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        • 3세 여아에서 발견된 십이지장 격막에 의한 십이지장 폐쇄: 증례 보고

          남소현,임윤정,Nam,,So,Hyun,Lim,,Yun-Jung 대한소아외과학회 2014 소아외과 Vol.20 No.2

          Congenital duodenal obstruction is a one of the emergent surgical conditions in neonates. Almost of them were diagnosed with double-bubble sign in prenatal ultrasonography. However, partial obstruction caused from duodenal web could be overlooked. We reported a duodenal web in early childhood. A three-year-old girl visited at our pediatric clinic for constipation. She had been showed non-bilious vomiting after weaning meal since 6 months old of her age, but her weight was relevant for 50-75 percentile of growth curve. Barium enema was initially checked, but any abnormal finding was not found. We noticed the severely distended stomach and 1st portion of duodenum. Upper gastrointestinal series revealed partial obstruction in 2nd portion of duodenum. After laparotomy, we found the transitional zone of duodenum and identified a duodenal web via duodenotomy. We performed duodeno-duodenostomy without any injury of ampulla of Vater. She was recovered uneventfully. During 6 months after operation, she does well without any gastrointestinal symptoms or signs, such as vomiting or constipation.

        • 재발성 서혜부 탈장으로 오인된 지방모세포종

          남소현,임윤정,김연미,Nam,,So,Hyun,Lim,,Yun-Jung,Kim,,Yeon,Mee 대한소아외과학회 2014 소아외과 Vol.20 No.2

          Palpable inguinal mass in children should be differentiated from inguinal hernia, hydrocele, lymph node, and tumor. Though using ultrasonography, fatty tumor would be misdiagnosed as incarcerated inguinal hernia containing fatty component. We experienced the huge inguinal lipoblastoma in 5-year-old girl mimicking recurrent incarcerated hernia. Laparoscopic exploration revealed it was not incarcerated hernia but well demarcated bulging mass from abdominal wall. Mass was about $10{\times}4{\times}3cm$ and extended from internal inguinal ring to saphenous opening. It was near total excised because of right external iliac vein injury. Pathologically, it was proven as lipoblastoma containing mature adipocyte with lipoblast and fibrous septa. Postoperatively, we noticed a segmental thrombotic occlusion of external iliac vein. After 1 year, she has no symptom related to occluded vessel. The remained lipoblastoma showed no interval change. Even lipoblastoma has a good prognosis with low recurrence rate, we need careful follow-up.

        • KCI등재

          소아의 천공성 충수염에 시행한 개복 충수절제술과 복강경 충수절제술의 비교

          남소현(So-Hyun Nam), 김대연(Dae-Yeon Kim), 김성철(Seong-Chul Kim), 김인구(In-Koo Kim) 대한외과학회 2009 Annals of Surgical Treatment and Research Vol.76 No.1

          Purpose: It is controversial to do laparoscopic appendectomy in children with perforated appendicitis. Recently, we have adopted laparoscopic appendectomy as a first-choice method in children with perforated appendicitis. We investigate the results of laparoscopic appendectomy in perforated appendicitis and compare it with open technique. Methods: We studied retrospectively the patients who underwent the appendectomy by either a laparoscopic or open technique for perforated appendicitis between January 2001 and December 2005. There were 117 patients in the open appendectomy (OA) group and 45 patients in the laparoscopic (LA) group. Results: The operation times were significantly longer for the LA group than for the OA group (OA group 76.3±23.7 vs. LA group 95.4±32.4 min) (P<0.05). The hospital days were also longer in the LA group than the OA group (OA group 8.7±4.4 vs. LA group 11.0±6.3 (days)). However, there was no difference in time to diet (OA group: 5.0±3.3 vs. LA group: 5.4±2.9 (days)) (P>0.05) and in the rate of complications (OA group: 36/117 vs. LA group: 13/45) (P>0.05) between the two groups. The incidence of postoperative ileus, intraabdominal abscess and wound infection was lower in LA group, but not significantly. Conclusion: Operation times and hospital days were longer in the LA group. But the incidence of complication was similar between the two groups. Considering little postoperative scar and less pain, laparoscopic appendectomy could be regarded as the optimal surgical therapy in children with perforated appendicitis.

        • KCI등재
        • KCI등재

          괴사성 장염의 수술 경험

          남소현(So-Hyun Nam), 김대연(Dae-Yeon Kim), 김성철(Seong-Chul Kim), 김인구(In-Koo Kim) 대한외과학회 2009 Annals of Surgical Treatment and Research Vol.76 No.4

          Purpose: Necrotizing enterocolitis (NEC) is a severe inflammatory disorder of the intestine, causing high mortality and morbidity. We investigated the single center experience about the operative indication, treatment method, and mortality in NEC. Methods: The medical records of infants (<1 year old) who underwent the operation due to complications of NEC at the Asan Medical Center from Jan 1997 to Dec 2007 were retrospectively reviewed. Results: Among 49 patients (M:F = 34:15), 37 underwent the operation at acute phase of NEC, average 26.43±35.43 days after birth (3∼168), due to pneumoperitoneum in 23, clinical deterioration in 12 and abdominal mass in 2. Average gestational age was 234.64±38.27 days (161∼279) and birth weight was 2,061.38±999.49 g (563∼3,740). The extent of necrosis was classified grossly as focal in 14 cases, multifocal in 14 and panintestinal in 9 and the operative methods were enterostomy in 30 patients, resection and anastomosis in 6 and open drainage in 1. Thirteen patients (35.1%) were expired - 8 (21.6%) died of necrotizing enterocolitis and 5 died of other causes. The other 12 patients underwent operation for stricture after NEC at average 81.17±77.22 days after birth (32∼317). Average gestational age was 240.83±34.4 days (173∼280) and birth weight was 2,089.83±862.47 g (710∼3,200). Eight patients underwent resection and anastomosis including stricture and 4 patients underwent enterostomy. Conclusion: Resection and enterostomy was the preferred procedure but resection and anastomosis did not increase morbidity or mortality. Quite a number of patients suffered from the stricture after NEC.

        • KCI등재후보
        • KCI등재

          선천성 공-회장 폐쇄의 치료 경험

          남소현(So-Hyun Nam), 박세염(Se-Yeom Park), 김대연(Dae-Yeon Kim), 김성철(Seong-Chul Kim), 김인구(In-Koo Kim) 대한외과학회 2010 Annals of Surgical Treatment and Research Vol.79 No.4

          Purpose: Intestinal atresia is a common cause of neonatal intestinal obstruction. Recently, the survival rate has been increasing from development of prenatal diagnosis, total parenteral nutrition (TPN) and neonatal intensive care. We evaluated the complication rate and cause of mortality after operative management for jejunoileal atresia. Methods: We reviewed 62 patients (36 males, 26 females) with jejuno-ileal atresia who underwent operation from 1998 to 2007. Results: There were 37 patients with jejunal atresia and 25 with ileal atresia. The average gestational age was 256±16.6 days and birth weight was 2,824±620 g. Prenatal diagnosis was performed in 45 patients (72.6%) around gestational age 27 weeks. Within 2nd day after birth, 44 patients (71%) underwent operation. Half of the jejunoileal atresia was type Ⅲa and type Ⅰ was in 8, type Ⅱ was in 3, type Ⅲb was in 12, and type Ⅳ was in 8. The operative treatment was resection & anastomosis in 59 patients and enterotomy & web excision in 3. They started feeding at 12.4±11.5 days after operation on average. The average duration of TPN was 26.7±23.5 days, and the incidence of cholestasis was 30.6%. Hospital days averaged 36.8±26 days. Early complication occurred in 14 patients (intestinal obstruction in 5, sepsis in 4, wound problem in 3, anastomosis leakage in 1, and intraabdominal abscess in 1). Late complication occurred in 7 patients (anastomosis stricture in 4 and intestinal obstruction in 3). There was only one case of mortality due to short bowel syndrome after re-operation for adhesive ileus. Conclusion: The operation for intestinal atresia was successful and aggressive management contributed to a low mortality rate.

        • KCI등재

          영아의 간혈관내피종에 대한 비수술적 치료경험

          남소현(So-Hyun Nam), 박정익(Jeong-Ik Park), 김대연(Dae-Yeon Kim), 김성철(Seong-Chul Kim), 김인구(In-Koo Kim) 대한외과학회 2010 Annals of Surgical Treatment and Research Vol.79 No.5

          Purpose: Hepatic hemangioendothelioma (HET) is a rare benign vascular tumor in infants. The clinical manifestations are variable from asymptomatic to life-threatening heart failure or Kasabach-Merritt syndrome (KMSD). We report our non-surgical treatment experience for infantile HET. Methods: We analyzed 15 infants (5 males, 10 females) of HET retrospectively, from January 1989 to December 2007. Results: All except 2 were full-term babies and median birth weight was 3,140 g. The median age at diagnosis was 15 days of life (0∼157 days). Three of 5 patients diagnosed prenatally presented heart failure symptoms and the remaining 2 showed KM SD. Among 6 neonates, 3 showed cyanosis due to congestive heart failure. Nine patients showed multiple nodules at both liver lobes. Three asymptomatic patients were followed with radiologic examinations, thus HETs regressed spontaneously in two and decreased in one. Four cases that showed hepatomegaly or increase in size of subcutaneous hemangioma, were treated with prednisolone. All patients improved from tumor related symptoms and tumor size decreased. Four patients (2 patients of heart failure, 1 with rapid progressive hepatomegaly and 1 with congenital heart disease) received interferon-α. Among them, 3 showed regression of tumor and the remaining 1 showed decrease of tumor size. Two patients who suffered from severe heart failure received prednisolone and interferon-α, and then recovered. In the 2 patients with KM SD, we tried hepatic artery embolization with medical treatment. One survived but the other is not followed after failure of embolization. Conclusion: We experienced that many patients who had clinical symptoms associated with HET very early in their life treated with an aggressive nonsurgical treatment in symptomatic patients showed favorable outcome.

        • KCI등재

          신생아기에 발견된 영아 섬유육종

          남소현(So-Hyun Nam), 조민정(Min-Jung Cho), 김대연(Dae-Yeon Kim), 김성철(Seong-Chul Kim), 김인구(In-Koo Kim) 대한외과학회 2010 Annals of Surgical Treatment and Research Vol.79 No.6

          Infantile fibrosarcoma is a rare malignant soft tissue tumor occurring especially in newborn and young children under 2 years. We experienced three cases of infantile fibrosarcoma presenting in the neonatal period. Case 1 presented with a multiseptated cystic mass on his left thigh at birth that was diagnosed as lymphangioma. After picibanil injection, we noted the size of the mass doubled and a solid lesion was prominent in the magnetic resonance image. Case 2 was found to have a reddish mass on his lower back mimicking hemangioma. Over 2 weeks, the mass grew rapidly with internal hemorrhaging. Case 3 was noted to have an encircling mass around the splenic flexure, which developed into congenital bowel obstruction. All of the tumors were resected completely, but microscopic resection margin was not clear in two patients. The two patients received adjuvant chemotherapy and all patients are well without evidence of recurrence.

        • KCI등재

          선천성 식도 협착증의 진단 및 치료

          남소현(So-Hyun Nam), 김대연(Dae-Yeon Kim), 김성철(Seong-Chul Kim), 김인구(In-Koo Kim) 대한외과학회 2009 Annals of Surgical Treatment and Research Vol.76 No.6

          Purpose: Congenital esophageal stenosis (CES) is a rare cause of esophageal narrowing due to intrinsic esophageal wall abnormalities such as tracheobronchial remnants (TBR), web, and fibromuscular dysplasia (FMD). It is sometimes associated with esophageal artesia (EA). Methods: The medical records of children, who underwent operation due to CES at the Asan Medical Center from Jan 1990 to Dec 2007, were retrospectively reviewed. Results: Among 12 patients (M:F=6:6), 9 patients had TBR and 3 had FMD. The median age of operation was 25 months (7 mo∼6 years). Four patients underwent operation for esophageal atresia at neonate, one underwent operation for duodenal atresia and one for ventricular septal defect. Recurrent vomiting or dysphagia was developed at weaning period or introduction of solid foods. The lesions of stenosis were low-esophagus in 11 and mid-esophagus in 1. Segmental resection of lesion and end-to-end anastomosis of esophagus were completed successfully by means of laparotomy in 9 and thoracotomy in 3 (left in 1, right in 2). One patient treated with ballooning at first, suffered from mediastinitis due to esophageal perforation. Postoperative complications were anastomosis leakage in 2 and lung abscess in 1. Esophageal ballooning for anastomosis stricture was performed in 2 patients and an esophageal stent was needed in 1 patient. All patients are relieved from dysphagia and able to eat solid food. Conclusion: CES is rare but should be considered for recurrent vomiting and dysphagia, especially for those who underwent operation for EA. Differential diagnosis from other causes such as gastro-esophageal reflux is essential and surgical treatment is treatment of choice.

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