10cm이상 거대 간세포암의 절제 후 성적

최기홍(Gi Hong Choi),김창희(Kim Chang Hee),한대훈(Dai Hoon Han),김동현(Dong Hyun Kim),최새별(Sae Byeol Choi),강창무(Chang Moo Kang),김경식(Kyung Sik Kim),최진섭(Jin Sub Choi),박영년(Young Nyun Park),박준용(Jun Yong Park),김도영(Do Yo 한국간담췌외과학회 2008 한국간담췌외과학회지 Vol.12 No.4

Purpose: Recent studies have reported improved perioperative and long-term outcomes for the initial postoperative results for patients with a huge HCC. The purpose of this study was to investigate the surgical outcomes of patients with a huge HCC and we wanted to identify any subgroup that would likely benefit from hepatic resection. Methods: From January 1996 to August 2006, 55 patients were diagnosed with a huge HCC (≥ 10cm in diameter). All the tumors were classified as either the expanding nodular type or the non- expanding nodular type. Results: The mean age of the patients was 50.6 years and 39 patients were male. The most common cause of liver disease was hepatitis B virus. The mean size of tumor was 11.9 cm. Microscopic liver cirrhosis was present in 17 patients. Twenty-three patients had tumors of the expanding nodular type. Curative resection was performed in 50 patients. The 5-year diseasefree and overall survival rates after resection were 35.8% and 41.0%, respectively. Univariate analysis revealed that surgical margins of ≤ 1.0, a non-curative resection, the non-expanding nodular type and microscopic vascular invasion were adverse prognostic factors for survival. Multivariate analysis indicated that the gross tumor classification (expanding nodular vs. nonexpanding nodular) was the only independent prognostic factor. Conclusions: Huge HCC is not a homogenous group and the gross tumor pattern may represent the biologic behavior of huge HCC. Because the outcome of surgical treatment is far better than that of non-surgical treatment, resection should be actively considered for patients with a huge HCC. An expanding nodular type tumor is the best candidate for surgical resection.

유방의 관상피내암과 미세침윤을 동반한 관상피내암의 임상 양상 및 병리학적 특성 비교

최기홍(Gi-Hong Choi),고승상(Seung-Sang Ko),김승기(Seung-Ki Kim),김승일(Seung-Il Kim),박병우(Byeong-Woo Park),이경식(Kyong-Sik Lee) 대한외과학회 2002 Annals of Surgical Treatment and Research(ASRT) Vol.63 No.3

노인의 여가활동이 생활만족도 및 고독감에 미치는 영향

최기홍(Choi Gi Hong),전태숙(Jun Tea Suk) 21세기사회복지학회 2018 21세기사회복지연구 Vol.15 No.1

본 연구는 서울시 소재 노인복지시설 이용 노인의 일반적 특성과 여가활동 참여특성이 생활만족도와 고독감에 어떤 변수가 얼마만큼의 영향을 미치는가에 대한 연구로 설문을 실시하였고, 수집된 195부를 중심으로 SPSS Ver18.0를 이용하여 빈도분석, 기술 통계분석, Ttest와 ANOVA 분석, 다중회귀분석을 실시하였다. 연구 결과 첫째, 가설1 여가활동 참여노인이 인지하는 생활만족도는 학력, 배우자유무, 거주가족, 수입발생, 여가시간대, 월 여가비용, 불참이유, 이용프로그램, 상담원 필요인식수준, 여가시설이용유형 등 여가활동에 참여하는 노인들에 따라 생활만족도는 차이가 있었다. 둘째, 가설2 여가활동에 참여하고 있는 노인은 저학력일수록, 건강할수록, 소득원이 마련될수록, 전문가의 여가활동지원 필요성 인식이 클수록, 정부지원의 필요성 인식이 강할수록 생활만족도는 더 높아졌다. 셋째, 가설3 여가활동에 참여하고 있는 노인이 고령, 저학력, 저소득, 독자참여, 여가활동비용이 적을수록, 종교적인 경우, 전문상담원의 필요성이 낮은 인식할수록 고독감은 더 높아지는 것으로 나타났다.

소아 가성비장동맥 파열의 동맥색전술 치험 1예

한석주,이도연,한애리,최기홍,오정탁,최승훈,황의호,Han, Seok-Joo,Lee, Do-Yun,Han, Ai-Ri,Choi, Gi-Hong,Oh, Jung-Tak,Choi, Seung-Hoon,Hwang, Eui-Ho 대한소아외과학회 2000 소아외과 Vol.6 No.2

Pseudoaneurysm of the splenic artery may arise from a vascular erosion by a surrounding inflammatory processes in acute and chronic pancreatitis. Rupture of the pseudoaneurysm may threaten the patient's life. Conservative management for massive hemorrhage may cause 100 percent mortality and even with prompt therapy there is a high mortality. Preoperative detection of bleeding source is desirable because of the difficult identification of the bleeding site at laparotomy. Angiographic identification and embolization of the hemorrhagic vessels in selected cases may obviate the risk of urgent surgery. The authors have recently managed a case of ruptured splenic artery pseudoaneurysm combined with a pancreatic pseudocyst in a 6 years old boy. A bolus enhanced CT scan and angiography confirmed the diagnosis. We managed this child successfully with the urgent transcatheter arterial embolization followed by elective surgery.

다발성 간세포암 환자에서 다발 부위 간절제 또는 고주파 치료를 병합한 간절제술 후 장기 성적

조민수(Min Soo Cho),최기홍(Gi Hong Choi),김동현(Dong Hyun Kim),강창무(Chang Moo Kang),최진섭(Jin Sub Choi),박영년(Young Nyun Park),이우정(Woo Jung Lee) 한국간담췌외과학회 2009 한국간담췌외과학회지 Vol.13 No.4

Purpose: Hepatic resection is the standard treatment for hepatocellular carcinoma (HCC). In some patients with multiple HCC, one-block resection is not feasible due to either the tumor location or the underlying liver function. In this study, we attempted to compare the outcomes of multiple - site resection or combined resection and radiofrequency ablation with those of one-block resection in patients with multiple HCC. Methods: We retrospectively reviewed 507 patients who underwent surgical resection. Among 507 patients who received surgical treatment with potentially curative aim from January 1996 to August 2006 in Yonsei University Health System, 58 patients had a radiologically detected multiple HCC. Patients with multiple HCC were divided into: group A, patients treated with one-block resection (n=40) and group B, patients with multiple-site resection or combined resection and RFA (n=18). Results: The 1-, 3- and 5-year overall survival rates for patients with single and multiple HCC were 90.2%, 76.2% and 66.7% and 82.7%, 61.4% and 37.9%, respectively (p<0.001). In group B, 6 patients received multiple-site resection and 12 patients underwent combined resection and RFA. The clinicopathological variables were not significantly different between the two groups except the distribution of multiple tumors. The postoperative complication rates for group A and B were 32.5% and 33.3%, respectively. The 1-, 3- and 5-year disease-free survival rates for group A and B were 53.0%, 27.6% and 24.1% and 18.3%, 24.1% and 18.3%, respectively (p=0.386). The overall survival rates were also not significantly different between the two group (80.0%, 59.6%, and 36.9% for group A and 88.9%, 65.7% and 39.4% for group B, p=0.528). The multivariate analysis revealed that Edmondsons-Steiner grade (III-IV) and Indocyanine green retention rate at 15 minutes (ICG R15) >10% were adverse prognostic factors for overall survival. Conclusion: Active treatments including multiple-site resection and combined resection and RFA showed similar treatment outcomes compared with one-block resection in patients with multiple HCC.

간세포암 근치적 절제 후 발생한 간외 재발암의 위험인자 분석

이형순(Hyung Soon Lee),최기홍(Gi Hong Choi),황호경(Ho Kyung Hwang),강창무(Chang Moo Kang),최진섭(Jin Sub Choi),이우정(Woo Jung Lee) 한국간담췌외과학회 2010 한국간담췌외과학회지 Vol.14 No.4

Purpose: A few studies have been reported on extrahepatic metastasis after curative resection for hepatocellular carcinoma (HCC). We investigated the patterns of extrahepatic recurrence and we identified the risk factors for extrahepatic recurrence after curative resection for HCC. Methods: We retrospectively reviewed 587 patients who underwent surgical resection with a curative aim from January 1998 to December 2007 in the Yonsei University Health Care System. Among the 571 patients, 291 (51.0%) patients developed recurrence. Sixty five patients initially presented with extrahaptic recurrence. The patients with extrahepatic recurrence were divided into Group A (peritoneal recurrence) and Group B (non-peritoneal extrahepatic recurrence). Results: Group A had higher rates of intraoperative bleeding>1,500 ml and perioperative transfusion too. On the multivariate analysis, perioperative transfusion, satellite nodule and the tumor size were the independent risk factors for Group A. The Edmondson-Steiner grade, satellite nodule and the tumor size were the independent risk factors for Group B. The 1, 3 and 5-year overall survival rates after curative resection for the patients with extrahepatic recurence were 83.1%, 48.9% and 27.4%, respectively. The recurrence patterns and treatment modalities did not affect the overall survival after treatment for extrahepatic recurrence. Conclusion: A perioperative transfusion was found to be a different risk factor for peritoneal recurrence, as compared to those risk factors for non-peritoneal extrahepatic recurrence. Therefore, efforts by physicians to decrease intraoperative bleeding may prevent peritoneal recurrence after performing curative resection for HCC.

10년간 단일 기관에서 간세포암의 수술적 절제의 경험

한대훈(Dai Hoon Han),최기홍(Gi Hong Choi),김동현(Dong Hyun Kim),최새별(Sae Byeol Choi),강창무(Chang Moo Kang),김경식(Kyung Sik Kim),최진섭(Jin Sub Choi),박영년(Young Nyun Park),박준용(Jun Yong Park),김도영(Do Yong Kim),한광협(Kwang-H 한국간담췌외과학회 2008 한국간담췌외과학회지 Vol.12 No.4

Purpose:Although surgical resection is the most effective treatment for hepatocellular 4 carcinoma (HCC), high recurrence after resection is a major challenging problem. We attempted to determine the optimal strategies for improving the long-term surgical outcome through the review of our 10 years’ experience with surgically treating HCC. Methods: We retrospectively reviewed 497 patients who received curative resection at the Yonsei University Health System from January 1996 to August 2006. Results: The 5 year disease-free rate and the overall survival rate after curative resection were 45.0% and 63.9%, respectively. Of the 497 patients, 491 (98.8%) were Child-Pugh A and 107 (56.3%) were diagnosed with liver cirrhosis. The postoperative complication and mortality rates were 28.6% and 1.8%, respectively. Of the 243 recurrent patients, 184 (75.7%) were diagnosed with intrahepatic recurrence alone. Of these intrahepatic recurrent patients, 169 (91.9%) received active treatment, including transplantation (n=7), re-resection (n=12), local ablation therapy (n=18) and transarterial chemoembolization (n=132). Multivariate analysis revealed that perioperative transfusion, a satellite nodule, the pathologic TNM stage, the Edmondsons-Steiner grade, the serum alkaline phosphatase (ALP) and aspartate aminotransferase levels and cirrhosis were associated with disease free survival, and perioperative transfusion, a satellite nodule, macroscopic vascular invasion, the Edmondsons-Steiner grade, the ALP and serum albumin levels and the platelet count were related with overall survival after resection. Conclusions: The long-term surgical outcome of HCC can be further improved by proper patient selection, delicately performed surgery and administering postoperative adjuvant therapy for patients with a high risk of recurrence. Early diagnosis and aggressive treatment are needed to treat the recurrence.

원위부 총수담관에 발생한 편평상피세포암 1예 보고

김강미(Gang Mi Kim),최기홍(Gi Hong Choi),김동현(Dong Hyun Kim),강창무(Chang Moo Kang),이우정(Woo Jung Lee) 한국간담췌외과학회 2008 한국간담췌외과학회지 Vol.12 No.3

Squamous cell carcinoma of the extrahepatic bile duct is very rare. Only limited information is available concerning its pathogenesis and prognosis, although it is reported to be associated with choledocolithiasis, recurrent pyogenic cholangitis, clonorchiasis, choledochal cyst formation, and primary sclerosing cholangitis. Therefore, we present a case of squamous cell carcinoma of the distal common bile duct. A 64-year-old male patient presented with abdominal pain and obstructive jaundice. Computed tomography and endoscopic retrograde cholangiography showed thickening of the wall and a segmental stricture of the distal common bile duct, and the biopsy confirmed poorly differentiated carcinoma with marked squamous differentiation. The patient underwent a pylorus-preserving pancreaticoduodencetomy. Histological examination revealed that the tumor invaded the pancreas and metastasized to regional lymph nodes (pT3N1M0). The patient developed multiple liver metastases 30 days later and died of rapidlyprogressive metastatic disease to the liver 5 months following resection. Squamous cell carcinoma of the distal bile duct with lymph node metastasis had a very poor prognosis, even though curative resection was performed.

간세포암의 근치적 절제 후 간내 재발암의 위험 인자 분석

김강미(Gang Mi Kim),최기홍(Gi Hong Choi),한대훈(Dai Hoon Han),김동현(Dong Hyun Kim),강창무(Chang Moo Kang),최진섭(Jin Sub Choi),박준용(Jun Yong Park),김도영(Do Yong Kim),한광협(Kwang-Hyub Han),전재윤(Chae Yoon Chon),박영년(Young Nyun 한국간담췌외과학회 2008 한국간담췌외과학회지 Vol.12 No.4

Purpose: Intrahepatic recurrent HCC has been classified according to location, the time to recurrence and the pattern of presentation. The purpose of this study is to classify intrahepatic recurrent HCCs into subgroups that have relatively similar recurrent patterns and to identify the risk factors for each recurrent type. Methods: A total of 353 patients were retrospectively studied. Intrahepatic recurrent HCC was classified into nodular recurrence (<4 nodules; type I), multinodular-diffuse recurrence (≥4 nodules; type II) and infiltrative recurrence (type III). The cut-off time between early and late recurrence was chosen to be 12 months following hepatectomy. Results: Among the 134 patients with only intrahepatic recurrence, 94 were type I, 27 were type II and 13 were type III. The median survival time following the recurrence of types I, II and III were 55, 16 and 8 months, respectively. As determined by multivariate analysis, perioperative transfusion and indocyanine green retention at 15 minutes (ICG R 15 >10%) were the independent risk factors for type I; an ICG R 15>10%, microvessel invasion and intrahepatic metastasis were the independent risk factors for type II; an ICG R 15>10% and microscopic portal vein invasion were the independent risk factors for type III. Multivariate analysis revealed that the prognosis of patients with IHR was associated with the recurrent types, the time to recurrence and the serum albumin level at the initial presentation. Following multivariate analysis, an ICG R 15>10% and intrahepatic metastasis were the independent risk factors for early type I recurrence; perioperative transfusion and a higher grade of hepatitis activity were the independent risk factors for late type I recurrence. Conclusions: The recurrent types and the time to recurrence may help us to predict the cellular origin of intrahepatic recurrent HCC and the prognosis of the patients who suffer with intrahepatic recurrent HCC.

화산재 피해 예측을 위한 손상함수 구축 방법 연구

유순영(Soonyoung Yu),윤성민(Seong-Min Yoon),강주화(Zhuhua Jiang),최기홍(Gi-Hong Choi) 대한지질학회 2013 대한지질학회 학술대회 Vol.2013 No.10