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임채춘,김성주,박영한,강정배,박성택,박성호,김홍배,장봉림 대한산부인과학회 2012 대한산부인과학회 학술대회 Vol.99 No.-
Hepatocellular carcinoma (HCC) spreads via the hematogenous route, the lymphatic route, or by direct invasion into adjacent argans. The common extrahepatic metastatic sites of HCC are the lungs, peritoneum, adrenal glands, and heart, and there are rare reports of nasal cavity, orbital cavity, skin, external auditory canals, and pharynx. The ovary is a rare site of metastasis for HCC, which was first reported in 1983. Metastasis of hepatocellular carcinoma to the ovary is notably rare. Although advance in imaging technology has allowed for earlier detection of disease, hepatocellular carcinoma is usually asymptomatic and discovered at an advanced stage with metastasis. The most common sites of metastasis include lung, peritoneum, adrenal gland, and bone, but rarely, the nasal cavity, orbit, gallbladder, and ovary can be metastatic sites. We experienced a case of metastatic hepatocellular carcinoma of the ovary in a living patient. An exploratory laparotomy was performed, and a soft, ovoid cystic mass was identified in the right ovary. Right salphingo-oophorectomy was performed. The pathological features showed metastasis of HCC with clear resection margins. Although metastasis of HCC to the ovary is very rare, it should be suspected in a female patient with a lower abdominal mass and an elevated serum AFP and CA125 levels in the absence of other demonstrable metastases. Recently we experienced a case of HCC metastasis to the ovary, so we report this case with reviewing of other literature.
임채춘(Chae Chun Rhim),노성래(Sung Rae Roh),김동주(Dong Joo Kim),송민경(Min Kyung Song),이재성(Jae Sung Lee),주하경(Ha Kyong Joo),박윤희(Youn Hee Park),유기성(Ki Sung Ryu),한구택(Gu Taek Han),이종건(Jong Kun Lee),이준모(Joon Mo Lee) 대한산부인과학회 2001 Obstetrics & Gynecology Science Vol.44 No.8
The malignant lymphomas are neoplastic transformation of cells that reside predominantly in lymphoid tissues. The two major variants of malignant lymphoma are non-Hodgkin's lymphoma and Hodgkin's disease. Although both of these tumors infiltrate reticuloendothelial organs, their biologic and clinical behaviors suggest that they are probably not related. More than 90% of all cases of non-Hodgkin's lymphomas are of B-cell derivation. This observation is based upon the expression of B-lineage-restricted antigens as well as clonal rearrangements of immunoglobulin heavy and light chain genes. The malignant lymphoma localized in uterine cervix is rare and characteristically symptom-free expressed. We experienced a case of malignant lymphoma originated from uterine cervix, so we report with a brief of literature.
암 수술시 Sentinel Lymph Node 의 임상적 유용성
임채춘(Chae Chun Rhim),황성진(Seong Jin Hwang),박종섭(Jong Sup Park),남궁성은(Sung Eun Namkoong) 대한산부인과학회 2002 Obstetrics & Gynecology Science Vol.45 No.6
목적 : 이 연구의 목적은 외음부 암 환자의 수술시 sentinel lymph node를 탐색하고 동결절편의 조직병리학적 결과를 통해 수술을 최소화 할 수 있는지에 대한 임상적 적용가능성을 평가하는 데 있다. 연구 대상 및 방법 : 2001년 3월부터 2002년 1월까지 가톨릭대학교 강남성모병원에서 외음부 암 확진 후 근치적 외음부 절제술 및 일측 또는 양측 서혜 대퇴부 임파절 절제술을 시행한 4명의 환자를 대상으로 하였으며, 수술전 technetium-99 m colloid albumin의 주입과 수술중 isosulfan blue dye를 주사한 후 sentinel lymph node를 찾아낸 뒤 이를 임상병리과에 보내고 그 동결생검 결과를 얻는다. 결과 : 4명의 환자에서 총 10개의 sentinel lymph node와 110개의 non-sentinel lymph node를 얻었다. 동결생검 결과 10개의 sentinel lymph node는 모두 음성 (benign)이었고 sentinel lymph node가 음성일 때 영구 조직검사 결과가 양성 (malignant)으로 나온 경우는 없었다. 결론 : 외음부 암 환자에서 sentinel lymph node를 찾아 이를 제거한 후, 동결절편의 조직병리학적 결과가 음성 (benign)일 경우에는 더 이상의 광범위한 서혜 대퇴부 임파 절제술을 피함으로써, 수술 후 합병증을 최소화하고 삶의 질을 향상시키는 데 임상적 유용성이 있을 것으로 생각된다. Objective : The purpose of this study is to evaluate the validity of sentinel lymph node detection and the possibility of clinical application in treatment of vulvar cancer patients. Patients and Methods : From March 2001 to January 2002, four patients with vulvar cancer were eligible for this study. All the patients were preoperative technetium-99 m colloid albumin and intraoperative isosulfan blue dye injection intradermally at the junction of tumor mass and normal skin. Superficial lymphatic channels and groin lymph node dissections were made to detect sentinel lymph node and then complete inguinofemoral lymph nodes dissection was performed. All the sentinel lymph nodes were sent to pathologic department for frozen biopsy. Results : Ten sentinel lymph nodes were identified in one-hundred and ten groin lymph nodes. All the ten sentinel lymph nodes showed benign. There was no case that non-sentinel lymph nodes were positive in the presence of negative sentinel lymph nodes by frozen biopsy (negative predictive value was 100%). Conclusion : Sentinel lymph nodes detection by combination use of technetium-99 m colloid albumin and isosulfan blue dye injection was simple and accurate in our preliminary study. To reduce postoperative morbidity, lymphedema and to minimize extensive inguinofemoral lymph nodes dissection, sentinel lymph node frozen biopsy may be a reasonable alternatives and a suitable method for limited control of vulvar cancer. This preliminary study showed the possibility of clinical application of sentinel lymph node detection in vulvar cancer surgery.
임채춘(Chae Chun Rhim),김용옥(Yong Ok Kim),박기영(Ki Young PARK),상미란(Mi Tan Sang),유순원(Soon Won Ryu),김진홍(Jin Hong Kim) 대한산부인과학회 2000 Obstetrics & Gynecology Science Vol.43 No.9
목적 : 본 연구는 반복제왕절개술시 복부 반월형 횡절개후 새로운 술기인 근막상 종절개술(Vertical incision on fascia) 을 비교하여 수술부위의 동통강도와 감각회복기간 및 재원기간에 미치는 영향을 알아보고자 하였다. 연구방법 : 1997년 1월 1일부터 동년 8월 31일 까지 가톨릭대학교 의과대학부속 성모병원에서 반복제왕절개술을 받은 산모들중 최초의 수술반흔이 복부 반월형 횡절개술(Pfannenstiel skin incision)로 시행받은 200명을 대상으로, 근막상 종절개술과 근막상 횡절개술로 수술한 산모를 각각 100명씩 선정한 후 이를 비교군과 대조군으로 나눈 뒤 설문조사를 시행하였다. 설문은 전화문의 및 입원기록을 병행하였다. 결과 : 수술 후 1병일 동통의 강도는 근막상 종절개술이 근막하 횡절개술보다 낮게 나타났다. (p<0.032) 제왕절개술후 수술부위 감각의 회복기간은 1개월이내 및 3개월이내에서 근막상 종절개술이 근막상 횡절개술보다 더 빨리 회복되는 것으로 나타났으며(p<0.0001), 수술후 평균 재원일수는 근막상 종절개술의 경우가 근막상 횡절개술보다 짧은 것으로 나타났다. (p<0.05) 결론 : 반복 제왕절개수술시 제12번 흉곽신경의 외측 피부가지신경, 음부대퇴신경 및 장골서혜신 경의 손상을 최소화함으로써, 수술후 동통의 감소 ,수술부위 감각회복기간의 단축 및 평균 재원기간의 단축에 근막상 종절개술(Vertical incision on fascia)이 근막상 횡절개술(Transverse incision on fascia) 보다 유의하게 우수한 것으로 나타난 바, 미용적효과와 수술후 산모의 만족도를 증진시킬 수 있는 근막상 종절개술기의 도입을 고려해볼 필요가 있다고 생각된다. Objective : Our purpose was to minimize the nerve and muscle injury during operation and to compare the strength of pain and sensory recovery intervals between vertical and transverse incision on fascia after Pfannenstiel skin incision in repeated cesarean section. Method : Two hundred women delivered by cesarean section from January 1st,1997. to August 31st, 1997. at St. Mary's Hospital were selected. They were divided into two groups. Each group was composed of one hundred women, respectively. One was vertical incision on fascia and the other was transverse incision on fascia. All of their initial skin scars were caused by Pfannenstiel approach and the cases of infraumbilical midline skin incision were excluded.Results : The strength of pain at postoperative first day (POD#1) was significantly diminished in vertical incision on fascia than in transverse incision on fascia(p<0.032). The sensory recovery intervals and mean hospitalization periods were significantly shortened in vertical incision than transverse incision on fascia(p<0.001 and p<0.05 respectively). Conclusion : The vertical incision on fascia after Pfannenstiel skin incision was significantly beneficial to repeated cesarean section delivery by diminishing the strength of pain, minimizing abdominal muscle injury, shortening the sensory recovery intervals and mean hospitalization periods. So it is the time that the introduction of new method-vertical incision on fascia after Pfannenstiel skin incision - that not only provides cosmetic effects but also improves the satisfaction of patients after operation will be taken into consideration.