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김유석,김성수,민영돈,Kim, Yoo Seok,Kim, Sung Soo,Min, Young Don 대한위암학회 2008 대한위암학회지 Vol.8 No.2
목적: 최근 내시경 및 각종 영상진단 기술의 발달로 위암의 조기 발견 및 수술 전 병기의 진단율이 높아지고 있으나 여전히 초진 시 진행 위암 상태로 진단되는 경우가 많고 개복 수술 후 병리조직 검사에서 4기 위암으로 진단이 되는 경우도 있다. 4기 위암은 예후가 극히 불량하지만 임상 분석을 통해 적극적인 치료 효과에 대한 의의를 찾아 보고자 본 연구를 시행하였다. 대상 및 방법: 1994년 1월부터 2006년 12월까지 위암으로 진단되어 개복수술을 받은 1,376명의 환자들 중 4기 위암으로 진단된 150명의 환자를 대상으로 후향적 연구를 시행하였다. 결과: 개복술을 시행 받은 4기 위암환자 150명의 평균 나이는 57.8세(28~93세)였으며 이 중 남자가 104명, 여자가 46명이었다. 119명은 위아전절제술 또는 위전절제술을 시행하였으며 31명은 절제 불가하였다. 절제술을 시행한 환자의 생존기간은 평균 722일(14일~4,559일)로 그렇지 않은 환자의 173일(16일~374일)과 통계적으로 유의한 차이를 보였다. 위절제술을 시행한 4기 위암 환자를 TNM 병기로 세분하였을 때 T4 환자들은 33명으로 평균 생존일은 534일(17일~3,378일)이었으며, N3 환자들은 63명으로 평균 생존일은 521일(14일~4,190일)이었으나 통계적 의미는 없었다. 항암화학요법을 시행한 환자는 98명이었고 52명에 대해서는 항암화학요법을 시행하지 않았으며 생존기간은 각각 792일, 243일로 통계적으로 의미 있는 차이를 보였다. 결론: 4기 위암에 대해서도 원격 장기 전이의 증거가 없는 한 확대 림프절제술을 포함한 근치적 위절제술과 항암화학요법 등 적극적인 치료를 시도함으로써 생존율의 향상을 기대할 수 있다. Purpose: The early detection of gastric cancer and accuracy of preoperative staging has currently been on the increase due to the development of endoscopy and imaging techniques, but there are still many cases of advanced gastric cancer detected at the first diagnosis and there are also many cases of stage IV gastric cancer diagnosed after a postoperative pathological examination. Although the prognosis of stage IV gastric cancer is very poor, this study was performed to determine the value of the use of aggressive treatment determined after a clinical analysis. Materials and Methods: We retrospectively analyzed 150 patients that were diagnosed with stage IV gastric cancer among 1376 patients who underwent a laparotomy for gastric cancer from January 1994 to December 2006. Results: Of the 150 patients with stage IV gastric cancer who underwent a laparotomy, there were 104 men and 46 women. The mean patient age was 57.8 years (age range, 28~93 years). A subtotal gastrectomy or total gastrectomy was performed in 119 patients and 31 patients underwent an explorative laparotomy. The mean survival time of patients that underwent a gastrectomy and patients that did not undergo a gastrectomy was 722 days (range, 14~4,559 days) and 173 days (range, 16~374 days), respectively this result was statistically significant. When patients that underwent a gastrectomy were classified according to the TNM stage, the mean survival time of 33 patients with stage T4 disease was 534 days (range, 17~3,378 days) and the mean survival time of 63 patients with stage N3 disease was 521 days (range, 14~4,190 days), but there was no statistical significance. Chemotherapy was administered to 98 patients and 52 patients did not receive chemotherapy. The mean survival time of patients that received chemotherapy was 792 days (range, 36~4,559 days) and the mean survival time of patients that did not receive chemotherapy was 243 days (range, 14~2,413 days), with statistical significance. Conclusion: If there is no evidence of distant metastasis in stage IV gastric cancer, one can expect improvement of the survival rate by the use of aggressive treatment, including curative gastric resection with radical lymph node dissection and chemotherapy.
비뇨기과적 수술 후 도뇨관 유치 환자에 있어서 국소 항생제 연고 도포의 효용성
김유석,김순기,이경인,민승기 대한요로생식기감염학회 2015 Urogenital Tract Infection Vol.10 No.1
Purpose: Catheter associated urinary tract infection and discomfort is common in patients with an indwelling urinary catheter. We investigated the effectiveness of prophylactic topical antibiotic ointment for genitourinary post-operative patients with a urinary catheter.Materials and Methods: We investigated 112 inpatients between March 2013 and October 2013, who had an indwelling urinary catheter ≥24 hours after a genitourinary operation in our institution from medical records. Among 112 patients, 59 patients applied ofloxacin ointment to urethral meatus around the indwelling catheter twice a day (ointment group: 52.7%) and 53 patients did not (non-ointment group: 47.3%). All patients were examined by urine analysis and urine culture before the operation, urethral sweep culture after catheter removal, and severity of pain was recorded as visual analogue scale (VAS) score while having an indwelling urinary catheter.Results: Mean duration of urinary catheter of both groups did not differ statistically (3.08±2.19 day, 2.91±2.25 day). Patients with pyuria detected at pre-operative urinalysis were 22.1% vs. 15.1%, pre-operative urine culture positive were 6.8% vs. 9.4%, urethra meatal culture positive after urethral catheter removal were 16.9% vs. 13.2%, respectively, and all results showed no significant differences between two groups. VAS scores of the ointment group (3.52±1.66) while having an indwelling urinary catheter were significantly lower than those of the non-ointment group (5.61±1.75) (p<0.001).Conclusions: Application of topical antibiotic ointment for genitourinary post-operative patients with urinary catheter had no benefit in reducing growth of urethral microorganisms, but it may decrease pain from an indwelling urinary catheter.