胃癌患者에 施行한 胃全切除術에 對한 臨床的 考察

張一成,全秉九 충남대학교 의과대학 지역사회의학연구소 1985 충남의대잡지 Vol.12 No.2

Total gastrectomy is indicated in patients with gastric cancer when the malignant lesion can not be encompressed by subtotal gastectomy such as cancer of proximal portion of stomach and linitis plastica type. The goal of cancer surgery is complete resection of cancer with possible cancer cell bearing prelymphatic tissue, but it has been suggested recently that one of the most effecting factors influencing upon survival rate after resection is extensive removal of all areas of malignant involvement as well as regional lymph nodes. But undesirable sequelae such as leakage of anastomosis site, high operative mortality and postoperative malnutrition are real concern. We performed 22 total gastrectomy on the malignancy of the stomach at Department of Surgery, Chungnam National University College of Medicine during a year from August 1980 to July 1985. and analysed them. Following results were obtained: 1. Gastrectomy was performed in 180 patients (69.2%) and 22 patients(8.5%) of them were performed radical subtotal gastrcetomy and total gastrectomy respectively. 2. The highest age group was the 6th decade(40.9% and male to female ratio was 2.1:1. 3. The symptom were epigastric discomfort, indigestion, weight loss and nausea & vomiting. 4. The location of tumor mass was body & antrum of stomach 9 cases(40.9%), fundus of the stomach 5 cases(22.8%), Cardia of the stomach 4 cases(18.2)%, diffuse infiltration of gastric wall 2 cases(9. 0%) and multiple location of gastric cancer(9. 0%). 5. Extended total gastrectomy was carried out in 7 cases(31.8%), total gastrectomy in 22 cases, extended total gastrectomy with segmental resection of jejunum in 1 case(4. 6%). 6. Several methods of anastomosis were used to restore alimentary tract continuity as follows loop esophagojejunostomy(end-to-side) with Braun anastomosis in 12 cases(54.5%), Roux-en-Y esophagojejunostomy in 10 cases(45.5%). 7. Operative mortality was 4.6%. Cause of death was leakage of anastomosis site in 1 case, 10 major postoperative complications ocured in 9 cases: wound infection 3 cases(13.6%), leakage of anastomosis site in 2 cases(9.0%), ileus 1 case(4.6%), pleural effusion(4.6%), subphrenic abscess(4.6%), pneumonia(4.6%) and tractitis(4.6%). 8. One year and two year survival rate were 73.3% and 26. 7% respectively.

조기 위암의 임상적 고찰

장일성,김영일 충남대학교 의과대학 지역사회의학연구소 1990 충남의대잡지 Vol.17 No.2

This report is a clinical review of 50 cases of early gastric cancer that were treated and followed during 6 years from June. 1985 to June 1990. 1. The peak incidence age was 50 decade(38%), the mean age was 50 years, the ratio of male to female was 3:2. 2. The preoperative diagnostic rate was 52% by double conrast and 60% by endoscopy and biopsy. 3. The most common size of lesions was 1.1-2cm(32%) the smaller of lesion, the greater incidence of invasion rate to submucosa but no relation to lymph node matastasis rate. 4. The most common type of lesion was IIc(28%), the depressed type(III, IIb+c, IIc) was lymph node metastasis, but the elevated type and flat type was not lymph node matastasis. 5. The most common histological type was moderate differentiated and signet-ring cell types(32.5%) the most common type of metastatic rate was moderate differentiated type (30.7%), the badder of differentiated type, the greater incidence of metastatic rate to lymph node. 6. The common sites were lower third and lesser curvature(50%). The greater incidence of metastatic rate and invasion rate to submucosa the site of posterior wall was. 7. The rate of lymph node matastasis was 6.3% in mucosa, 26.4% in submucosa and 20% in total. 8. Follow up studies were possible in 45 cases, in these 1 case was died, 1 case was recurred but alive.

외과환자에 있어서 지방유제 "Intralipos"의 임상적 응용

장일성,장재구 충남대학교 의과대학 지역사회의학연구소 1985 충남의대잡지 Vol.12 No.2

An intravenous fat emulsion "intralipos" were given to 27 patients with surgical disease and following results were obtained. 1. Adverse effect by intravenous drip infusion of fat emulsions such as allergic symptoms, colloid shock, vascular pain or thrombophlebitis were not observed. 2. Hematologic, biochemistry change such as anemia, liver dysfunction and blood coagulation disturbance were not observed. These facts indicates that "intralipos" can be used safely in clinical patients.

Fibroadenoma에 대한 임상적 고찰

장일성,김지연,이희만 충남대학교 의과대학 지역사회의학연구소 1993 충남의대잡지 Vol.20 No.2

Fibroadenoma is the most common benign tumor of breast in human female between the age of 20 and 35 years. The great majority of patients should be treated by excisional biopsy to remove the tumor and establish the diagnosis. Authors have reviewed 110 case of fibroadenoma who underwent surgical operation during the period from Jaunary 1990 to Jaunary 1993 at the department of General Surgery in Chungnam National University Hospital. The circumareolar skin incision was selected if the tumor was compatible with benign fibroadenoma on the finding of preoperative mammogram and sonogram. But, the diagnosis was uncertain and the distance from the mass to nipple was over 3 cm, the skin incision was made on the just above the palpable mass. In order to minimize the seroma, hemostasis was taken completely, the use of electrocautery was restricted as possible, a close suction drain was kept to surgical dead space via the main wound by vaccum tube in case of leaving large dead space, and compressive dressing was applied on the defected wound site after the operation. The major complication after the excision of suspicious fibroadenoma was seroma, and its complication rate was about 8% (9/110 cases). But, another complication was not found. The rate of discharge at the first postoperative day was calculated to 73.2 % among the total patients and the remaining of all patients could be discharged at the second postoperative day. In conclusion, the young female who was under suspicion of fibroadenoma must be treated with excision and the excised specimen should undergo histologic examination to rule out carcinoma or to confirm the diagnosis. The associated major complications were revealed to minimal.

여성형유방(Gynecomastia)에 대한 임상적 고찰

장일성,이희만,홍은표 충남대학교 의과대학 지역사회의학연구소 1994 충남의대잡지 Vol.21 No.2

A Clinical Study was made in 94 cases of the gynecomastia at the department of General Surgery. Chungnam National University Hospital from January, 1986 to August, 1994. The results were as follows : 1) The most frequent age group in gynecomastia was sixties, 27 cases(28.7 %). 2) The most common duration from symptom onset to the first visit was within 6 months, 73 cases (77.7%). 3) The breast masses were located at the left breast in 45 cases (47.9%), at the right breast in 35 cases (37.2%), and bilateral in 14 cases (14.9%). 4) The most prominent symptom was palpable mass in 62 cases (66.0%), followed by palpable mass and pain in 30 cases(31.9%), palpable mass and nipple discharge in 2 cases(2.1%). 5) The etiology of gynecomastia was as follows : Association with other systemic diseases in 25 cases(26.5%), pubertal gynecomastia in 20 cases(21.3%), senescent gynecomastia in 17 cases(18.1%), idiopathic gynecomastia in 19 cases(20.2%), drug related gynecomastia in 12 cases(12.8%), and chromosomal abnormality in one case(1.1%). 6) The results of laboratory test were as follows : Liver function test was performed in 67 cases(71.3%), ultrasonography of liver in 26 cases(27.6%), liver scan in 10 cases(10.6%), and hormonal assay in 13 cases(13.5%). The results of liver function test were reported as abnormal in 12 cases(12.8%), the results of ultrasonography as abnormal in 8 cases(8.6%), the results of liver scan as abnormal in one case(1.1%), and the resutls of hormonal assay as normal in all cases. 7) Excision was performed in 16 cases(17.0%), pathological diagnosis of all cases were gynecomastia and one case was gynecomastia with intraductal papillomatosis.

치핵에 대한 임상적 고찰

장일성 충남대학교 의과대학 지역사회의학연구소 1983 충남의대잡지 Vol.10 No.2

For centuries the human race has been plagued with a disease called "hemorrhoid", but a precise definition of hemorrhoid does not exist because exact nature of the condition is not completely understood. Moreover, there is no universal agreement as to the optimal management of hemorrhoids. A clinical analysis was made about 54 cases of the hemorrhoids, admitted at department of surgery, Chungnam National University Hospital, during the past 4 years and 9 months from Jan, 1979 to Sept, 1983. The following results were obtained. 1. The peak incidence was in the age group of 3rd and 4th decade(59.3%), and male outnumbered female by 2.4 : 1. 2. The most common symptom was bleeding(42.6%), and next prolapsed mass(24.1%), pain(9.3%). 3. The most common duration between onset and admission was 1-5 years(27.7%), but 10 cases(18.6%) was over 10 years. 4. Previous treatments were done in 12 cases(22.3%), and 9 cases(16.7%) were treated by unauthorized persons with severe sequeles. 5. The average number of piles were 2.7, and the most common type of hemorrhoid was mixed type(63.4%), and next external hemorrhoid (21.4%), then internal hemorrhoid(15.2%). The most predominent site was right poster portion(39.3%). 6. All the hemorrhoids were treated by closed hemorrhoidectomy with good results. 7. The postoperative complications were hemorrhage and stenosis, 1 case respectively.

일반외과 영역에서 Ticarcillin 효과에 대한 임상적 고찰

장일성,박인근,김종철 충남대학교 의과대학 지역사회의학연구소 1987 충남의대잡지 Vol.14 No.1

The clinical study for ticarcillin effect on prophylactic and therapeutic use has been perfomed in 53 patients in Department of Surgery .and the results as follows 1. In prophylactic use, the efficacy of the ticarcillin was 94%(33/35). 2. In therapeutic use, efficacy of theticarcillin was 89%(16/18). 3. There was no significant systemic or local complication after ticarcillin therapy. As shown above, ticarcillin was effective and safe for prophylactic and therapeutic use in surgical patients.

갑상선 항진증에 관한 외과적 치료의 임상적 연구

장일성,최길돈,하기정 충남대학교 의과대학 지역사회의학연구소 1987 충남의대잡지 Vol.14 No.2

A clinical study of hyperthyroidism was performed for 20 patient who received operation at the department of surgery of C. N. U. H. from March, 1973 to July, 1987. The results were as follows: 1) In clinical classification, 14 cases (80%) were diffuse toxic goiter and 6 cases (20%) were nodular toxic goiter. 2) Male to female ratio was 1 : 19 and the highest incidence in the 3rd decade. 3) Main symptoms and signs were, in the order of decreasing frequency, neck mass (95%), palpitation (85%), fatigability (80%), heat intolerance (75%), weight loss (65%), tremor (60%) headache (50%). 4) Pulse rate changed from 130 per minute preoperatively to 60 postoperatively. 5) Thyroid function test revealed high level above the normal in 16 (80%) and the mean value of T_3RI_4 4.06mg/ml, T_3RI_4 10.48mg/ml, free T_4 4.65/ug/dl, postoperatively all cases showed teuthyroid function. 6) Electro-cardiographic findings were sinus tachycardia 9 cases (45%), normal 6 cases (30%). sinus bradycardia 5 cases (25%). 7) In preoperative preparation, Lugol solution was more frequently used 8 cases (40%) and others prophylthiouracil plus lugol solution 4 cases (20%), Inderal plus lugol solution 4 cases (20%) Methimazole plus lugol solution 2 cases (10%), prophylthiouracil plus Inderal plus comthyroid plus lugol solution 2 cases (10%). Average mean duration of preoperative preparation was 12.8 days. 8) The types of operation were in the order of decreasing frequency near total thyroidectomy 9 cases (45%), subtotal thyroidectomy 6 cases (30%), Lobectomy 4 cases (20%) and total thyroide ctomy 1 case (5%), 9) Early postoperative complication were transient tremor 3 cases (15%) transient hoarseness 1 case (5%), hypothyroidism 1 case (5%), recurrent hyperthyrodism 1 case (53%), hypoparathyroidism l. case (53%) but there was no case of operative motality.

胃·十二指腸의 消化性潰瘍에 對한 臨床的 比較考察

張一成 충남대학교 의과대학 지역사회의학연구소 1977 충남의대잡지 Vol.4 No.2

A conparative clinical study on 106 cases of surgical patients with gastric and duodenal ulcer who were admitted to the department of surgery of Chungnam National University Hospital April 1973 to March 1977 was presented. The results were as follows: 1. The ratio of gastric and duodenal ulcer was 1.3 : 1, with 59 gastric and 47 duodenal ulcer. 2. Bleeding was the most common complication in gastric ulcer (38.9%), and perforation in duodenal ulcer (63.8%). 3. The Sex distribution assumed a ratio of 6.4 : 1, with 51 males and 8 females in gastric ulcer and 5.7 : 1, with 40 males and 7 females in duodenal ulcer. 4. The peak of age incidence was 4th decade in both gastric and duodenal ulcer, but duodenal ulcer was more common than gastric ulcer in the age group below 3rd decade. except neonates, with a ratio of 1 : 3, but gastric ulcer was more common in the group over 6th decade, with a ratio of 2 : 1. 5. There was no significant difference in the seasonal distribution in both gastric and duodenal ulcer. 6. The duration of symptoms showed 2-5 years in the majority of both gastric and duodenal ulcer, and 23 cases(38.9%) of gastric ulcer and 22 cases(46.8%) of duodenal ulcer had not ulcer history. 7. Alcoholism is the most common disorder associated with both gastric and duodenal ulcer. 8. In blood group, B and 0 type(32. 6% respectively) were the most common in gastric ulcer, and B type (31.5%) in duodenal ulcer. 9. There was no significant difference in gastric acidity between the gastric and duodenal ulcer. 10. The subdiaphragmatic free air was seen in the 94% of gastric perforation and 86.6% of the duodenal perforation. 11. In operative procedures except simple closure, subtotal gastrectouiy was the most common procedure in gastric ulcer(82.5%), but vagotomy with partial gastrectomy(such as antrectomy or hemigastrectomy), or with pyloroplasty(76.7%) in duodenal ulcer. 12. Secondary operation after simple closure due to recurrent ulcer, was done in 3 cases (21.4%) of gastric ulcer and 1 case(10.5%) of duodenal ulcer, this means more recurre. nce in gastric ulcer than duodenal ulcer, with a ratio of 3 : 1, after simple closure. 13. The postoperative complications were noted in 13 cases (22%) of gastric ulcer and in 13 cases (27.6%) of duodenal ulcer and pulmonary complications such as atelectasis, effusion and pneumonia, and wound infection were common in both perforated ulcers. 14. The postoperative deaths were 6 cases (10.1%) in gastric ulcer and 1 case (2.1%) in duodenal ulcer and causes of deaths were septicemia(3). bleeding(1), hepatic coma(1), renal failure(1), heart failure (1).

유암에 대한 임상적 연구

장일성 충남대학교 의과대학 지역사회의학연구소 1984 충남의대잡지 Vol.11 No.2

This is clinical analysis and review of 34 cases of breast cancer patients which treated at this department of Chungnam National University Hospital during 5 years from July, 1979 to June, 1984. 1) Most cases of breast cancer were female (97.6%), high incidence of age group was between 40 and 59 years old. 2) All cases were complaint of breast mass, the most frequent period of interval between symptom and arrival to hospital was within 3 months (18 case, 52.9%). 3) Predominent group in size of mass was 2-5cm. in diameter (18 cases, 52.9%). 4) Left breast cancer was more frequent than right breast cancer (1. 2 : 1), and the highest incidence of site was upper outer quadrant (47%) 5) 20 cases (58.8%) had axillarv lymph node metastasis, most frequent group of number of metastatic lymph node was 1-3 (44.1%). 6) In T. N. M. classification: most frequent group was stage II (50%). 7) In pathologic classification: most breast cancer wvas infiltrating ductal cancer (94. 1%). 8) The most frequent method of operation was radical mastectomy (55. 9%). and then modified radical mastectomy (32.4%). 9) 12 cases (35.4%) was noted systemic metastasis. 10) The complication of operation were skin edge necrosis(29. 4%), seroma (26. 5%), arm edema (14.7%) and motion limitation (5.9%)