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근치적인 수술 이후 조기 재발하였으나 서로 다른 예후를 보인 간세포암종 2예
조영윤 ( Young Youn Cho ),이정훈 ( Jeong Hoon Lee ),이남준 ( Nam Joon Yi ),이광웅 ( Kwang Woong Lee ),서경석 ( Kyung Suk Suh ),김윤준 ( Yoon Jun Kim ),윤정환 ( Jung Hwan Yoon ) 대한간암학회 2015 대한간암학회지 Vol.15 No.2
Hepatocellular carcinoma (HCC) has poor prognosis, even after curative resection. Earlyrecurrence after curative treatment is a major cause of the poor prognosis. Pathologic factors such as vessel invasion, satellite nodule, size of tumor and pathologic grade are prognostic factors predicting early recurrence and poor prognosis. We share our experience of two cases which both showed early recurrence after curative hepatic resection, but eventually demonstrated different prognosis. Since the most common cause of death after potentially curative treatment is tumor recurrence, suppression of tumor recurrence might be linked to survival gain. Currently, there is no adjuvant therapy for HCC endorsed by international guidelines. However, recent studies have shown that antiviral treatment for hepatitis B virusrelated HCC and immunotherapy using autologous cytokine-induced killer cell reduced HCC recurrence. Further study is needed to select patients who will benefit from adjuvant treatments. (J Liver Cancer 2015;15:126-131)
간이식 후 발생한 간세포암의 폐 전이에 대한 종양절제술의 역할
김현수(Hyun Soo Kim),서경석(Kyung-Suk Suh),전영민(Young-Min Jun),김태훈(Teahoon Kim),신우영(Woo Young Shin),이남준(Nam-Joon Yi),한국남(Kook Nam Han),김영태(Young Tae Kim),김태유(Tae-You Kim),이건욱(Kuhn Uk Lee) 한국간담췌외과학회 2009 한국간담췌외과학회지 Vol.13 No.4
Purpose: Liver transplantation (LT) has been advocated as a good management option for patients with hepatocellular carcinoma (HCC). The rate of HCC recurrence after LT is about 20%. Although the median survival time of patients with HCC recurrence is 7∼9 months, the role of surgical treatment for metastatic tumors has been reported on. In this study, we evaluated the role of metastasectomy for treating patients with pulmonary metastasis from HCC after LT. Methods: We retrospectively analyzed 10 patients with pulmonary metastasis after LT and who were treated between April 2005 and October 2007. The underlying liver disease was cirrhosis caused by chronic viral hepatitis. The surveillance protocol for HCC recurrence was as follows: assessing the serum alpha-fetoprotein level every 1 month, chest and abdomen-pelvic computed tomography every 3 months and a bone scan every 1 year or when bone metastasis was suspected. The patients with less than 3 metastatic lesions were recommended to undergo metastasectomy (Group S, n=6) and the patients with more 4 lesions were recommended nonsurgical management, including chemotherapy (Group N, n=4). Results: All the metastatic lesions were detected on the protocol chest CT scans. The median recurrence time was 7.4 months (0.8∼18.2) after LT; this was 11.0 (4.8∼18.2) months for Group S and 2.0 (0.8∼3.3) months for Group N. One patient had a single lesion and the others had multiple lesions on multilobes. The median survival times of Group S were 29.3 (18.5∼41.3) months after pulmonary metastasis and 40.3 (23.3∼48.0) months after transplantation; 5 patients had no recorded evidence of their disease status. The median survival time of Group N was 4.3 (4.0∼6.3) months after metastasis and 6.2 (5.3∼7.1) months after transplantation; all the patients have since died. Conclusion: The survival outcome seemed to be good for the patients who underwent pulmonary metastasectomy for HCC, if it was detected earlier and it was resectable (≤3 lesions). However, further study is required for validating the survival benefit of pulmonary metastasectomy.
고령 환자에서 위전절제술 후 발생한 다양한 수술 후 합병증 치험 1례
김현아,한호성,김영우,김유진,이남준,박성훈 梨花女子大學校 醫科大學 醫科學硏究所 2001 EMJ (Ewha medical journal) Vol.24 No.1
The number of the aged patient who undergo the operation has been increased in recent years. The risk of the operation is formidable in old patient. After general surgery, the morbidity and the mortality are associated with the pre-operative medical illness. And, the old age have more pre-operative medical illnesses than the younger. We experienced multiple postoperative complications in 85 years old patient. He has past history of old myocardiac infarction without other disease. He underwent the total gastrectomy with esophagojejunostomy due to advanced gastric cancer. After surgery, multiple post operative complications have occurred such as arrhythmia, hyponatremia, intraperitoneal abscess, gastrointestinal hemorrhage, pneumonia, heart failure, post operative delirium, phlebitis, hearing disturbance, nephropathy, would seroma, liver dysfunction, glucose intolerance. We summarized this case and give a brief review of the literature.