소장암에 관한 임상적 고찰

최홍교,박영관 계명대학교 醫科大學 外科學敎室同門會 1990 남경 박영관 교수 정년퇴임기념 논문집 Vol.S No.-

Clinicopathologic data on 14 patients with 12 primary malignant tumors and 2 benign tumors of small intestine covering ten year period from March, 1972 to March, 1982, at the Department of Surgery of Keimyung University Medica1 College and Hospita1 are presented and the literature is reviewed. Ma1es outnumbered fema1es by about 1. 8 to 1 (nine ma1es and 5 fema1es) with an age range 5-70 years. Adeno Ca. accounted for 5 cases of which 1 10cated in the duodenum and 3 in the jejunum and 1 in the ileum, and in one case, adeno Ca. is 10cated both duodenum and jejunum. And 1eiomyosarcoma formed 7 cases of which 3 in the jejunum and 4 in the ileum. The clinica1 manifestations caused by small bowe1 tumors in the 14 casts were abdomina1pain(12 cases) , pa1pab1e mass(8 cases) , vomiting(6 cases) , bowe1 dysfunction such as diarrhea or constipation (4 cases) , weight 10ss (4 cases) , abdominal distension (4 cases) , anorexia, indigestion(3 cases) , melena &/or Hematemesis (2 cases). The initial symptom was abdominal pain in 12 cases and the abdomina1 mass was palpated about one to 36 months after the onset of initial symptom. The duration of symptoms before seeking our hospita1 for operation varied between one to 36 months with the average duration of 8.2 months and 6 patients were admitted about 1 to 3 months after the onset of initia1 symptom. 10 cases out of 14 showed metastatic invasion or spread to surrounding 1ymphnodes and organs at laparatomy. We cou1d establish correct diagnosis by gastroduodenoscopy preoperative1y in on1y 1 case in 14.

先天性 小腸閉鎖症

安干燮,朴永寬 계명대학교 醫科大學 外科學敎室同門會 1990 남경 박영관 교수 정년퇴임기념 논문집 Vol.S No.-

Intestinal obstruction are the most common surgical emergencies encountered in newborn infants. These defects of gastrointestinal tract result from a variety of embryonic anomalies, intrauterine accidents and functional abnormalities. Vomiting, abdominal distension and the failure to pass a normal meconium stool are symptoms which the various forms of gastrointestinal tract obstructions have in common. Vomiting results in rapid dehydration and loss of electrolytes. In addition, aspiration, of the vomitus threatens these weakened infants with chemical and bacterial pneumonitis. Abdominal distension may be severe enough to elevate the diaphragm and further emb-arrass the child’ s respiration. The combination of distension with vascular insufficiency is often,a factor in either prenatal or postnatal intestinal perforation with peritonitis. These chains of events are reversible with early diagnosis, effective preparation management, skillful surgery and meticular postoperative care.

原發性 後腹膜腫瘍 48例에 對한 臨床的 考察

林榮根,郭再濚,朴永寬 계명대학교 醫科大學 外科學敎室同門會 1990 남경 박영관 교수 정년퇴임기념 논문집 Vol.S No.-

A clinical and statistical analysis was performed on 48 cases of primary retroperitoneal tumors which were experienced(at the dept. of surgery, presbyterian medical center, Taegu, Korea.) from January 1960 till June 1978. The results were as follows: 1) The age incidence of primary retroperitoneal tumors revealed prevalence under the age of ten and in the 5th decade. 2) In the majority of cases (77%), symptoms had been present for one year or less. 3) The common clinical manifestation at the time of admission in order of frequency was gastrointestinal symptoms in 77%, systemic manifestation in 46% and genitourinary symptoms in 27%. 4) The positive findings of physic-al examination were palpable abdominal mass in 92%, abdominal distension in 25% and abdominal tenderness in 13%. 5) There were 10 benign and 38 malignant tumors. The malignant lymphomas were most frequent in occurrence, while the teratomas were the most frequent tumors of benign histology. The ratio of malignant to benign tumors was 3.8: 1. 6) The clinical diagnosis of retroperitoneal tumors was made by analysis of the clinical symptoms, positive physical findings and special X-ray examinations, such as intravenous pyelography, small and large bowel series with fluoroscopy. 7) 28% of patients were treated with curative resection, others were treated with -biopsy or palliative resection with irradiation ect.

消化性 潰瘍穿孔에 對한 臨床的 考察

정승호,박영관 계명대학교 醫科大學 外科學敎室同門會 1990 남경 박영관 교수 정년퇴임기념 논문집 Vol.S No.-

A clinical study on 160 patients with peptic ulcer perforation who were admitted to the Depart. of Surgery, Keimyung University, Medical Co11ege and Hospital from Jan, 1975 to June, 1980 has been analized and summarized as the fo11ows. 1) The ratio of perforation between stomach and duodenum was 1: 12.3, as . 12 cases in stomach 148 cases in duodenum. 2) The sex distribution was predominant in males with contrast to females as a ratio of12.3 : 1, with 148 males and 12 females. 3) The age distribution was occurred in every age and the peak incidence of age was 5 th decade. 4) The seasonal distribution was predominant in Autumn and least in Winter. The monthly occurence was predominant in September. 5) The duration of characteristic peptic ulcer symptom priorto perforforation was most commonly had 1-3 yrs, in 35 cases(21. 9%). 6) The majority of the patients were diagnosed as peptic uler perforation preoperatively. 7) Analysis of physical findings on admission revealed the majority of the cases had whole abdominal tenderness (96.9%), abdominal rigidity (9 1. 9%), and decreased bowel sound (90.6%). 8) The interval between perforation and admission was within 24 hrs in the majority of the cases, as 44 cases within 12 hrs and 75 cases(46. 9%) with 13-24 hrs. 9) Demonstration of subphrenic free air on plain X-ray was revealed 102 cases. 10) The ratio of perforated site in stomach antrum, body, pylorus and first portion of the duodenum was 1.9%, 5.6%, 8.8% and 83.8% in order. 11) In the majority of the cases, 102 cases , the size of perforated orifices was less than 5mm in diameter. 12) In the peritoneal fluid culture, 37.8% was positive and E. coli was the most common organism. 13) As for operative procedure, bilateral trunkal vagotomy and partial gastrectomy was done in 93 cases (58. 1 %), bilateral trunkal vagotomy and pyloroplasty in 43 cases , primary closure in 12 cases, selective vagotomy and pyloroplasty in 3 cases( 1. 9%) and subtotal gastrectomy in 9 cases(5.6%). 14) The postoperative complications were noted 58 cases (36. 2%). And the commonest complication was wound infection, in 16 cases. 15) The postoperative mortality rate was 5.6% and the most common cause of death was sepsis, in 4 cases.

절제가능했던 유방암환자의 예후에 관한 비교

최승호,조원현,박영관 계명대학교 醫科大學 外科學敎室同門會 1990 남경 박영관 교수 정년퇴임기념 논문집 Vol.S No.-

The survival rates of 170 cases of breast cancer, which were underwent by various types of mastectomy at the department of surgery. Keimyung University. School of medicine from January 1980 through December 1986.were analysed according to various prognostic factors. In according to the age, the relative 7 year survival rates were 70%. 75.1%. 74.3%. 54.4% and 48. 2% at ages below 30, 31-40, 41-50, 51-60 and over 61 years, respectively. The 5 year survival rate of the group whose symptom duration were less than 1 month was 81.8% and that of more than 1 year group was 64.8% but 파lowed no constant relations between the survival and duration of symptom. In the group whose tumor size were less than 2 cm showed 89.4 % of 7 year survival rate but it drop야d to 73.1% and 46.2% in 2-5cm al념 over 5cm size groups respectively. More than 65% of the patients had their mass at the lateral half of the breast and their 5 year survival rate was 74.4% and it was comparable to the survival of the medially located group (68.4%). The patients without palpable axillary node had a better survival rate than the patients with palpable node (75.4% versus 47.8%). Among the axillary metastatic groups. less than 3 positive axillary nodes group had similar survival rates (84.0% at 7 year) of pathologically negative node group (82.4 % at 7 year) but more than 4 positive nodes group showed significant lower survival rates(less than 50% at 7 year). In the group whose axillary lymph node was not enlarged showed better survival compare with enlarged group even they had metastatic axillary nodes pathologically.

門脈壓 減壓에 있어서 脾靜脈과 下空靜脈의 端側吻合術에 關한 새로운 手術方法

鄭紀溶,姜信學,朴永寬,李鐵 계명대학교 醫科大學 外科學敎室同門會 1990 남경 박영관 교수 정년퇴임기념 논문집 Vol.S No.-

This article deals with a report of a case with cirrhosis of the liver accompanying portal hypertension and ruptured esophageal varices in which a new operative technic for portal decompression was successfully app1ied. The operative technic was described and other decompression procedures previously described were chlonogically reviewed and discussed in some aspects of the procedures already published.

手術後 癒着에 依한 腸閉塞症 140例 對한 臨床的 考察

金秉鎬,朴永寬 계명대학교 醫科大學 外科學敎室同門會 1990 남경 박영관 교수 정년퇴임기념 논문집 Vol.S No.-

The materials in this report were based on 140 cases of intestinal obstruction caused by postoperati ve adhesions which were treated in this surgical department at the Presbyterian Hospital during 12 years and 6 months from October 1, 1958 to March 31, 1971. 1) The majority of the patients ranged 30 to 39 years of age was 39 cases. The sex ratio two for men to one for women. 2) . The cardinal symptoms and signs were very similar to usual intestinal Obstruction expect past history of abdominal surgery. They were abdominal pain 피 77%(18 cases), vomiting in 58%(81 cases) and abdominal distension in 28% (39 cases). 3) The laboratory data were as folIowings: leukocytosis in 32% (45 cases), leukocytes within nor. mal limit in 45% (64 cases), increased segmented neutrophils in 53% (74 cases), hematocrit within normal limit in 45% (63 cases), increased urine specific gravity (over 1, 021) in 35% (49 cases). All of above data were within normal limits except neutrophil count and specific gravity of urine. 4) The diagnosis of intestinal obstruction caused by postoperative adhesions was reIatively easy by previous history of abdominal surgery, cardinal symptoms and signs of intestinal obstruction, and simple abdominal X-ray films. 5) Incidence of previous operations was classified as foIlowings freruency in order: appendectomy in 34.3% (48 cases). gynecological surgery in 19.2% (27 cases), surgery of small intestine in 18.7% (26 cases). Most of gynecological operations were hysterectomies which counted 8. 6% (12. cases). 6) Duration from precious operations to these illnesses were various. These illnesses developed with 30 days were 29(ca앓s (20%) and over 30 days were 111 cases (80%). The longest duration was over 30 years after apendectomy. 7) As for the methods of treatment: 34 cases were treateated by intubation of Miller-Abbott tube, 50 cases (35. 8%) by Iysis of adhesions. All cases using Miller-Abbott tube were 68 cases (49.3%), and none of them was recurrent intestinal obstruction cased by readhesions. Recurrent 12cases of surgical patients didn’ t use the Miller-Abbott tube. The majority of postoperative complications was wound infection in 12% (17 cases), and most of causative organisms were enteric bacilli in 9.2% (Escherichia coli in 5%). 9) The mortality was 7.1% (10 cases). Most of them were in over 60 years of age. 10) The incidence of intestinal obsturuction caused by postoperative adhesions was 34.3% (140 cases of 408 cases of intestinal obstruction).

간내 담석증 및 재발성 담석중에서의 Roux-en-Y식 담도공장 문합술의 임상적 고찰

이상엽,임태진,박영관 계명대학교 醫科大學 外科學敎室同門會 1990 남경 박영관 교수 정년퇴임기념 논문집 Vol.S No.-

This study is a clinical observation and review of 21 cases of patients with newly formed gall stones, recurrent or residual stones and intrahepatic stones, preoperatively or postopera-tively, seen in Department of Surgery, presbyterlan Medical Center, Keimyung Unlversity, Medical School, Taegu, Korea from January 1976 to December 1981. Total numbers of 21 cases were treated with Roux-en-Y Choledochojejunostomy(end-to end or side-to-end) and end-to-end hepaticojeojejunostomy. And then, following results w~re obtained; 1) 14.2% of all gall stone patients were found to be intrahepatic stone and recurrent or residual stones. 2) The ratio of female was 1:1.3 in 21 cases. 3) The most common age groups were 6th decades(42.9%). 4) There was a history of cholecystectomy and choledochotomy In 66.7% of 21 cases. 5) The shortest interval from previous operation was 1 month and the longest was 10 yrs. 6) The most common symptom and signs was right upper quadrant pain(71. 4%). 7) The most reliable laboratory finding was increasing of alkaline phosphotase(85.7%). 8) postoperativly, there was 4 complicated cases with wound .infection ane One is expired due to hepatorenal syndrome on post-operation 7th day.

담낭 및 간외담도의 악성종양

배옥석,임태진,박영관 계명대학교 醫科大學 外科學敎室同門會 1990 남경 박영관 교수 정년퇴임기념 논문집 Vol.S No.-

A clinical review was made of 65 cases of primary cancer of the extrahepatic tract and were treated surgically from January 1972 to December 1982 for 10 years department of general surgery. 1) There is a growing tendency of primary cancer of the biliary tract every year. 2) The mean age was 54 years, and it was most prevalent in the 6th decade. biliary m our 3) The male to female ratio was 1 :1.7 in gallbladder cancer and 1.9 : 1 in the extrahepatic bile duct cancer. 4) The prominant symptoms were pain . in R. U.Q. in gallbladder cancer, and jaundice in extrahepatic bile duct cancer. 5) The gallbladder should be opened and examined in the operating suite in every cholecystectomy and any suspicious lesion should be submitted for immediate histologic examination. 6) Gall stones were found in 17% of the patient with carcinoma of the gallbladder. 7) The most common histologic type was adenocarcinoma. 8) Operative mortality of biliary tract cancer was 3%. The causes of deathwere hemobilia and severe obstructive jaundice. Nineteen of thirty patients died within first six months. One patient of thirty survived. In the survivor, cancer was not noted during the operation and was diagnosed later by pathologic examination

혈액투석을 위한 내동정맥수술

조원현,박성대,박영관 계명대학교 醫科大學 外科學敎室同門會 1990 남경 박영관 교수 정년퇴임기념 논문집 Vol.S No.-

To obtain vascular access for hemodialysis, and to keep these vessels patent for a long time, is essential for the treatment of chronic renal failure. Since Brescia and Cimino used the arterialized forearm vein after arteriovenous fistula, several modifications have been made including a vascular substitute which can be used on the patient who has no more available vessels of their own. In order to make the fistula adequately and preserve it for a long time, several factors should be considered to minimize the early failure of the fistula. One hundred sixteen cases of arteriovenous fistula which were performed on the upper extremities of one hundred and six patients of chronic renal failure were reviewed and analyzed for their patency with regard to diabetes, immediate postfistula state, level of BUN, level of creatinine and preoperative systolic blood pressure. The fistula patency of the diabetic group was 69.2%, 46.2%, 30.8% and 23. 1% at the 3,6,9 and 12th month after creation of the fistula. But the fistula patency of the non-diabetic group was 94.0%, 92.0%, 82.0% and 80.0% during the same period of time. It can be seen that there are statistically significant differences between these two groups. Another group that showed a statistically significant difference at the 12 th month patency was the good immediate postfistula group at 82. 6% and the poor immediate postfistula group at 29.4%. The 3rd month fistula patency of the high systolic blood pressure group was 90.0% and it was much higher than that of the lower blood pressure group at 76.1%. It was observed that there were no significant differences between the patency and the level of BUN or serum creatinine.