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담낭과 십이지장에 발생한 동시성 원발성 암의 동반절제 1례
조철균 한국간담췌외과학회 2007 한국간담췌외과학회지 Vol.11 No.3
PURPOSE: The incidence of multiple primary malignant tumor has ranged from 0.7% to 11% in 3 the medical literature. Various organs in the digestive system are the sites of multiple primary cancer (MPC). MPC may be synchronous or metachronous depending on the interval between their diagnosis. To the best of our knowledge, there are only rare reports of resected cases of synchronous primary carcinomas that developed in the GB and duodenum. METHODS : We present here a patient who underwent an operation for synchronous primary carcinomas of the GB and duodenum. A 51-year-old female was admitted for postprandial abdominal discomfort. CT scan and MRI of the abdomen showed a 3 x 2 cm sized heterogenously enhancing mass in the GB and a 3.7 x 2.7 cm sized hetrogenously enhancing mass in the 2nd portion of the duodeum. The laboratory findings, including the tumor markers, were non-specific. An elective operation was done under the impression of combined GB cancer and cancer in the 2nd portion of the deuodenum. On the operative findings, there was a 3 x 2.5 cm sized mass in the GB and a 5 x 4 cm sized duodenal mass with near complete luminal obstruction 3 cm distal from the pyloric ring. Radical cholecystectomy with wedge resection of the liver bed and Whipple's operation was performed. RESULTS: On microscopic examination, the GB mass was well differentiated adenocarcinoma and the duodenal mass was moderately differentiated adenocarcinoma, and one lymph node (a lymph node along the common hepatic artery) among the 18 dissected lymph nodes was invaded by tumor cells. The microscopic findings showed that the GB mass and duodenal mass were synchronous primary carcinomas. The patient recovered uneventfully and is alive and doing well without evidence of recurrence at 21-months of follow up evaluation. CONCLUSIONS: We report here on a case of combined curative resection for synchronous primary carcinomas of the gallbladder and duodenum. PURPOSE: The incidence of multiple primary malignant tumor has ranged from 0.7% to 11% in 3 the medical literature. Various organs in the digestive system are the sites of multiple primary cancer (MPC). MPC may be synchronous or metachronous depending on the interval between their diagnosis. To the best of our knowledge, there are only rare reports of resected cases of synchronous primary carcinomas that developed in the GB and duodenum. METHODS : We present here a patient who underwent an operation for synchronous primary carcinomas of the GB and duodenum. A 51-year-old female was admitted for postprandial abdominal discomfort. CT scan and MRI of the abdomen showed a 3 x 2 cm sized heterogenously enhancing mass in the GB and a 3.7 x 2.7 cm sized hetrogenously enhancing mass in the 2nd portion of the duodeum. The laboratory findings, including the tumor markers, were non-specific. An elective operation was done under the impression of combined GB cancer and cancer in the 2nd portion of the deuodenum. On the operative findings, there was a 3 x 2.5 cm sized mass in the GB and a 5 x 4 cm sized duodenal mass with near complete luminal obstruction 3 cm distal from the pyloric ring. Radical cholecystectomy with wedge resection of the liver bed and Whipple's operation was performed. RESULTS: On microscopic examination, the GB mass was well differentiated adenocarcinoma and the duodenal mass was moderately differentiated adenocarcinoma, and one lymph node (a lymph node along the common hepatic artery) among the 18 dissected lymph nodes was invaded by tumor cells. The microscopic findings showed that the GB mass and duodenal mass were synchronous primary carcinomas. The patient recovered uneventfully and is alive and doing well without evidence of recurrence at 21-months of follow up evaluation. CONCLUSIONS: We report here on a case of combined curative resection for synchronous primary carcinomas of the gallbladder and duodenum.
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조철균 한국간담췌외과학회 2007 한국간담췌외과학회지 Vol.11 No.3
Purpose: Even with recent advances of diagnostic tools and therapeutic strategies, the prognosis of gallbladder cancers remains poor. The clinical outcome has not improved much over the past couple of decades. This study analyzed our surgical results to evaluate the prognostic factors associated with survival after surgery in patients with gallbladder malignancies. Methods: Retrospective review of 69 patients with gallbladder carcinomas operated on at our surgical department over a period of 9 years from May 1995 to April 2004. Results: The overall 5-year survival rate was 45.9%, 3-year survival rate 52.8% and 1-year survival rate 72.4%. The 5-year survival rates according to the AJCC stage were 0 100%, Ia 100%, Ib 71.0%, IIa 41.7%, IIb 23.8%, III 50.0%, and IV 11.0% for each. The 5-year survival rates according to the depth of invasion were Tis 100%, T1a 100%, T1b 66.6%, T2 57.1%, T3 36.8%, and T4 22.7%. A univariate analysis of clinicopathologic factors showed that the T stage, N stage, M stage, radical surgery, tumor location, surgical procedure and histological grade were significant prognostic factors. Multivariate Cox-regression analysis of these eight important factors demonstrated that lymph node metastases and the degree of radical surgery were independent variables associated with prognosis. . Conclusion: The results of this study showed that lymph node metastases and degree of radical surgery were associated with patient prognosis. Therefore, long-term survival may be achieved by an early diagnosis with curative radical tumor resection. Purpose: Even with recent advances of diagnostic tools and therapeutic strategies, the prognosis of gallbladder cancers remains poor. The clinical outcome has not improved much over the past couple of decades. This study analyzed our surgical results to evaluate the prognostic factors associated with survival after surgery in patients with gallbladder malignancies. Methods: Retrospective review of 69 patients with gallbladder carcinomas operated on at our surgical department over a period of 9 years from May 1995 to April 2004. Results: The overall 5-year survival rate was 45.9%, 3-year survival rate 52.8% and 1-year survival rate 72.4%. The 5-year survival rates according to the AJCC stage were 0 100%, Ia 100%, Ib 71.0%, IIa 41.7%, IIb 23.8%, III 50.0%, and IV 11.0% for each. The 5-year survival rates according to the depth of invasion were Tis 100%, T1a 100%, T1b 66.6%, T2 57.1%, T3 36.8%, and T4 22.7%. A univariate analysis of clinicopathologic factors showed that the T stage, N stage, M stage, radical surgery, tumor location, surgical procedure and histological grade were significant prognostic factors. Multivariate Cox-regression analysis of these eight important factors demonstrated that lymph node metastases and the degree of radical surgery were independent variables associated with prognosis. . Conclusion: The results of this study showed that lymph node metastases and degree of radical surgery were associated with patient prognosis. Therefore, long-term survival may be achieved by an early diagnosis with curative radical tumor resection.
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조철균 中央醫學社 1992 中央醫學 Vol.57 No.3
The clinical study was made on 430 cases of anal diseases who had been treated at the department of general surgery, Nonsan Armed Forces General Hospital from January 1990 to December 1991. The results were as follows: The most frequent disease was hemorrhoid (74.0 %), followed by anal fissure (14.6 %), anal fistula (5.8 %), perianal abscess (4.0 %). The seasonal distribution revealed the peak incidence on spring in hemorrhoid, anal fissure and perianal abscess, and on summer in anal fistula. Examining the anatomical location of hemorrhoid, multiple distribution was observed in 47.8 %, and the most frequent location of single hemorrhoid was on the direction of 7 o'clock (14.4 %), followed by 4 o'clock (11.6 %), 11 o'clock (7.5 %). The type of hemorrhoid was external in 50.0 %, internal in 30.2 % and complicated in 19.8 %. The anal fissure (77.8 %) and perianal abscess (47.1 %) were seen most commonly in the posterior aspects of anus. The most frequent site of fistula opening was posterior aspect of anus (external 36.0 %, internal 48.0 %). In the 3 cases (12 %), the internal opening was not identified. The main clinical symptoms of hemorrhoid were pain (56.9 %), bleeding (55.4 %) and foreign body sensation due to mass (54.8 %). In the anal fissure, bleeding was the most common symptom (82.5 %). And the discharge (80.0 %) and pain (100 %) were main clinical symptom of anal fistula and perianal abscess, respectively. The symptom duration was within one week in 47.417o. Operation was performed in 86 patients (20%) of the total. Postoperative complications were noted in 7 cases (8.1 %) of the operated 36 patients and the most frequent complication was bleeding (42.8 %).
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