena cava reconstruction. Therefore, we planned an ante situm liver resection under TVE and venovenous bypass with hypothermic perfusion. After adhesiolysis, hilar dissection was carried out. The inflow to the medial segment was interrupted, and then the liver and inferior vena cava (IVC) were mobilized fully. During controlling the bleeding of a short hepatic vein, we found adhesion of the hepatocaval portion. Therefore, TVE and venovenous bypass were performed along with suprahepatic IVC transection. The long conduit of V5 was preserved during hepatic parenchymal dissection, and the paracaval portion of the caudate lobe was readily detached from the IVC. The suprahepatic IVC was reconstructed after V5 reconstruction with using the saphenous vein. Portal vein anastomosis was then conducted. After reperfusion, an end-to-side anastomosis was performed between the saphenous vein graft and the IVC. Finally, a Roux-en- Y hepaticojejunostomy was carried out. The patient remains well without recurrence 12 months after the last operation.
위암에서 복강경 위절제술과 개복 위절제술의 비무작위 전향적 비교 연구
조규석(Gyu-Seok Cho),김형철(Hyung-Chul Kim),이문수(Moon-Su Lee),임철완(Cheol-Wan Lim),신응진(Eung-Jin Shin),주종우(Chong-Woo Chu),강길호(Kil-Ho Kang),김용진(Young-Jin Kim),유기원(Ki-Won Yu),이효원(Hyo-Won Lee),송옥평(Ok-Pyung Song) 대한외과학회 2006 Annals of Surgical Treatment and Research(ASRT) Vol.70 No.3