간문부 혈류 차단하에서 간절제술을 시행한 환자에 있어서의 일시적인 문맥-하대정맥 우회로술의 의의

윤영국 한국간담췌외과학회 2000 한국간담췌외과학회지 Vol.4 No.1

Background : Hepatectomy under prolonged inflow occlusion in compromised liver is an acceptable procedure, despites of ischemic liver injury. However, the effect of abdominal visceral stagnation during the occlusion periods was not fully investigated. We examined the effectiveness of the temporary portal decompression during prolonged hepatic inflow occlusion. Methods : 20 patients who underwent hepatectomy under the continuous inflow occlusion were divided into two groups according to the with(Group I) or without(Group II) temporary portosystemic shunt.(n=10, respectively) Temporary portosystemic shunt was built between portal vein tributarity in the mesentery and infrahepatic inferior vena cava by inserting the heparin-bonded Anthrone tube. In order to estimate the intestinal stress, we measured cytokine(IL-6) levels in the portal venous blood and the systemic blood at preclamping, before and 1hour after declamping. Also we measured ICGR15, routine liver fuction tests, coagulation parameters and portal vein pressure of the two groups. Results : The duration of hepatic inflow occlusion(HIO) and the increase of portal vein pressure during HIO showed a trend of correlation with the level of IL-6 during HIO. Conclusion : These data indicates that the production of IL-6 in the portal circulation is closely related to the hepatocyte injury in ischemia/reperfusion of the liver and the congestion of bowel. The temporary portosystemic shunt during HIO seems to be a useful maneuver, especially when the portal pressure increased significantly during HIO. Background : Hepatectomy under prolonged inflow occlusion in compromised liver is an acceptable procedure, despites of ischemic liver injury. However, the effect of abdominal visceral stagnation during the occlusion periods was not fully investigated. We examined the effectiveness of the temporary portal decompression during prolonged hepatic inflow occlusion. Methods : 20 patients who underwent hepatectomy under the continuous inflow occlusion were divided into two groups according to the with(Group I) or without(Group II) temporary portosystemic shunt.(n=10, respectively) Temporary portosystemic shunt was built between portal vein tributarity in the mesentery and infrahepatic inferior vena cava by inserting the heparin-bonded Anthrone tube. In order to estimate the intestinal stress, we measured cytokine(IL-6) levels in the portal venous blood and the systemic blood at preclamping, before and 1hour after declamping. Also we measured ICGR15, routine liver fuction tests, coagulation parameters and portal vein pressure of the two groups. Results : The duration of hepatic inflow occlusion(HIO) and the increase of portal vein pressure during HIO showed a trend of correlation with the level of IL-6 during HIO. Conclusion : These data indicates that the production of IL-6 in the portal circulation is closely related to the hepatocyte injury in ischemia/reperfusion of the liver and the congestion of bowel. The temporary portosystemic shunt during HIO seems to be a useful maneuver, especially when the portal pressure increased significantly during HIO.

아니사키스 선충과 연관된 호산구성 위장염

윤영국,황일우 慶北大學校 醫科大學 1987 慶北醫大誌 Vol.28 No.2

저자들은 아니사키스 유충이 원인으로 판단되는 호산구성 위장염 1예를 경험하고 문헌고찰과 함께 보고하였다. 호산구성 위장염이 기생충감염증과는 별개의 질환으로 생각해야 한다는 설도 있으나, 원래 호산구성 위장염이란 병리조직학적인 병명이므로 기생충이 병변내에서 발견되었을 때 별개의 질환으로 분류할 것이 아니라, 병리조직학적으로 호산구성 위장염의 특징을 가지면 기생충증을 원인질환으로 보는 것이 타당할 것이다. 그러므로 아니사키스 유충이 호산구성 위장염을 일으킬 수 있다고 생각한다. 물론 아니사키스감염증 만이, 혹은 기생충 감염증 만이 호산구성 위장염의 원인이라고 주장하는 것은 아님을 밝혀 둔다. Eosinophilic gastroenteritis is characterized by the triad peripheral eosinophilia, eosinophilic infiltration of segments of the gastrointestinal tract, and abnormalities of gastrointestinal function. Pathophysiology is still obscure, but allergy seems to play a role. We have experienced a case of eosinophilic gastroenteritis in which a larval anisakine nematode was found at the site of the lesion. Although many different agent including ingested allergen, may cause eosinophilic gastroenteritis, we are in no doubt that anisakine larva can on occasion give rise to this

담낭의 용종성 병변에서 담낭암의 위험인자와 수술후 결과

윤영국 한국간담췌외과학회 2005 한국간담췌외과학회지 Vol.9 No.3

Purpose: Most polypoid lesions of the gallbladder (PLGs) are benign, and laparoscopic cholecystectomy is the treatment of choice unless the suspicion of malignancy is high. PLGs were reviewed to identify risk factors for neoplastic polypoid lesions. Methods: Between March 1992 and February 2005, 205 cases of PLGs, including 67 neoplastic and 138 nonneoplastic PLGs, were evaluated. Risk factors for neoplastic PLGs and gallbladder carcinomas were analyzed using multiple regression analysis. A receiver operating characteristics (ROC) curve was used to obtain a cut-off value of the tumor size and age of patients for predicting neoplastic PLGs and gallbladder carcinomas. Results: The mean age of the patients, and the size, number and type of polyp were statistically different between 67 neoplastic (47 adenomas, 20 adenocarcinomas) and 138 nonneoplastic PLGs (104 cholesterol polyps, 22 hyperplastic polyps, 11 adenomyomas, and 1 xanthogranulomatous polyp). A multiple regression analysis showed that the size, number and type of polyp were significant risk factors for neoplastic PLGs. Of the 67 neoplastic PLGs, the age of the patient, and the size and type of polyp were significant risk factors of carcinomas. The sizes of tumors for predicting neoplastic PLGs and carcinomas were 0.85 and 1.1 cm, respectively, while the age for predicting a carcinoma was 55 years. In 5 carcinoma patients, an additional curative resection was performed. No recurrence or carcinoma relateddeath were observed in the laparoscopic cholecystectomy (LC) only (15 cases) and additional surgery groups (5 cases). Conclusion: Risk factors of a carcinoma in PLGs include the age of the patients, and the size and sessile type of the PLG. The ROC curve showed that the appropriate size of the tumor and the age of the patient for predicting gallbladder cancer in PLGs were 1.1 cm and 55 years, respectively. Additional curative surgery immediately after an LC seems to increase the survival of gallbladder carcinoma patients, but its role should be determined through long term follow-up. Purpose: Most polypoid lesions of the gallbladder (PLGs) are benign, and laparoscopic cholecystectomy is the treatment of choice unless the suspicion of malignancy is high. PLGs were reviewed to identify risk factors for neoplastic polypoid lesions. Methods: Between March 1992 and February 2005, 205 cases of PLGs, including 67 neoplastic and 138 nonneoplastic PLGs, were evaluated. Risk factors for neoplastic PLGs and gallbladder carcinomas were analyzed using multiple regression analysis. A receiver operating characteristics (ROC) curve was used to obtain a cut-off value of the tumor size and age of patients for predicting neoplastic PLGs and gallbladder carcinomas. Results: The mean age of the patients, and the size, number and type of polyp were statistically different between 67 neoplastic (47 adenomas, 20 adenocarcinomas) and 138 nonneoplastic PLGs (104 cholesterol polyps, 22 hyperplastic polyps, 11 adenomyomas, and 1 xanthogranulomatous polyp). A multiple regression analysis showed that the size, number and type of polyp were significant risk factors for neoplastic PLGs. Of the 67 neoplastic PLGs, the age of the patient, and the size and type of polyp were significant risk factors of carcinomas. The sizes of tumors for predicting neoplastic PLGs and carcinomas were 0.85 and 1.1 cm, respectively, while the age for predicting a carcinoma was 55 years. In 5 carcinoma patients, an additional curative resection was performed. No recurrence or carcinoma relateddeath were observed in the laparoscopic cholecystectomy (LC) only (15 cases) and additional surgery groups (5 cases). Conclusion: Risk factors of a carcinoma in PLGs include the age of the patients, and the size and sessile type of the PLG. The ROC curve showed that the appropriate size of the tumor and the age of the patient for predicting gallbladder cancer in PLGs were 1.1 cm and 55 years, respectively. Additional curative surgery immediately after an LC seems to increase the survival of gallbladder carcinoma patients, but its role should be determined through long term follow-up.

교정용 미니스크류 임플랜트의 제거회전력 및 골형성에 관한 연굴

윤영국,류재준,서규원,Yun, Young-Kuk,Ryu, Jae-Jun,Suh, Kyu-Won 대한치과보철학회 2007 대한치과보철학회지 Vol.45 No.4

Statement of problem: An orthodontic miniscrew implant has been used as a skeletal anchorage for orthodontic treatment. However, any relation among the influence of the cortical bone, morphologic differences of orthodontic miniscrew implants and new bone formation hasn't been made clear yet. Purpose: The purpose of this study was to evaluate whether the orthodontic miniscrew implant could work as an intraoral skeletal anchorage immediately and stably for orthodontic treatment after insertion of it. Material and methods: Two types of orthodontic miniscrew implants were used in this experiment; tapered type and straight type. One hundred and sixty eight orthodontic miniscrew implants were inserted into the tibiae of 21 rabbits and sacrificed on 3, 7, 11, 14, 21 and 28days later after insertion of them to study removal torque values and histologic and histomorphometric analyses. Results: The results were as follows. 1. The removal torque values of the tapered type were higher than those of the straight type in all groups(p<0.05). 2. There wasn't any distinguishing differences between the tapered type and the straight type about the new bone formation percentage. 3. The removal torque values for both the tapered type and the straight type were gradually decreased at early stages of the test but started to increase at the 7 days group of the straight type and the 11 days group of the tapered type. 4. New bone formation percentage was increased gradually for both the tapered and the straight types as time passed(p<0.05). 5. It was found that the tapered type showed lower values in the cortical bone about both the maximum equilibratory stress distribution and the maximum principal stress distribution than the straight type in linear finite elements analysis. Conclusion: According to the research, the removal torque values were decreased at 7 days group of the tapered type and 11 days group of the straight type after the insertion of the orthodontic miniscrew implants in tibiae of rabbits. Considering the human bone activity, it is better to apply the orthodontic force $3{\sim}4$ weeks later than to apply it immediately after the insertion of orthodontic miniscrew implants. Considering that general orthodontic force is about $250{\sim}500$ grams, the tapered type can be worked as a stable skeletal anchor age in an orthodontic treatment even if the orthodontic force is applied on it immediately after the insertion of it.

잔류담석의 임상적 관찰

윤영국,문종세 慶北大學校 醫科大學 1985 慶北醫大誌 Vol.26 No.1

1976년 6월 부터 1984년 5월까지 경북대학교 의과대학 외과학교실에 입원가료한 잔류담석 28예에 대한 임상적 고찰을 하여 다음과 같은 결과를 얻었다. 1) 이 기간 중 본 병원에서 발견된 잔류담석은 13예로, 총수담관탐색을 했던 예에서 6.7%, 하지 않았던 예에서 2.8%의 발생율을 나타내었다. 2) 28예에 대한 과거수술술식은 총수담관탐색을 동반한 담낭절제술이 60.7%로 가장 많았으며 그다음 단순담낭절제술, 담석중에 대한 2차수술 등의 순이었다. 3) 1차수술시 종결담관조영술을 재 검토한 결과 7예중 1에는 판단착오를 했으며 1예는 간내담석이 있었다. 4) 잔류담석의 진단은 T-튜브 담관조영술이 가장 정확하였으며 경정맥 담관조영술이 가장 부정확하였다. 5) 내과적 치료를 했던 6예중 5예에서 생리식염 수관류법을 시행하여 그중 1예에서만 성공하였다. 또 Heparin 용해법을 1예에서 실시하여 실패하였다. 6) 외과적치료는 총수담관십이지장문합술이 48.0% 가장 많았으며, 그다음 T-튜브 배액술, 괄약근성형술 등의 순이었다. 7) 합병증은 창상감염이 24%로 가장 많았으며 사망예는 없었다. Despite major improvements in biliary tract surgery, particularly with incressing adoption of the use of operative cholangiography, stones in the common bile duct are still occasionally overlooked. A series of twenty-eight cases of ratained stone was analyzed clinically in order to find out the best treatment modality and the way to decrease the incience of ratained stone. The results are as follows. The incidence of the retained stones among the cases who underwent the operation upon the calculous biliary tract disease, and it was more frequentle encountered after choledocholithotomy. Review of the Previous completion cholangiogram revealed a case of misinterpretation among those seven cases who had been checked completion cholangiogram. The most accurate diagnostic tool was T-tube cholangiography. We tried flushing method with saling as an initial treatment in patients with T-tube, but it was successful in only one of the five cases. There are many other ethical forms of recently develped non-operative treatment, and most of them are easy to perform. The auther recomments to try non-operative technique as an initial treatment except for the dissolution method because most oriental gall stones are mixed or pigment stones.

부분담낭염 4례 보고

윤영국,황윤진 대한외과학회 1997 대한외과학회 학술대회 초록집 Vol.1997 No.11

제27차 학술대회 : 65. 비기생충성 간낭종 4예 보고

윤영국,정무달,홍희희 대한외과학회 1975 대한외과학회 학술대회자료집 Vol.- No.-

담석의 외과적 치료

윤영국 대한외과학회 1996 대한외과학회 학술대회 초록집 Vol.1996 No.5

안전한 복강경 담낭절제술을 위한 Calot triangle 후측 박리의 중요성

윤영국 대한외과학회 2001 대한외과학회 학술대회 초록집 Vol.2001 No.11

아니 사키스 선충과 연관된 호산구성 위장염(증례보고)

윤영국,유완식,황일우 대한외과학회 1987 대한외과학회 학술대회 초록집 Vol.1987 No.11