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      • 간세포암에서 방사선 치료의 역할

        이헌주,최교원,김명세,은종렬 영남대학교 의과대학 2000 Yeungnam University Journal of Medicine Vol.17 No.2

        간세포암에 대한 방사선 치료의 효과를 평가하고자 1984년 1월부터 2000년 1월까지 영남대학교 의과대학 부속병원에서 간세포암으로 진단된 환자들 중에서 방사선 치료 단독 혹은 간동맥 색전술과 병합요법을 한 18명의 환자들의 의무기록과 방사선 사진을 검토하여 다음과 같은 결과를 얻었다. 남자가 15명, 여자가 3명이었으며 평균 나이는 51세였다. 복수가 4명(22.2%)에서 있었으며 간경변이 11명(61.1%)에서 있었다. 간기능은 Child-Pugh class A, B, C가 각각 6명, 3명, 2명이었다. 14명(77.8%)에서 HBs 항원 양성이었으며 anti-HCV 양성은 없었다. 사망원인은 간성혼수를 포함한 간부전이 2명(11.1%), 위장관출혈이 1명(5.6%), 암사망이 1명(5.6%), 현재 생존이 4명(22.2%)였으며 10명(55.6%)은 불명이었다. 종양의 위치는 간우엽이 10례 좌엽이 3례 양쪽 모두가 5례였으며, 종양의 형태는 결절형이 4례, 괴상형이 7례, 미만형이 7례였다. 8례(44.4%)에서 동정맥우회(shunt)가 있었으며 간문맥혈전증이 4례(22.2%)에서 있었다. 병기는 Ⅰ기, Ⅱ기, Ⅲ기, Ⅳ기 각각 0례, 5례, 4례, 9례였다. 종양의 크기(volume percentage)는 4025%(5-96)였다. 치료에 대한 반응은 partial response가 2례(11.1%), minimal response가 4례(22.2%), no change가 11례(61.1%), progressive disease가 1례(5.6%)였다. 평균 생존률은 97개월(2-25)로 반응률(response rate)은 33.3%였다. 3개월, 6개월, 12개월, 24개월 생존률은 각각 81.3%, 43.8%, 18.8%, 6.3%였다. 결론적으로, 간세포암에 있어서 방사선 치료는 생존률을 향상시키지는 못하더라도 종양의 크기를 줄이는데 효과가 있었다. 간동맥 색전술과의 병합치료가 치료효과를 강화하는 것으로 생각되나 방사선 단독 치료의 효과를 알기 위해서는 더 많은 연구가 필요할 것으로 생각된다. Background : Hepatocellular carcinoma(HCC) has been considered to be relatively radioresistant. The role of radiotherapy(RT) in the treatment of HCC is controversial. But RT has a role in the treatment of hepatocellular carcinoma as a single or combination modalities. The effect of radiotherapy on HCC was evaluated. Material and Methods : From January 1984 through January 2000, a total of 18 patients with unresectable HCC underwent radiotherapy alone or in conjunction with transarterial imbolization(TAE). We reviewed the medical records of patients with RT and measured the tumor size using planimetry method. The Kaplan-Meier method was used to calculate the survival rate. Results : The RT patients were 15 men and 2 women. The mean age was 51 years. Four(22.2%) of them were accompanied with ascites. Eleven(61.1%) of them were accompanied with liver cirrhosis and their functions were 6, 3, 2 in each Child-Pugh A, B, C, respectively. A partial response(PR) was observed in 1 patients(11.1%), minimal response(MR) in 4 patients(22.2%) and no change(NC), in 11 patients(61.1%), whereas progressive disease(PD) was seen in 1 patients(6%). The survival rate determined at 3, 6, 12, and 24 months were 81.3%, 43.8%, 18.8%, and 6.3%, respectively. Conclusions : Although the radiotherapy in HCC did not improve the survival rate, it decreased the tumor size. Radiotherapy strengthens the therapeutic efficacy when compbined with TAE, but more studies are needed.

      • KCI등재후보

        Hepatic Arterial Infusion Chemotherapy Using the Port System in Advanced Gallbladder Cancer

        은종렬,김재운,최준혁 대한내과학회 2018 대한내과학회지 Vol.93 No.1

        Gallbladder (GB) cancer is relatively rare and has a poor prognosis, with a median survival time of less than 3 months. It is resistant to chemotherapy. Therefore, the role of systemic chemotherapy is limited. However, administering the anticancer agent directly into the hepatic artery can result in a higher drug concentration in the cancer tissue. In this paper, we report a case of advanced GB cancer treated with hepatic arterial infusion chemotherapy (HAIC) using the port system. The patient received six cycles of HAIC with 5-fluorouracil (750 mg/m2) and cisplatin (25 mg/m2); each cycle lasted for 4 days every month. The tumor showed objective response during HAIC, and the patient survived for 15 months from the first therapy. HAIC using the port system might be a promising therapeutic modality for treating locally advanced GB cancer.

      • SCOPUSKCI등재
      • KCI등재후보

        담즙 유출의 원인과 내시경 치료 효과

        은종렬,김태년,최선택,장병익 대한소화기내시경학회 2006 Clinical Endoscopy Vol.33 No.6

        Background/Aims: This study evaluated the efficacy of endoscopic treatment in a bile leak that occurred through various causes. Methods: The medical records of 35 patients (mean age 55.4 years; male/female 25/10), who were diagnosed with a bile leak by endoscopic retrograde cholangiopancreatography in Yeungnam University Hospital from January 1998 to January 2006, were reviewed. Results: The most common cause of the bile leak was an open cholecystectomy (n=13, 37.1%) followed by a laparoscopic cholecystectomy (n=10, 28.6%), trauma (n=2, 5.7%), transarterial chemoembolization (n=3, 8.6%), spontaneous (n=3, 8.6%), and a hepatic resection (n=4, 11.4%). Thirty-four patients were treated endoscopically by the insertion of a plastic stent with/without a sphincterotomy (70.6%, 24/34), a nasobiliary drainage (11.8%, 4/34), or a sphincterotomy alone (17.6%, 6/34). Of these 34 patients, 30 were cured by the endoscopic treatment, 2 patients died from liver failure despite the use of nasobiliary drainage and 2 patients did not improve after endoscopic treatment. One patient underwent surgery without endoscopic treatment because of a transsection of the common bile duct. With the exception of the two who died from liver failure, the overall cure rate of endoscopic treatment was 90.9% (30/33). There were no complications associated with the endoscopic treatment. Conclusions: Endoscopic treatment for a bile leak is safe and effective regardless of the cause. (Korean J Gastrointest Endosc 2006;33:346 352)

      • SCOPUSKCI등재
      • 소장질환의 진단에 캡슐내시경 검사의 유용성

        은종렬,장병익 영남대학교 의과대학 2006 Yeungnam University Journal of Medicine Vol.23 No.1

        소장질환을 진단하는데 있어서 캡슐내시경의 유용성을 평가하고자 본 연구를 시행하였다. 2003년 8월부터 2006년 3월까지 영남대학 병원에서 캡슐내시경을 시행한 66명(평균나이: 52.1세, 남/녀: 39/27)의 의무기록과 내시경 기록을 검토하였다. 상부 및 하부 위장관 내시경에서 이상이 발견되지 않아 소장질환을 확인하기 위한 목적으로 시행되었으며, 특히 소장출혈의 확인을 위해 시행한 경우가 47명(71.3%)으로 가장 많았다. 이 가운데 궤양 또는 미란이 22예(46.8%), 종양 5예(10.6%), 혈관이형성증 3예(6.4%), 용종 3예(6.4%), 협착이 동반된 궤양 1예(2.1%), 활동성 출혈 1예(2.1%), 정상 소견 12예(25.5%) 등이었다. 이들 가운데 출혈과 관련이 있을 것으로 생각되는 병소는 32예(68.1%)였다. 종양이 발견된 5명에서 수술을 하였는데 위장관간질종양이 4예, 림프관종 1예가 진단되었다. 비특이적 복부 증상으로 시행한 경우의 병변발견율은 42.9%(6/14)였는데, 증상과 관련있는 경우는 1예에 불과하였다. 캡슐내시경 검사로 인한 합병증은 발생하지 않았다. 결론적으로, 캡슐내시경은 소장질환에 대해 안전하고 비침습적인 검사법이며, 소장출혈에 대해 우수한 결과를 보였다. 그러나, 출혈 이외의 복부증상에 대해서는 더 연구가 필요하다. Background: This study was conducted to evaluate the usefulness of capsule endoscopy (CE) for the diagnosis of small bowel diseases. Materials and Methods: We reviewed the medical records of 66 patients (mean age: 52.1 years, male/female: 39/27), who underwent CE at Yeungnam University Hospital from August 2003 to March 2006. Results: Suspicious gastrointestinal (GI) bleeding presenting as anemia or history of gross bleeding was the most common reason to perform CE (71.2%). Other indications included GI symptoms (21.2%) such as abdominal pain/discomfort, nausea, diarrhea, and others (7.6%). In studies performed for GI bleeding (n=47), ulcer/erosion was the most common finding (n=22, 46.8%) followed by tumor (n=5, 10.6%), angiodysplasia (n=3, 6.4%), polyp (n=3, 6.4%), active bleeding (n=1, 2.1%), ulcer with stenosis (n=1, 2.1%), and normal findings (n=12, 25.5%). Of these, a bleeding focus was detected in 32 cases (68.1%) undergoing CE studies. Among 14 patients with GI symptoms, only two patients had typical findings related with symptoms. Surgical resection was performed in five cases with tumor. Of these, four were diagnosed as gastrointestinal stromal tumor and the other one was a lymphangioma. There were no complications associated with the CE procedure. Conclusion: Capsule endoscopy is a safe, noninvasive diagnostic tool for small bowel diseases and may be useful for the diagnosis of small bowel hemorrhage including obscure bleeding. However, further studies are needed to confirm its utility for abdominal symptoms other than hemorrhage because of the low diagnostic yield.

      • KCI등재후보
      • KCI등재후보

        바터 팽대부의 혈관이형성증으로 인한 상부위장관 출혈 1예

        은종렬,장병익 대한소화기내시경학회 2006 Clinical Endoscopy Vol.32 No.6

        Although angiodysplasia can be found along the whole gastrointestinal tract, it is extremely rare at the ampulla of Vater. We experienced a case of chronic bleeding due to an angiodysplasia of the major papilla. A 53-year-old man was admitted due to intermittent melena and dyspnea for approximately 4 months. Esophagogastroduodenoscopy revealed bleeding from the ampulla of Vater. A subsequent examination with side-viewing duodenoscopy revealed vascular ectasia around the orifice of the major papilla and blood oozing from this lesion. Hemostasis was successfully performed by endoscopic bipolar electrocoagulation. No further bleeding was observed and the previous vascular abnormality disappeared at the follow-up duodenoscopy. (Korean J Gastrointest Endosc 2006;32:405-408) 비록 혈관이형성이 전 위장관에서 발견되지만 바터 팽대부에서는 매우 드물고, 바터 팽대부 혈관이형성증에 의한 출혈은 국내에서 보고된 바가 없다. 저자들은 4개월간의 간헐적 흑색변과 호흡곤란으로 내원한 53세 남자 환자에서 바터 팽대부 혈관이형성증에 의한 출혈을 발견하여 내시경적 양극성 전기응고법으로 성공적으로 지혈하였기에 문헌고찰과 함께 보고하는 바이다.

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