소아 위저부주름술의 11년간 경험

김선태,이철구,김혜은,서정민,이석구,Kim, Seon-Tai,Lee, Cheol-Koo,Kim, Hea-Eun,Seo, Jeong-Meen,Lee, Suk-Koo 대한소아외과학회 2008 소아외과 Vol.14 No.1

Fundoplication is a common surgical procedure for gastroesophageal reflux disease (GERD). Recently the procedure has been performed with increased frequency laparoscopically. The aim of this study is to review our 11 years experience with fundoplication in infants and children. From October 1994 to December 2005, 59 fundoplications in 55 patients were performed at Sungkyunkwan University Samsung Medical Center. Medical records and laboratory results of these children were retrospectively reviewed for sex, age, symptoms and signs, coexisting disease, diagnostic methods, treatment modalities and length of operative time. Open fundoplication was performed in 41 cases and laparoscopic fundoplication in 18 cases. Simultaneous gastrostomy was done in 27 cases. Recurrent GERD symptom occurred in four patients (7.2 %) within 2 years after first fundoplication and all 4 patients had re-do fundoplication. There were no intra- and immediate post-operative complications. Gastrointesitnal symptoms were the most common indication for fundoplication in neurologically normal patients. The most frequent diagnostic studies were upper gastrointestinal series (76.3 %) and 24 hour esophageal pH monitoring (78.2 %). Fundoplication had been increased since 2004 and mostly done laparoscopically. In conclusion, our 11 years' practice of open and laparoscopic fundoplication indicates that both approaches are safe and effective in the treatment of GERD for infants and children.

소아 요막관 기형

강은영,이철구,박관현,서정민,이석구,Kang, Eun-Young,Lee, Cheol-Koo,Park, Kwan-Hyeon,Seo, Jeong-Meen,Lee, Suk-Koo 대한소아외과학회 2005 소아외과 Vol.11 No.2

Failure of the urachus to regress completely results in anomalies that may be classified as patent urachus, urachal sinus, urachal cyst and bladder diverticula. The presenting symptoms of children with urachal anomalies are variable and uniform guidelines for diagnosis and treatment are lacking. The purpose of this study was to analyze our experience and develop conclusions regarding the presentation, diagnosis and treatment of urachal anomalies. We retrospectively analyzed the records of 32 patients who were admitted for urachal anomalies from March 1995 to February 2005. The age distribution of these patients at presentation ranged from 1 day to 14 years old (median age 1 month). There were 20 boys and 12 girls. The 32 cases comprised 13 cases of urachal sinus (40.6 %), 10 urachal cyst (31.3 %), and 9 patent urchus (28.1 %). In 30 patients ultrasonography was used for diagnosis and 2 patients with patent urachus were explored without using a diagnostic method. Twenty-three patients were confirmed by ultrasonography alone and 7 patients were examined using additional modalities, namely, computed tomography for 2 patients with an urachal cyst, magnetic resonance imaging for 1 patient with an urachal cyst, and fistulography for 3 patients with an urachal sinus. The presenting symptoms were umbilical discharge (14 patients), umbilical granuloma (8), abdominal pain and fever (3), fever (3), abdominal pain (2), and a low abdominal mass (2). Excision was performed in 29 patients, and 3 patients were conservatively managed. Urachal anomalies in children most frequently presented in neonates, and the most common complaint was umbilical discharge with infection. Urachal anomalies can be diagnosed by a physical examination and an appropriate radiographic test. Ultrasound was the most useful diagnostic method. Complete surgical excision of an urachal anomaly is recommended to avoid recurrence, and the rare development of carcinoma.

소아 충수염의 복강경충수절제술 및 개복충수절제술의 비교

이세경,이철구,서정민,이석구,Lee, Se-Kyung,Lee, Cheol-Gu,Seo, Jeong-Meen,Lee, Suk-Koo 대한소아외과학회 2007 소아외과 Vol.13 No.1

Pediatric laparoscopic appendectomy is controversial particularly in complicated appendicitis. We evaluated the outcomes of laparoscopic appendectomy (LA) and open appendectomy (OA) in simple appendicitis and complicated appendicitis respectively. Since June 2004, initial LA has been our policy in all appendicitis including complicated ones. A total of 160 patients were included in this study, consisting of 80 OA (August 2001 - August 2003) and 80 LA (June 2004 - June 2006). We compared the operating time, the length of hospital stay, the length of antibiotics use, and the postoperative complications between LA and OA. In simple appendicitis (73), there were no differences between LA and OA. However in the 87 patients with complicated appendicitis, the operating time was longer in LA (64.8 min vs. 50.2 min) but the length of hospital stay was shorter in LA than OA (8.5 days vs. 9.6 days). There was one complication in simple appendicitis group and six in complicated appendicitis group (3 cases in LA, 3 cases in OA). There was no difference in the results of LA versus OA in simple appendicitis. Therefore for simple appendicitis, LA is recommended in consideration of the cosmetic effect (fewer scar). In complicated appendicitis, early discharge was an advantage and there were no differences in complications in LA despite a longer operative time. So we conclude LA can be considered as the first choice of treatment for all pediatric appendicitis including complicated appendicitis. To confirm our impressions, more well controlled randomized prospective studied need to be done.

간내 담도가 확장된 담관낭의 수술 후 간내 담도의 변화

정수민,김혜은,이철구,서정민,이석구,Jung, Soo-Min,Kim, Hea-Eun,Lee, Cheol-Koo,Seo, Jeong-Meen,Lee, Suk-Koo 대한소아외과학회 2009 소아외과 Vol.15 No.1

Choledochal cyst is a congenital dilatation of the bile duct. Intrahepatic bile duct dilatation of type IVa by Todani's classification at the time of diagnosis resolved spontaneously after cyst excision and hepaticojejunostomy in many cases. It should be distinguished from the true cystic dilatation of the intrahepatic ducts, which tends to persist, albeit after some regression. We therefore studied postoperative intrahepatic duct dilatation changes in choledochal cyst. A total of seventy-six choledochal cysts were managed at the Division of Pediatric Surgery, Department of Surgery, Samsung Medical Center from May 1995 to December 2005. The ratio of males to females was 1:2.8. Preoperative radiologic diagnosis by Todani's classification was Type I (n=52, 68.4 %), II (n=1, 1.3 %), IVa (n=23, 30.3 %). Among fifty-five patients with intrahepatic bile duct dilatation we were able to follow up forty-eight by ultrasonography. Twenty-two patients were type IVa, and twenty-six patients were type I and showed intrahepatic duct dilatation. Mean follow-up duration was 35.3 months (9~105 months). Complete regression of dilated intrahepatic duct was observed in fifteen patients of type IVa and twenty-four patients of type I. Incomplete regression of dilated intrahepatic duct was observed in six patients in type IVa and two patients in type I. Only one patient in type IVa showed no change in ductal dilatation during a follow-up period of 15 months. We conclude that true type IVa is much less frequent than what was diagnosed preoperatively by imaging study. Therefore in type IVa patients who are diagnosed preoperatively the decision to perform liver resection should be carefully considered. Postoperative long term follow up of choledochal cyst with intrahepatic bile duct dilation is needed.

소아에서 복막투석도관 삽입시 복강경을 이용한 방법과 기존의 수술법에 따른 초기 합병증 발생의 차이

정수인,이현영,이철구,서정민,이석구,김수진,곽민정,진동규,백경훈,Jeong, Soo-In,Lee, Hyun-Young,Lee, Cheol-Gu,Seo, Jeong-Meen,Lee, Suk-Koo,Kim, Su-Jin,Kwak, Min-Jung,Jin, Dong-Kyu,Paik, Kyung-Hoon 대한소아신장학회 2007 Childhood kidney diseases Vol.11 No.1

목적 : 복강경을 이용한 복막투석도관 삽입술은 직접 복강 내를 들여다보며 시술할 수 있어 위치 선정이 쉽고, 조직 손상이 적으며 합병증이 적다는 장점이 있으나, 소아에서의 경험은 많지 않다. 본 연구에서는 소아에서 복강경을 이용한 복막투석도관 삽입술의 유용성을 평가하고자 한다. 방법 : 2002년부터 2006년까지 삼성서울 병원에서 31명의 환아를 대상으로 복강경을 이용하여 복막투석도관 삽입술을 시행한 21례와 고식적 수술 방법으로 투석도관을 삽입한 16례의 의무기록을 바탕으로 복막투석관 삽입 후 첫 2개월간 투석도관의 누출, 폐쇄, 삽입 부위의 감염, 위치 이동 등 복막투석관 삽입과 관련된 합병증에 대해 후향적 분석을 시행하였다. 결과 : 고식적 수술을 받은 군(16례)에서 1례(6.3%)에서 수술 직후 심한 출혈로 재수술을 받았고, 복막액의 누출은 2례(12.5%) 있었으며, 보존적인 치료로 호전되었다. 삽입 부위 감염은 없었으나, 2례(12.5%)에서 복막염이 발생하였다. 투석도관의 이동으로 인한 기능부전이 3례 있었고 이중 2례에서 재수술을 받았으며, 1례는 보존적인 치료로 호전되었다. 복강경 수술을 받은 군(21례)에서 2례(9.5%)에서 투석액의 누출이 있었고, 보존적인 치료로 호전되었다. 삽입 부위의 감염은 없었고, 복막염이 2례(9.5%)에서 있었다. 1례에서 투석도관의 막힘이 있었고, 이 경우는 기존의 고식적 수술로 투석관 삽입 후 투석관 이동으로 재 삽입 후 불응성 복막염으로 투석관을 제거한 뒤 복강경 수술을 받은 증례였다. 투석도관의 이동은 없었다. 두 군의 합병증의 발생빈도는 통계적으로 유의한 차이는 없었다. 결론 : 본 연구에서 소아에서 복강경적 투석도관 삽입술을 시행한 경우, 1세 미만의 소아에서도 시술이 가능하였으며, 기존의 수술법에 비해 합병증이 증가하지 않았다. 또한 절개범위를 더 넓히지 않으면서도 장간막 절제 및 투석도관의 고정이 가능하여, 이를 통해 추후 투석도관의 이동이나 폐쇄의 위험요소를 줄일 수 있다는 장점이 있었다. 따라서 소아에서 복막투석도관 수술 시 복강경적 방법을 이용하는 것이 효율적인 복막 투석을 위해 유용하다고 생각된다. Purpose : To assess the early complication of laparoscopic peritoneal dialysis catheter implantation in children. Methods : Medical record review was carried out on 21 laparoscopic and 16 conventional peritoneal dialysis catheter implantations which were performed in 31 children under 18 years of age between 2002 and 2006. All medical records were retrospectively analyzed. The patients were followed until 2 months after catheter placement. Patient characteristics and catheterrelated complications, such as significant bleeding, leakage, obstruction, migration, insertion site infection and peritonitis during the first 60 days after implantation were recorded. Results : After conventional operation, dialysate leakage occurred in 2 of 16 cases and all cases improved after conservative management. In 1 case, significant bleeding occurred and re-operation was performed. Three cases of obstruction due to migration were reported, 2 cases underwent reoperation and 1 case improved without intervention. After laparoscopic surgery, outflow obstruction occurred in 1 out of 21 cases, which was caused by adhesion after several reinsertions of the catheter and recurrent peritonitis. No migration was noted after laparoscopic surgery. There was no significant difference in the complication rate between the two groups. Conclusion : Laparoscopic peritoneal dialysis catheter placement is feasible in children of all age groups, with at least equivalent functional results compared to conventional surgery. The additional advantage of laparoscopic catheter insertion is the option to identify and eliminate anatomical risk factors, such as intra-abdominal adhesions, and to perform partial omentectomy without additional incisions.

소아 췌장종양의 임상적 고찰

임라주,김해솔,김태석,이철구,서정민,이석구,Im, Ra-Joo,Kim, Hae-Sol,Kim, Tae-Seok,Lee, Cheol-Gu,Seo, Jeong-Meen,Lee, Suk-Koo 대한소아외과학회 2007 소아외과 Vol.13 No.2

Pancreatic tumors in children are very rare but have a better prognosis compared with that in adult. Pediatric pancreatic tumors are more often benign and easier to resect. To evaluate the characteristics and prognosis, the records of 13 patients who underwent pancreatic resection, from June 1997 to May 2005, at Samsung Medical Center were reviewed. The mean follow up period was 48 months. The male to female ratio was 1: 1.6. Mean age was 10.3 years. Signs and symptoms included abdominal pain (7), abdominal palpable mass (5), jaundice (1), hypoglycemic (1), and non-specific GI symptoms (4). The commonly used diagnostic tools were CT and abdominal sonography. In addition, MRI, ERCP, EEG, and hormone test were also done when indicated. Surgical procedures included distal pancreatectomy (5), pylorus preserving pancreaticoduodenectomy (4), tumor excision (3), and subtotal pancreatectomy (1). Locations of lesions in pancreas were head (4), tail (5), and body and tail (4). Postoperative complications developed in 3 cases; postoperative ileus (1), wound problem (1), and pancreatitis (1). The pathologic diagnosis included solid-pseudopapillary tumor (6), congenital simple cyst (1), pancreatic duplication cyst (1), serous oligocystic adenoma (1), mucinous cystadenocarcinoma (1), rhabdomyosarcoma (1), insulinoma (1), and pancreatoblastoma (1). Three cases received adjuvant chemotherapy and radiotherapy. Overall survival rate was 81 %. One patient with a mucinous cystadenocarcinoma died. In this study, pancreatic tumors in children were resectable in all patients and had good survival. Surgery of pancreatic tumors should be regarded as the gold standard of treatment and a good prognosis can be anticipated in most cases of benign and malignant tumors.

유전 및 육종 : 재래돼지를 이용한 IGF2 유전자의 연관불균형과 유전자발현양상에 대한 분석

이송란 ( Song Lan Li ),이소평 ( Xiao Ping Li ),최봉환 ( Bong Hwan Choi ),이철구 ( Cheol Koo Lee ),조병욱 ( Byung Wook Cho ),김종주 ( Jong Joo Kim ),김관석 ( Kwan Suk Kim ) 한국동물자원과학회 2009 한국축산학회지 Vol.51 No.1

Investigation of Single Nucleotide Polymorphisms in the Adipocyte Fatty-Acid Binding Protein (FABP4) Gene

Sang Wook Kim(김상욱),Ji Hye Jung(정지혜),Kwan Suk Kim(김관석),Cheol Koo Lee(이철구),Jong Joo Kim(김종주),Bong Hwan Choi(최봉한),Tae Hun Kim(김태헌),Ki Duk Song(송기덕),Byung Wook Cho(조병욱) 한국생명과학회 2007 생명과학회지 Vol.17 No.11

본 연구는 돼지 4번 염색체에서 FAT1 좌위의 후보유전자인 Adipocyte Fatty-Acid 결합단백질 (FABP4) 유전자에서 8개의 Single Nucleotide Polymorphisms (SNPs) 를 발견하였다. Duroc, Landrace, Berkshire, Yorkshire를 기초 축으로 이용한 800두에 대해 FABP4 유전자의 단일염기 분석과 PCR-RFLP를 이용하여 그 다형성을 조사하고 돼지의 일당증체량, 등지방두께, 사료요구율, 정육율과 그 유전자형 간의 연관성을 규명하고자 실시하였다. FABP4 유전자에 대해 각 단일염기에 관한 PCR-RFLP를 이용하여 400~800 bp 산물을 증폭한후 각각의 제한효소로 사용하여, 얻어진 FABP4 유전자의 빈도는 품종별로 다르게 나타났다. 통계적 분석을 통하여 각 유전자형에 대한 경제형질과 연관성을 분석한 결과 일당증체량, 등지방두께, 정육율, 사료요구량은 다른 유전자형을 가진 개체들이 유의적으로 우수한 능력을 보였다 (P<0.05). FABP4유전자는 일당증체량, 정육율, 등지방두께 에 높은 연관성이 있음을 관찰하였다. 따라서 돼지의 성장과 정육율에 관련된 선발력을 높이기 위해서 FABP4 유전자의 다형성 분석에서 검증된 PCR marker를 우량돼지육종 계획에 있어 분자생물학적 선발 marker로 사용할 수 있을 것으로 사료된다. We found 8 single nucleotide polymorphisms (SNPs) in adipocyte fatty acid bonding protein (FABP4) gene as candidate gene of FAT1 locus on pig chromosome 4. With over 800 heads of major commercial pig breeds including Duroc, Landrace, Berkshire and Yorkshire, we analyzed SNPs of FABP4 gene to determine possible effects of FABP4 genotype to economically important traits. 400~800 bp amplicons in FABP4 gene were used PCR-RFLP for each SNPs and we found that the frequency of some SNPs of this gene was different among the breeds. According to the statistical analyses to determine possible associations of each genotype with economic traits, it was found that subgroup with different genotypes showed significant differences in daily gain, backfat thickness, lean percentage and feed conversion ratio (P<0.05). Thus, as a part of enhancing the selection competence related to swine growth rate and lean percentage, it is expected that FABP4 gene markers verified in this study will be useful to use for Korean commercial pig industry.