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          궤양성 대장염 환자에서 시행되는 회장낭 수술에 대한 이견

          유창식 대한대장항문학회 2009 Annals of Coloproctolgy Vol.25 No.3

          Restorative proctocolectomy (RPC) has become a standard procedure over 30 yr in patients with ulcerative colitis and familial adenomatous polyposis. However, there are several controversies in surgical method and strategy. From oncological point of view, mucosal proctectomy and hand-sewn ileal pouch anal anastomosis has advantage because of relatively complete removal of columnar epithelium. However, long-term follow-up results after stapled anastomosis revealed extremely low incidence of dysplasia in the anal transitional zone (ATZ). Furthermore, recent publication of 26 cancer occurrence after RPC showed more prevalence in mucosectomy group. Risk factors of dysplasia after RPC are supervening cancer or dysplasia on the proximal colon, long duration of symptom, and history of primary sclerosing cholangitis. Preservation of ATZ by stapled anastomosis may have functional superiority, which is supported by some manometric and functional studies. However, two randomized controlled trials showed no difference between the groups. Although there are some surgeons who advocate one stage RPC, majority of centers prefer two stage RPC with ileostomy. According to meta-analysis one stage RPC revealed 2-3 times frequent anastomotic leakage or pelvic sepsis. Five to ten percent of ulcerative colitis has some pathologic characteristics of Crohn’s disease, which is classified as indeterminate colitis (IC). Long-term results of RPC in patients with IC revealed similar results with ulcerative colitis and superior to Crohn’s disease. So RPC may be justified in patients with IC. Conclusively, RPC should be tailored according to clinicopathologic details and operative findings. Restorative proctocolectomy (RPC) has become a standard procedure over 30 yr in patients with ulcerative colitis and familial adenomatous polyposis. However, there are several controversies in surgical method and strategy. From oncological point of view, mucosal proctectomy and hand-sewn ileal pouch anal anastomosis has advantage because of relatively complete removal of columnar epithelium. However, long-term follow-up results after stapled anastomosis revealed extremely low incidence of dysplasia in the anal transitional zone (ATZ). Furthermore, recent publication of 26 cancer occurrence after RPC showed more prevalence in mucosectomy group. Risk factors of dysplasia after RPC are supervening cancer or dysplasia on the proximal colon, long duration of symptom, and history of primary sclerosing cholangitis. Preservation of ATZ by stapled anastomosis may have functional superiority, which is supported by some manometric and functional studies. However, two randomized controlled trials showed no difference between the groups. Although there are some surgeons who advocate one stage RPC, majority of centers prefer two stage RPC with ileostomy. According to meta-analysis one stage RPC revealed 2-3 times frequent anastomotic leakage or pelvic sepsis. Five to ten percent of ulcerative colitis has some pathologic characteristics of Crohn’s disease, which is classified as indeterminate colitis (IC). Long-term results of RPC in patients with IC revealed similar results with ulcerative colitis and superior to Crohn’s disease. So RPC may be justified in patients with IC. Conclusively, RPC should be tailored according to clinicopathologic details and operative findings.

        • SCOPUSKCI등재
        • SCOPUSKCI등재
        • KCI등재

          폐쇄성 좌측 대장암에서 스텐트 삽입 후 단단계 복강경 대장 절제술의 단기 예후: 비폐쇄성 좌측 대장암의 복강경 대장 절제술군과의 비교

          김현실,김성근,안창혁,강원경,이윤석,이인규,김형진,이상철,조현민,박종경,오승택,김준기 대한대장항문학회 2009 Annals of Coloproctolgy Vol.25 No.6

          Purpose: Laparoscopic surgery has been considered to be contraindicated for treating malignant colorectal obstruction. Stent insertion for obstructive colorectal cancer has recently allowed laparoscopic surgery to be performed by means of preoperative bowel decompression and bowel preparation. The aim of this study is to evaluate the safety and the feasibility of a one-stage laparoscopic resection for obstructive left-sided colon cancer after stent insertion by comparing the results to those for nonobstructive left-sided colon cancer. Methods: Between May 2006 and January 2009, a laparoscopic colorectal operation was performed on 18 consecutive patients with obstructive left-sided colon cancer after placement of a self-expandable stent by one colorectal surgeon, and the results were compared retrospectively to those for 43 patients with non-obstructive left-sided colon cancer who had undergone a laparoscopic procedure with the same surgeon. The collected data were the clinicopathologic characteristics, the perioperative complications, the oncologic outcomes, the postoperative recovery results, and the survival rate. Results: The obstructive left-sided colon cancer group had significant benefits in retrieved lymph nodes (18.8±5.3 vs. 14.0± 8.7, P=0.036), and distal resection margin (5.5±3.0 cm vs. 3.6±2.4 cm, P=0.011). There were no significant differences in other clinicopathological characteristics and oncologic outcomes, including the overall 3-yr survival rate, between the two groups. Conclusion: Preoperative stent decompression followed by a laparoscopic colorectal resection is a safe and feasible option for treating obstructive left-sided colon cancer. A further large-scale prospective study should be performed to evaluate the long-term outcome of a one-stage laparoscopic resection using stent insertion in cases of obstructive left-sided colon cancer. Purpose: Laparoscopic surgery has been considered to be contraindicated for treating malignant colorectal obstruction. Stent insertion for obstructive colorectal cancer has recently allowed laparoscopic surgery to be performed by means of preoperative bowel decompression and bowel preparation. The aim of this study is to evaluate the safety and the feasibility of a one-stage laparoscopic resection for obstructive left-sided colon cancer after stent insertion by comparing the results to those for nonobstructive left-sided colon cancer. Methods: Between May 2006 and January 2009, a laparoscopic colorectal operation was performed on 18 consecutive patients with obstructive left-sided colon cancer after placement of a self-expandable stent by one colorectal surgeon, and the results were compared retrospectively to those for 43 patients with non-obstructive left-sided colon cancer who had undergone a laparoscopic procedure with the same surgeon. The collected data were the clinicopathologic characteristics, the perioperative complications, the oncologic outcomes, the postoperative recovery results, and the survival rate. Results: The obstructive left-sided colon cancer group had significant benefits in retrieved lymph nodes (18.8±5.3 vs. 14.0± 8.7, P=0.036), and distal resection margin (5.5±3.0 cm vs. 3.6±2.4 cm, P=0.011). There were no significant differences in other clinicopathological characteristics and oncologic outcomes, including the overall 3-yr survival rate, between the two groups. Conclusion: Preoperative stent decompression followed by a laparoscopic colorectal resection is a safe and feasible option for treating obstructive left-sided colon cancer. A further large-scale prospective study should be performed to evaluate the long-term outcome of a one-stage laparoscopic resection using stent insertion in cases of obstructive left-sided colon cancer.

        • SCOPUSKCI등재
        • KCI등재

          다발성 대장암의 치료

          백옥주,오승엽,서광욱 대한대장항문학회 2009 Annals of Coloproctolgy Vol.25 No.1

          Purpose: The detection of synchronous and metachronous colon cancer is important for the surgical treatment. The aim of this study is to review the clinicopathological characteristics of multiple colon cancers. Methods: A retrospective analysis was performed with 43 patients with multiple colon cancers who underwent surgical treatment from June 1996 to May 2008. Patients with familial adenomatous polyposis and cancer from inflammatory bowel disease were excluded. Results: There were 43 cases of multiple colon cancers. Synchronous colon cancers were present in 30 patients and metachronous colon cancers were present in 18 patients. The mean age was 61.33±11.44, and the male-to-female ratio was 23:20. The index cancer and the second cancers in synchronous colon cancers, as well as the first colon cancer in metachronous colon cancers showed, significantly more distal tumor locations. However, the second cancers in metachronous colon cancers showed no significant differences in tumor location. As for stage, a more advanced stage was noted in the index cancer than in the second cancers in synchronous cancer. However, an early stage was noted for the first colon cancer in metachronous cancers. Seventeen patients with synchronous cancer and 14 patients with metachronous colon cancer underwent a total or a subtotal colectomy. Conclusion: Detection of synchronous colon cancer was important for deciding the extent of surgical resection. Patients with colon cancer should be considered for frequent colonoscopy follow-up for early detection of metachronous colon cancer. Purpose: The detection of synchronous and metachronous colon cancer is important for the surgical treatment. The aim of this study is to review the clinicopathological characteristics of multiple colon cancers. Methods: A retrospective analysis was performed with 43 patients with multiple colon cancers who underwent surgical treatment from June 1996 to May 2008. Patients with familial adenomatous polyposis and cancer from inflammatory bowel disease were excluded. Results: There were 43 cases of multiple colon cancers. Synchronous colon cancers were present in 30 patients and metachronous colon cancers were present in 18 patients. The mean age was 61.33±11.44, and the male-to-female ratio was 23:20. The index cancer and the second cancers in synchronous colon cancers, as well as the first colon cancer in metachronous colon cancers showed, significantly more distal tumor locations. However, the second cancers in metachronous colon cancers showed no significant differences in tumor location. As for stage, a more advanced stage was noted in the index cancer than in the second cancers in synchronous cancer. However, an early stage was noted for the first colon cancer in metachronous cancers. Seventeen patients with synchronous cancer and 14 patients with metachronous colon cancer underwent a total or a subtotal colectomy. Conclusion: Detection of synchronous colon cancer was important for deciding the extent of surgical resection. Patients with colon cancer should be considered for frequent colonoscopy follow-up for early detection of metachronous colon cancer.

        • SCOPUSKCI등재
        • KCI등재후보

          CEA Expressions in Colorectal Tumor

          배옥석,이태순,박성대 대한대장항문학회 2004 Annals of Coloproctolgy Vol.20 No.1

          Purpose: The purpose of this research is to investigate the clinical usefulness of carcinoembryonic antigen (CEA) expression in colorectal cancer tissue. Methods: We performed immunohistochemical staining of CEA on 64 surgically resected colorectal cancer tissues obtained during the period from May 2000 to May 2001. CEA expression was detected by immunohistochemistry using a CEA monoclonal antibody. The degrees of CEA expression in the tumor cell cytoplasm and the luminal secretion of the tumor gland were grouped into positive (strongly positive) and negative groups (weakly positive) by using the Sinicrobe method and were compared with clinicopathological variables. Results: The expression rates were positive in 38 cases (59.4%) and negative in 26 cases (40.6%). The preoperative CEA level showed a higher trend in the positive group (8.23±13.7) than it did in the negative group (17.89±38.7 ng/ml), but the difference was not statistically significant. The relationships between the CEA expressions of the two groups and the clinicopathologic factors were not statistically significant. We observed CEA expression in the luminal secretion of the tumor gland in 41 cases. The expression rates in the luminal secretion were positive in 21 cases (51.2%) and negative in 20 cases (48.8%). No significant clinical difference were noted between the two groups. Conclusions: The results suggest that CEA expression may not play a role as a prognostic factor for colorectal cancer. 대장암에서 CEA의 발현 계명대학교 의과대학 외과학교실 대장항문 분과 배옥석․이태순․박성대 목적: 종양조직내의 CEA 발현의 정도가 환자의 예후예측을 위한 탐지자로서의 가능성 유무를 확인하고자 본 연구를 시작하였다. 대상 및 방법: 2000년 5월부터 2001년 5월까지 계명대학교 동산의료원 대장항문과에서 결직장암으로 수술한 환자에서 획득한 암조직 64예를 CEA항체를 이용하여 면역조직화학염색을 시행하여 암세포와, 관강 내 분비물의 발현양상을 양성 음성으로 구분후 각 환자들의 술 전 혈청 CEA치, 병기와 혈관 침범유무, 술 후 2년 내 암재발과의 관계를 분석하였다. 결과: 64예의 암조직의 발현은 양성 26예, 음성 38예였으며 술전 말초혈액 CEA치와 비교에서 음성과 양성은 각각 8.23±13.7, 17.89±38.7 ng/ml로 양성군에 증가하였으나 통계적 유의성은 없었으며 병기, 혈관침범유무, 재발 등과의 비교에서도 유의한 차이는 없었다. 관강 내 분비물의 발현에서도 임상적인 조건들과의 유의한 관계가 없었다. 결론: 대장암에서 CEA의 발현은 예후인자와의 상관관계를 확인할 수 없어서 환자의 예후예측을 위한 탐지자로서의 임상적 의의가 없는 것으로 사료된다.

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