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위전절제술 후 Kim 's Tie 부근 공장에 국소 재발한 위암환자 1예
배병구,서병조,유항종,강윤경,김진복,Bae Byung-Gu,Suh Byoung-Jo,Yu Hang-Jong,Kang Yun-Kyung,Kim Jin-Pok 대한위암학회 2005 대한위암학회지 Vol.5 No.1
위암은 국내에서 발생 빈도가 가장 높은 암으로서 근치적 절제술 및 확대 영역 림프절 절제술의 도입과 더불어 술후 보조 항암화학요법 및 면역요법 등의 이용으로 최근 치료성적의 향상을 보이고 있다. 그러나 수술적 치료를 포함한 치료법의 발전에도 불구하고 다양한 형태의 재발을 경험하게 되고, 대부분의 재발은 3년 이내에 일어난다. 재발양상으로는 크게 국소재발, 원격재발, 복막재발 등이 있으며, 여러 가지 재발양상이 한꺼번에 보이는 경우도 있다. 이 중 국소재발의 호발 부위로는 림프절($48\%$), 문합부($32\%$, 잔존 위($20\%$)의 순으로 보고되고 있다. 증례: 51세의 여자 환자로 1999년 10월 진행성 위암으로 근치적 위전절제술을 시행 받았고, 당시 병기는 T3N1M0(IIIa,AJCC 1997)이었다. 수술 후 10회의 보조적 정맥 주사용 항암화학요법 및 경구용 항암화학요법을 2년간 실시하였고, 외래를 통한 추적검사상 약 5년간 재발을 보이지 않았으나 2004년 9월 시행한 내시경상 Kim's tie 부근공장에서 궤양성 병변을 발견하고 조직검사를 시행, 병리학적으로 낮은 분화도를 보이는 인환 세포암종 형태의 위선암 재발로 진단하고 수술을 시행하였다. 수술 방법은 Kim's tie 위치를 포함해 근위부 6.5 cm, 원위부 4 cm의 절제연을 두고 공장부분 절제술을 시행하였다. 수술 당시 다른 복부장기로 전이는 없었으며 전이성 복수도 없었다. 수술 후 별다른 합병증 없이 회복하였으며 보조 항암화학요법 제제로써 TS-1을 사용하며 외래 통한 추적검사 중이다. Despite improvements in the surgical treatment of gastric adenocarcinomas, the recurrence rates remain high in patients with advanced-stage disease. Most of the recurrence occurs within 3 years of the surgical resection, and nearly $90\%$ of the patients with recurrence die within 2 years of the diagnosis of recurrence. A recent study analyzed recurrence patterns for patients who had undergone a potentially curative gastrectomy. For those patients, $33\%$ of the recurrences involved locoregional sites, $44\%$ the peritoneum, and $38\%$ distant sites. A 51-year-old female patient was diagnosed with stomach cancer and underwent a total gastrectomy with D2 lymph node dissection during Oct. 1999. The pathologic report indicated a T3N1M0 tumor. We performed immunochemotherapy for 2 years with regular follow up. A gastrofiberscopic examination done during sep. 2004, cancer recurrence was found at the Kim's tie site of the jejunual loop. We did an abdominal exploration and a segmental resection of cancer site with pathologically negative resection margins. After the operation, we started secondary chemotherapy with TS-1.
豫防的 抗生劑의 適正한 投與期間을 決定하기 위한 臨床硏究 : To determine the adequate duration of administration
金善會,金相遵,金鎭福 대한화학요법학회 1983 대한화학요법학회지 Vol.1 No.2
A prospective, randomized, comparatiTie clinical study was performed to determine the adeqnatR duration of administration of prophylactic antibiotics in presenting septic complications after electim clean-contaminated operation including gastro-duodenal and biliary tract surgery. The patients were stratified into three clinical arms Group A(l day administration; 11.=66), Group B (3 d a s n=713 and Group C(5-7 days; %=fig). Each group mas stratified into two subgroups by the antibiotics instituted; Snbgroup I (cefazolin) and Subgroap I[ (penicillln-Gigenta.micin). The each group of paj5ent-S were similar in regard to age, sex, weight, duration of operation, preoperative hospital day and distribution of disease and operation. The overall incidence of infection in the study was 7.3%. There was no evidence of infection otber than wound infection. The infection rate of Group A was 4.5%, Group B 8.596, Group C 8.7%. No significant difference was observed among three groups (~30.3). No statistically sigI;idic+t diffexnce was fomd between cefazolin done (6- 7%) and penicillin plus gentamicin (7.9%) in the mte of infection. Our study revealed that there was no need for continuing antibiotic prophylaxis beyond the day of operation for the clean-contaminated surgery.
대장 및 직장수술에서 패혈증 예방을 위한 Metronidazol 과 Gentamicin 비경구 병합투여의 효과에 대한 연구
김상준,김진복 대한화학요법학회 1984 대한화학요법학회지 Vol.2 No.1
The infectious complicitions after the electhe colorectal surgery are mainly caused by anaerobic organisms from the intestine. The importance of perioperative a-ntibiodc priphylaxis has been' recognized recen시y. ' We performed a study to know the eUects of a two-dose infusion regimen of metronidazob together with gentwniciri in thk prevention of 'sepsis in elective colorectal surgery bring the Seribd betweezi Sept. 1982 and Mar. 1984. 500mg of intravenous metronidazole' was administered at the he of induction of 'anesthesia and at 12 .hours after the first dose and 60mg of gentamicin intamuscularly at the time of induction of anesthesia, at 8 hours and 16 hours after the first dose. Wound- infections developed in 3 out of 37@. 1%) patients. Anaerobic infe~tions did not develop in aiy of metronidazole plus Zentamick treated patients. This stnay reveals that intravenous metronidazde together with gentamkin has prophylactic effect on reducing the infectious co&pIications ,after elective colorectal surgery: